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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. When is an MI patent at highest risk for fibrionous pericarditis?
Pulsating nail bed
1-3 days out
45%
Months out fibrosis

2. Low voltage EKG w/diminished QRS amplitude.
Janeway lesions
Restrictive cardiomyopathy
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Type I

3. How do ACE inhibitors tx MI?
Fibrosis and dystrophic calcification
Sterile vegetations on mitral valve along lines of closure
Pancarditis
Decreases LV dilation by decreasing volume

4. What is the rate of congenital heart defects?
NG or Ca channel blocker
PDA
1%
Red border granulation tissue

5. What is chronic rheumatic heart disease?
Indomethacin - decreases PGE
PDA
Valve scarring that arises as a consequence of rheumatic fever
PDA

6. What causes heart failure cells?
R-->L
Decrease in blood flow to an organ
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Dilation of all four chambers of the heart

7. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
AD mutation in sarcomere proteins
1%
Fetal alcohol syndrome
Adult coarctation of the aorta

8. What is an Aschoff body?
Loss of LV fx
Dressler syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Chronic rheumatic heart disease

9. How do beta blockers tx MI?
Squatting - expiration
Slow HR - decreasing O2 demand and risk for arrhythmia
Type I
Mitral mitral+aortic

10. Boot - shaped heart on x- ray?
Loeffler syndrome
Tetralogy of fallot
S epidermidis
Streptococcus bovis/

11. With what endocarditis is S epidermidis associated?
S epidermidis
Endocarditis of prosthetic valves
Fetal alcohol syndrome
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

12. What is cardiogenic shock?
Harmartoma
2-3%
Inability to maintain systemic pressure w/lack of O2 to vital organs
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

13. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Adult coarctation of the aorta
1-3 days
2-4 hours - 24 hours - 7-10 days
Months out fibrosis

14. Poor myocardial fx due to chronic ischemic damage?
Tender lesions on fingers or toes.
Large - destructive vegetations
Chronic ischemic heart disease
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

15. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Chest pain <20 min brought on by exertion or emotional stress
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

16. What type of shunt does transposition of the great vessels cause?
R-->L
SLE
PDA
Infectious

17. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
S epidermidis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

18. Erythematous nontender lesions on palms and soles.
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
Janeway lesions
Infectious
LA

19. What bug causes acute rheumatic fever?
Friction rub and chest pain
Group A beta - hemolytic streptococci
Cardiac tamponade
Libman - Sacks endocarditis

20. What two things cause coronary artery vasospasm?
Spontaneous
Prinzmetal angina - cocaine
Pulsating nail bed
RCA

21. Which angina is relieved by Ca channel blockers?
Prinzmetal
Mitral stenosis
2-4 hours - 24 hours - 7-10 days
Systemic venous congestion

22. What is the most common type of ASD? What %?
Decreases LV dilation by decreasing volume
Fibrinous pericarditis
Ostium secundum (90%)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

23. What maintains patency of the PDA?
ASD - R-->L
PGE
Pericardial effusion due to pericardial involvement
Low voltage EKG w/diminished QRS amplitude

24. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Mitral insufficiency
Wear and tear
Chest pain <20 min brought on by exertion or emotional stress

25. What is the most common form of cardiomyopathy?
Valve replacement once LV dysfx develops
RBC damaged while crossing the calcified valve causing schistocytes
Shunt - PGE to maintain PDA until surgical repair can be performed
Dilated

26. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Ventricles cannot pump
Decreased forward perfusion pulmonary congestion
Endocarditis of prosthetic valves

27. How does restrictive cardiomyopathy present?
Circumflex
Congestive heart failure
RHF
VSD

28. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Subendocardial
Nonbacterial thrombotic endocarditis (marantic endocarditis)
>70%

29. What are the sx of PDA at birth?
Aschoff bodies
Asymptomatic
Autoimmune pericarditis 6-8 wks post MI
Mitral regurg

30. What imaging test is useful for detecting lesions on valves?
Tuberous sclerosis
Split S2 on auscultation
Transesophageal echo
Mitral mitral+aortic

31. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Group A beta - hemolytic streptococci
LHF
Regurg vs stenosis
AD mutation in sarcomere proteins

32. What always follows necrosis?
Coronary artery vasospasm
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Tetralogy of fallot
Acute inflammation

33. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Acute inflammation
Preductal - post aortic arch
Asymptomatic
Coexisting mitral stenosis and fusion of commisures exist

34. What is diastolic dysfx?
Posterior wall of LV - posterior septum - papillary muscles
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Infantile coarctation of the aorta
Inability to fill ventricles

35. What does a biopsy of hypertrophic cardiomyopathy look like?
Degree of pulmonary artery stenosis
Preductal - post aortic arch
Regurg vs stenosis
Myofiber hypertrophy with disarray

36. What are the clinical features of RHF?
Ostium secundum (90%)
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
PGE

37. Is scar tissue or myocardium stronger?
Myocardium
Ventricles cannot pump
Open blocked vessels
Contraction band necrosis

38. What is the 1day-1wk -1mo mneumonic for MI?
Nitroglycerin
Ostium secundum (90%)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Boot shaped heart

39. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Valve scarring that arises as a consequence of rheumatic fever
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

40. When does the heart have a yellow pallor post MI?
Colon cancer
RCA
Day 1-7
Fibrinous pericarditis

41. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Posterior wall of LV - posterior septum - papillary muscles
Inability to fill ventricles

42. Which vasculitis can cause MI?
Kawasaki disease
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LAD
Decrease preload -->lowers myocardial stress

43. What type of ischemia does stable angina cause?
Congestive heart failure
Subendocardial
1-3 days
Shunt

44. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
>60 years - bicuspid aortic valve
Group A beta - hemolytic streptococci
Myocarditis in acute rheumatic heart fever

45. What artery is the 2nd most often occluded in an MI?
Harmartoma
Chronic rheumatic heart disease
Nonspecific - eg fever and elevated ESR
RCA

46. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
RCA
Ventricles cannot pump
Coexisting mitral stenosis and fusion of commisures exist

47. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Ostium secundum (90%)
>60 years - bicuspid aortic valve
Eisenmenger syndrome
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

48. With what disease is infantile coarctation of the aorta associated?
Myocardium
Turner syndrome
Louder - increased systemic resistence decreases LV emptying
Months out fibrosis

49. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Right -->left
Pulsating nail bed
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

50. What are the tx for MI?
Circumflex
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Rhabdomyoma