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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What generally causes ischemic heart disease?
ST- segment depression
Infectious endocarditis
Atherosclerosis of coronary arteries
CK- MB

2. What vavular defect results from acute rheumatic fever?
Cyanosis - RV hypertrophy - polycythemia - clubbing
S viridans
Mitral regurgitation due to vegetations
Congenital rubella

3. Which vasculitis can cause MI?
Left -->right
Kawasaki disease
2-3 weeks
Libman - Sacks endocarditis

4. What causes the nutmeg color in nutmeg liver?
Congested central veins
Dark discoloration coagulative necrosis
Maternal diabetes
White scar fibrosis

5. What is the rate of mitral valve prolapse in the US?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
2-3%
4-7 days
Granulation tissue

6. What is the murmur of mitral valve prolapse?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Aneurysm - mural thrombus - Dressler syndrome
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Mid - systolic click followed by regurgitation murmur

7. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Months out fibrosis
LV dilation and eccentric hypertrophy
LHF
Pump failure

8. What is the definition of ischemia?
Gelatinous - abundant ground substance
Decrease in blood flow to an organ
Tender lesions on fingers or toes.
Opening snap followed by diastolic rumble

9. What % of MIs involve the LAD?
Posterior wall of LV - posterior septum - papillary muscles
45%
Red border granulation tissue
Mid - systolic click followed by regurgitation murmur

10. What valves are involved in rhuematic endocarditis?
Preductal - post aortic arch
Mitral mitral+aortic
Kawasaki disease
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

11. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Months out fibrosis
Subendocardial
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

12. Tender lesions on fingers or toes.
Infectious
Osler nodes (ouch - ouch Osler)
Stable and unstable prinzmetal
Pericardial effusion due to pericardial involvement

13. What is the most common cause of RHF? What are others?
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral regurg
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Coexisting mitral stenosis and fusion of commisures exist

14. What is dilated cardiomyopathy?
Valve replacement
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Dilation of all four chambers of the heart
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

15. What does chronic ischemic heart disease progress to?
Hemosiderin laden macrophages
Dilated
CHF
Aortic regurg

16. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Fibrosis and dystrophic calcification
Myocardium
Atria and RV
Prinzmetal angina

17. How does Eisenmeger syndrome occur?
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
Coxsackie A or B
Bounding pulse
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

18. What is the cause of the red border around granulation tissue?
Coronary artery vasospasm
Blood vessels coming in from normal tissue
Rhadbomyoma - benign
ASD - R-->L

19. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Granulation tissue
ACE inhibitor
Pump failure
ASD - R-->L

20. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
PDA
VSD
RBC damaged while crossing the calcified valve causing schistocytes
MI

21. What causes notching of the ribs in adult coarctation of the aorta?
Troponin I
R-->L
Intercostal arteries enlarged due to collateral circulation
Paradoxical emboli

22. With what disease is infantile coarctation of the aorta associated?
Metastasis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Turner syndrome
Red border granulation tissue

23. What are the cancers that most commonly metastasize to the heart?
Fetal alcohol syndrome
Breast and lung carcinoma - melanoma - lymphoma
Contraction band necrosis - reperfusion injury
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea

24. What gross and microscopic changes occur 4-24 hours after an MI?
Infectious endocarditis
Indomethacin - decreases PGE
Dark discoloration coagulative necrosis
Increased blood in right heart delays closure of P valve

25. What are the clinical features of LHF due to?
Myxoid degeneration
Nonbacterial thrombotic endocarditis (marantic endocarditis)
2-3 weeks
Decreased forward perfusion pulmonary congestion

26. What are the sx of PDA at birth?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Acute inflammation
LA
Asymptomatic

27. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Within the first day
RHF
Elevated ASO anti - DNase B titers
PGE

28. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Valve scarring that arises as a consequence of rheumatic fever
Inability to fill ventricles
Limits thrombosis

29. When is an MI pt at greatest risk for cardiogenic shock?
Spontaneous
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
First 4 hours
Turner syndrome

30. What are the sx/complications of myocarditis?
RCA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
ASD - R-->L
Coxsackie A or B

31. What typically causes hypertrophic cardiomyopathy?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Tetralogy of fallot
AD mutation in sarcomere proteins
LAD

32. What is the tx for dilated cardiomyopathy?
Chronic ischemic heart disease
Heart transplant
3-8 wks
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

33. What is a complication of chronic rheumatic heart disease?
Left -->right
Infectious endocarditis
Mitral insufficiency
Large vegetations of S aureus

34. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Valve replacement AFTER the onset of complications
Migratory polyarthritis
Ehlers - Danlow and Marfan syndrome
Type I

35. When do neutrophils infiltrate the myocardium post MI?
RCA
1-3 days
ACE inhibitor
Months out fibrosis

36. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Left -->right
Ehlers - Danlow and Marfan syndrome
Bounding pulse

37. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Squat in response to cyanotic spell
Endocarditis of prosthetic valves
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

38. Which angina(s) show ST elevation on EKG? ST depression?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Prinzmetal stable and unstable
3-8 wks
Left -->right

39. Why would cardiac enzymes continue to increase after the initial MI?
VSD
Dilated
Nitroglycerin
Reperfusion injury

40. What coronary artery supplies the mitral valve papillary muscles?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
RCA
Prinzmetal angina - cocaine
Myofiber hypertrophy with disarray

41. How does restrictive cardiomyopathy cause LHF?

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42. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Bounding pulse
Stable angina
4-24 hours
Asymptomatic

43. Dilated cardiomyopathy is a late complication of what illness?
Rhadbomyoma - benign
Squat in response to cyanotic spell
4-7 days macrophage infiltration
Myocarditis

44. Large vegetations on tricuspid valve?
Rhabdomyoma
Contraction band necrosis
S aureus
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

45. What gross and microscopic changes occur 1-3 weeks after an MI?
4-6 hours - 24 hours - 72 hours
Ostium secundum (90%)
Papillary muscle - free wall - IV septum
Red border granulation tissue

46. With what developmental disorder is VSD associated?
Right -->left
Fetal alcohol syndrome
Stable and unstable prinzmetal
Turner syndrome

47. What are the clinical features of endocarditis? What causes each feature?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Hemosiderin laden macrophages
Restrictive cardiomyopathy
Thickening of chrodae tendinae and cusps - mitral stenosis

48. Friction rub and chest pain.
Within the first day
Infectious endocarditis - arrythmias - severe mitral regurg no
Pericarditits
Aortic regurg

49. What causes angina and syncope in aortic stenosis?

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50. When does the heart have a yellow pallor post MI?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Day 1-7
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Hypertophy of RV atrophy of LV