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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 is the most common cause of endocarditis in IV drug users?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Positive blood cultures anemia of chronic disease
Granulation tissue
S aureus

2. What type of valvular vegetations does S aureus cause?
Bicuspid aortic valve
Large - destructive vegetations
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Congenital rubella

3. How does restrictive cardiomyopathy present?
Left -->right
LAD
Congestive heart failure
Group A beta - hemolytic streptococci

4. How does Eisenmeger syndrome occur?
Bacterial endocarditis
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
Dressler syndrome
Preductal - post aortic arch

5. Ostium primum ASD is associated with what congenital disorder?
Opening snap followed by diastolic rumble
Trisomy 21
Fibrinous pericarditis
Gelatinous - abundant ground substance

6. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Valve replacement AFTER the onset of complications
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
RHF
PDA

7. Is injury due angina reversible or irreversible?
Rhadbomyoma - benign
20 min
Reversible
Infectious endocarditis

8. What is the leading cause of death in the US?
Intercostal arteries enlarged due to collateral circulation
Ischemic heart disease
Mitral and tricuspid regurg - arrhythmia
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

9. Poor myocardial fx due to chronic ischemic damage?
PGE
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
IV drug users
Chronic ischemic heart disease

10. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Right -->left
Aortic stenosis
45%

11. What characterizes acute rheumatic fever endocarditiis?
Heart transplant
Gelatinous - abundant ground substance
Small vegetations along the line of closure
Prophylactic abx during dental procedures

12. With what disease is Libman - Sacks endocarditis associated?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
20 min
SLE

13. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Anterior wall of LV and anterior septum
Valve replacement once LV dysfx develops
MI

14. What type of shunt does transposition of the great vessels cause?
R-->L
Mitral regurgitation due to vegetations
Loeffler syndrome
1-3 days

15. What % stenosis causes stable angina?
4-24 hours
NG or Ca channel blocker
>70%
Libman - Sacks endocarditis

16. What are the complications that occur months after an MI?
Degree of pulmonary artery stenosis
Thickening of chrodae tendinae and cusps - mitral stenosis
Aneurysm - mural thrombus - Dressler syndrome
S aureus

17. L- to - R shunt switching to R- to - L shunt.
Eisenmenger syndrome
Stable angina
Granulation tissue
LV dilation and eccentric hypertrophy

18. What is the only Jones criteria that doesn't resolve with time?
Sterile vegetations on surface and undersurface on mitral valve
20 min
Ventricle
Pancarditis

19. What causes endocarditis of prosthetic valves?
Tender lesions on fingers or toes.
S epidermidis
Hypertrophic cardiomyopathy
L->R

20. What is the most comon cause of aortic regurg? What are the other causes?
Type I
Nonspecific - eg fever and elevated ESR
Dense layer of elastic and fibrotic tissue in the endocardium - children
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

21. What causes acute endocarditis?
Chronic rheumatic heart disease
Bounding pulse
Squat in response to cyanotic spell
Large vegetations of S aureus

22. What is molecular mimicry?
Aneurysm - mural thrombus - Dressler syndrome
Months out fibrosis
Hemosiderin laden macrophages
When a bacterial protein resembles a protein in human tissue

23. What are the laboratory findings of bacterial endocarditis?
Indomethacin - decreases PGE
ASD - R-->L
Anterior wall of LV and anterior septum
Positive blood cultures anemia of chronic disease

24. What congenital heart defect does indomethacin tx?
Tetralogy of fallot
Bacterial endocarditis
PDA
Asymptomatic

25. How does squating decrease hypoxemia in tetralogy of fallot?
Mitral valve prolapse
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
ST- segment depression
Eisenmenger syndrome

26. What effect does transposition of the great vessels have on the ventricles?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Hypertophy of RV atrophy of LV
LA
Eisenmenger syndrome

27. What does chronic ischemic heart disease progress to?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
CHF
Tetralogy of fallot
Fibrinous pericarditis

28. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Nonspecific - eg fever and elevated ESR
Membrane damage
Doxorubicin - cocaine

29. EKG for stable angina?
Prinzmetal stable and unstable
ST- segment depression
Thickening of chrodae tendinae and cusps - mitral stenosis
Mitral regurg

30. What is the most common cause of death during the acute phase of rheumatic fever?
Systolic dysfx leading to biventricular CHF
Pedunculated mass in the LA that causes syncope due to obstruction of MV
3-8 wks
Myocarditis

31. What type of shunt dose PDA cause?
1-3 days
3-8 wks
Left -->right
LV dilation and eccentric hypertrophy

32. What is the most common tumor of the heart?
Eisenmenger syndrome
Ventricle
Metastasis
Pulsating nail bed

33. What is an important complication of ASD?
Ostium primum
Paradoxical emboli
>60 years - bicuspid aortic valve
Limits thrombosis

34. What valves are most commonly involved in chronic rheumatic heart disease?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Chronic rheumatic heart disease
Stable and unstable prinzmetal
Mitral mitral+aortic

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

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36. What is Loeffler syndrome?
Endocardial fibroelastosis
IV drug users
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

37. What are the sx of pericardiits?
L->R
Contraction band necrosis
Friction rub and chest pain
Reperfusion injury

38. What are Osler nodes?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Tender lesions on fingers or toes.
Systemic venous congestion
Erythematous nontender lesions on palms and soles.

39. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
ACE inhibitor
PDA

40. Which congenital heart defect is associated with congenital rubella?
PDA
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Mitral mitral+aortic
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

41. How does asprin/heparin tx MI?
Limits thrombosis
Indomethacin - decreases PGE
Endocardial fibroelastosis (rare)
Squatting - expiration

42. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Type I
Tender lesions on fingers or toes.

43. What two things cause coronary artery vasospasm?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Prinzmetal angina - cocaine
Reversible
First 4 hours

44. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
MI
Fibrinous pericarditis
ACE inhibitor

45. What causes prinzmetal angina?
Hemosiderin laden macrophages
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
ST- segment depression
Coronary artery vasospasm

46. What causes mitral valve prolapse?
Mitral valve prolapse
Stable angina
2-4 hours - 24 hours - 7-10 days
Myxoid degeneration

47. In which chamber of the heart are cardiac myxomas found?
Systemic venous congestion
LA
Slow HR - decreasing O2 demand and risk for arrhythmia
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

48. Pericarditis 6-8 wks post MI.
Gelatinous - abundant ground substance
Large vegetations of S aureus
Minimizes ischemia
Dressler syndrome

49. How does O2 tx MI?
Squatting - expiration
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Minimizes ischemia
Infectious endocarditis - arrythmias - severe mitral regurg no

50. What is a Quincke pulse?
Mitral valve prolapse
Pulsating nail bed
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Contraction band necrosis