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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 a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Low voltage EKG w/diminished QRS amplitude
Janeway lesions
Aneurysm - mural thrombus - Dressler syndrome

2. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Increased blood in right heart delays closure of P valve
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Coronary artery vasospasm - emboli - vasculitis

3. Is scar tissue or myocardium stronger?
Atria and RV
Eisenmenger syndrome
IV drug users
Myocardium

4. What causes acute endocarditis?
Myocardium
Ostium primum
1-3 days
Large vegetations of S aureus

5. How does MI cause LHF?
PDA
Doxorubicin - cocaine
Loss of LV fx
Months out fibrosis

6. What effect does mitral stenosis have on the heart chambers?
Surgical closure small defects may close spontaneously
Plump fibroblasts - collagen - blood vessels
LA dilation
Left -->right

7. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Infectious
Endocardial fibroelastosis (rare)
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

8. What does a biopsy of hypertrophic cardiomyopathy look like?
2-3%
Myofiber hypertrophy with disarray
Large - destructive vegetations
ST- segment depression

9. What is the characteristic murmur of aortic stenosis?
Erythematous nontender lesions on palms and soles.
4-24 hours
Reversible
Systolic ejection click followed by crescendo - decrescendo murmur

10. What is the classic EKG finding of restrictive cardiomyopathy?
Open blocked vessels
LAD
Valve replacement once LV dysfx develops
Low voltage EKG w/diminished QRS amplitude

11. At what point in development do congenital heart defects arise?
Sterile vegetations on mitral valve along lines of closure
3-8 wks
Boot shaped heart
Decrease preload -->lowers myocardial stress

12. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Squatting - expiration
2-4 hours - 24 hours - 7-10 days
Migratory polyarthritis

13. Turner syndrome is associated with which congenital heart defect?
Group A beta - hemolytic streptococci
Infantile coarctation of the aorta
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

14. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
PDA
RHF
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Membrane damage

15. What type of tumor is a rhabdomyoma?
Harmartoma
Mitral regurg
Positive blood cultures anemia of chronic disease
Aneurysm - mural thrombus - Dressler syndrome

16. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Low voltage EKG w/diminished QRS amplitude
S aureus
Transposition of the great vessels
Migratory polyarthritis

17. What are the sx of cardiac myxoma?
Minimizes ischemia
RHF
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Heart transplant

18. Where is the coarctation in infantile coarctation of the aorta?
3-8 wks
Congestive heart failure
Ventricle
Preductal - post aortic arch

19. What is the most common cause of infectious endocarditis?
Anterior wall of LV and anterior septum
Streptococcus viridans
Within the first day
Infectious endocarditis

20. What are the sx of pericardiits?
Trisomy 21
Eisenmenger syndrome
Ostium secundum (90%)
Friction rub and chest pain

21. What is Dressler syndrome? When does it occur?
RBC damaged while crossing the calcified valve causing schistocytes
Erythematous nontender lesions on palms and soles.
Autoimmune pericarditis 6-8 wks post MI
Group A beta - hemolytic streptococci

22. Which angina(s) show ST elevation on EKG? ST depression?
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
Rhadbomyoma - benign
Prinzmetal stable and unstable
Decreases LV dilation by decreasing volume

23. What drug relieves stable angina?
PDA
PDA
Mitral regurgitation due to vegetations
Nitroglycerin

24. What areas of the heart does the RCA supply?
Elevated ASO anti - DNase B titers
Posterior wall of LV - posterior septum - papillary muscles
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Valve replacement once LV dysfx develops

25. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Dense layer of elastic and fibrotic tissue in the endocardium - children
Infantile coarctation of the aorta PDA
Squatting - expiration

26. What is chronic rheumatic heart disease?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
2-3%
Metastasis
Valve scarring that arises as a consequence of rheumatic fever

27. What is the most common form of cardiomyopathy?
4-24 hours
Dilated
Ischemic heart disease
Chest pain <20 min brought on by exertion or emotional stress

28. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Open blocked vessels
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

29. What type of shunt does ASD cause?
4-24 hours
Hypercoagulable state or underlying adenocarcinoma
Dense layer of elastic and fibrotic tissue in the endocardium - children
Left -->right

30. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
4-7 days
Myocarditis
Blood vessels coming in from normal tissue

31. What causes an early - blowing diastolic murmur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Congenital rubella
Aortic regurg
Large - destructive vegetations

32. What % stenosis causes stable angina?
Restrictive cardiomyopathy
>70%
1-3 days
Sterile vegetations on surface and undersurface on mitral valve

33. What is eythema marginatum? What parts of the body does it commonly involve?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Increased blood in right heart delays closure of P valve
Cyanosis - RV hypertrophy - polycythemia - clubbing
Annular - non pruritic rash w/erythematous borders trunks and limbs

34. What causes the dependent pitting edema in RHF?
Minimizes ischemia
VSD
Increased hydrostatic pressure
Maternal diabetes

35. What is the JOneS mneumonic?
Loss of LV fx
Holosystolic blowing murmur
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
Sudden cardiac death

36. Myofiber hypertrophy with disarray.
Gelatinous - abundant ground substance
Libman - Sacks endocarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Hypertrophic cardiomyopathy

37. Boot - shaped heart on x- ray?
LAD
Tetralogy of fallot
Backward LHF pulm htn and RHF - afib and associated mural thombis
RCA

38. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Reactive histiocyte with caterpillar nucleus
Turner syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

39. What characterizes acute rheumatic fever endocarditiis?
PDA
Hypertrophic cardiomyopathy
Small vegetations along the line of closure
Janeway lesions

40. What is the tx for VSD?
Posterior wall of LV - posterior septum - papillary muscles
Stable and unstable prinzmetal
Surgical closure small defects may close spontaneously
PDA

41. What is endocardial fibroelastosis? In what population is it found?
Ehlers - Danlow and Marfan syndrome
Reactive histiocyte with caterpillar nucleus
Aortic regurg
Dense layer of elastic and fibrotic tissue in the endocardium - children

42. What creates the immune reaction in acute rhuematic fever?

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43. How does adult coarctation of the aorta present?
Nonspecific - eg fever and elevated ESR
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RCA
Limits thrombosis

44. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Bounding pulse
Myocarditis
PDA

45. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Spontaneous
Aneurysm - mural thrombus - Dressler syndrome
Chronic ischemic heart disease

46. What does Libman - Sacks endocarditis cause?
Ventricular arrhythmia
Elevated ASO anti - DNase B titers
Mitral regurg
1-3 days out

47. In which chamber of the heart are rhabdomyomas found?
ASD - R-->L
Pericarditits
Ventricle
Tricuspid

48. What are the complications of mitral stenosis?
Autoimmune pericarditis 6-8 wks post MI
Degree of pulmonary artery stenosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Prinzmetal

49. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Split S2 on auscultation
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Aortic regurg

50. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Dilation of all four chambers of the heart
Boot shaped heart
S aureus