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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 type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Increased hydrostatic pressure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

2. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Small - nondestructive vegetations (subacute endocarditis)
Myxoid degeneration
4-6 hours - 24 hours - 72 hours
Months out fibrosis

3. What causes angina and syncope in aortic stenosis?

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4. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Dressler syndrome
Bounding pulse
Ventricles cannot pump

5. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Elevated ASO anti - DNase B titers
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Degree of pulmonary artery stenosis

6. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Decreased forward perfusion pulmonary congestion
Pulsating nail bed
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

7. What tests show prior group A beta - hemolytic strep infection?
Cardiac tamponade
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Minimizes ischemia
Elevated ASO anti - DNase B titers

8. What is the only Jones criteria that doesn't resolve with time?
Volume overload and LHF
Pancarditis
1-3 days
Large - destructive vegetations

9. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Mitral regurg
Backward LHF pulm htn and RHF - afib and associated mural thombis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

10. What are the major criteria of the Jones criteria?
Prophylactic abx during dental procedures
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Yellow pallor neutrophils
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

11. What is eythema marginatum? What parts of the body does it commonly involve?
Opening snap followed by diastolic rumble
Cardiac tamponade
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Annular - non pruritic rash w/erythematous borders trunks and limbs

12. How does restrictive cardiomyopathy present?
Anitschow cell
Congestive heart failure
Membrane damage
Open blocked vessels

13. Low voltage EKG w/diminished QRS amplitude.
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Restrictive cardiomyopathy
Anitschow cell
Intercostal arteries enlarged due to collateral circulation

14. What % stenosis causes stable angina?
Transesophageal echo
Kawasaki disease
Libman - Sacks endocarditis
>70%

15. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
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
Metastasis

16. With what developmental disorder is VSD associated?
PDA
Chronic ischemic heart disease
Fetal alcohol syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)

17. What is migratory polyarthritis?
Prinzmetal angina - cocaine
Months out fibrosis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Acute inflammation

18. What is the gold standard blood marker for MI?
Loeffler syndrome
Troponin I
Endocardial fibroelastosis (rare)
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

19. What increases the volume of mitral regurg murmur?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Myocarditis
Squatting - expiration

20. What are the minor critera of the Jones criteria?
Congested central veins
Nonspecific - eg fever and elevated ESR
Aortic regurg
Dilation of all four chambers of the heart

21. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Hypertophy of RV atrophy of LV
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Heart can't fill

22. What is the main cause of MV regurg? What are other causes?
Prinzmetal stable and unstable
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Nitroglycerin
Ischemic heart disease

23. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Sterile vegetations on mitral valve along lines of closure
Stable and unstable prinzmetal
Paradoxical emboli
4-6 hours - 24 hours - 72 hours

24. What structures are susceptible to rupture post MI?
Group A beta - hemolytic streptococci
Valve replacement once LV dysfx develops
Papillary muscle - free wall - IV septum
Stable angina

25. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Left -->right
Myofiber hypertrophy with disarray
Rhadbomyoma - benign
Dressler syndrome

26. With what condition are rhabdomyomas associated?
Atherosclerosis of coronary arteries
Tuberous sclerosis
Pulsating nail bed
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

27. Dilated cardiomyopathy is a late complication of what illness?
Subendocardial
CHF
Myocarditis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

28. What is the classic EKG finding of restrictive cardiomyopathy?
Yellow pallor neutrophils
Positive blood cultures anemia of chronic disease
Low voltage EKG w/diminished QRS amplitude
Aortic regurg

29. What are the causes of LHF?
Membrane damage
Infectious endocarditis - arrythmias - severe mitral regurg no
Valve replacement AFTER the onset of complications
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

30. What is the most common cause of death during the acute phase of rheumatic fever?
S aureus
Myocarditis
Ehlers - Danlow and Marfan syndrome
Reperfusion injury

31. What causes acute endocarditis?
Infectious
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Large vegetations of S aureus
RCA

32. What makes the MV prolapse murmur louder? Why?
4-6 hours - 24 hours - 72 hours
Decreases LV dilation by decreasing volume
Stretched muscle loses contractility
Squatting - increased systemic resistence decreases LV emptying

33. How does restrictive cardiomyopathy cause LHF?

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34. What effect does mitral stenosis have on the heart chambers?
Inability to maintain systemic pressure w/lack of O2 to vital organs
LA dilation
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Myofiber hypertrophy with disarray

35. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Preductal - post aortic arch
Minimizes ischemia
NG or Ca channel blocker
Colon cancer

36. When would arrhythmia occur after MI?
Myocardium
Mid - systolic click followed by regurgitation murmur
Within the first day
Mitral and tricuspid regurg - arrhythmia

37. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
>70%
Circumflex
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

38. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Bacterial endocarditis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Infectious endocarditis

39. When do macrophagess infiltrate the myocardium post MI?
Posterior wall of LV - posterior septum - papillary muscles
Valve scarring that arises as a consequence of rheumatic fever
Within the first day
4-7 days

40. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
PDA
Left -->right

41. How does hypertension cause LHF?

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42. What are the sx/complications of myocarditis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Hypertrophic cardiomyopathy
Aschoff bodies
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

43. What heart sound manifest with an ASD?
Split S2 on auscultation
Mitral regurg
Type I
White scar fibrosis

44. What congenital heart defect presents later in life with lower extremity cyanosis?
Within the first day
Endocarditis of prosthetic valves
CHF
PDA

45. What is the murmur of mitral regurg?
Hemosiderin laden macrophages
Holosystolic blowing murmur
Fetal alcohol syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

46. What compensatory mechanism do tetralogy of fallot pts learn?
Mitral valve prolapse
Rhadbomyoma - benign
Hypertrophic cardiomyopathy
Squat in response to cyanotic spell

47. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Granulation tissue
Myocarditis

48. What are the sx of cardiac myxoma?
Hypercoagulable state or underlying adenocarcinoma
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Membrane damage
First 4 hours

49. What type of shunt does transposition of the great vessels cause?
Mitral regurgitation due to vegetations
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
R-->L
Holosystolic blowing murmur

50. What is the 1day-1wk -1mo mneumonic for MI?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Stable and unstable prinzmetal
Metastasis