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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. In which chamber of the heart are cardiac myxomas found?
Rhadbomyoma - benign
LA
Congested central veins
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

2. How do beta blockers tx MI?
Friction rub and chest pain
Concentric LV hypertophy
Slow HR - decreasing O2 demand and risk for arrhythmia
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

3. In which chamber of the heart are rhabdomyomas found?
Minimizes ischemia
Ventricle
Louder - increased systemic resistence decreases LV emptying
VSD

4. What does rupture of the IV septum cause?
Intercostal arteries enlarged due to collateral circulation
Shunt
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
R-->L

5. What drugs can cause dilated cardiomyopathy?
Slow HR - decreasing O2 demand and risk for arrhythmia
Doxorubicin - cocaine
4-7 days
Turner syndrome

6. Infects predamaged valves after transient bacteremia?
Intercostal arteries enlarged due to collateral circulation
Libman - Sacks endocarditis
Prophylactic abx during dental procedures
S viridans

7. What is the characteristic murmurr of mitral stenosis?
Ostium primum
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Opening snap followed by diastolic rumble
Valve replacement once LV dysfx develops

8. What is the tx for VSD?
Hypertophy of RV atrophy of LV
Minimizes ischemia
4-7 days
Surgical closure small defects may close spontaneously

9. What are the forward and backward sx of LHF?
Coronary artery vasospasm
Myocarditis
>60 years - bicuspid aortic valve
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

10. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Turner syndrome
Stable and unstable prinzmetal
Chronic ischemic heart disease

11. What genetic conditions predispose a pt to mitral valve prolapse?
Rhadbomyoma - benign
Ehlers - Danlow and Marfan syndrome
Preductal - post aortic arch
Congenital rubella

12. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Hemosiderin laden macrophages
Right -->left
Left -->right

13. What causes endocarditis of prosthetic valves?
RCA
Chest pain <20 min brought on by exertion or emotional stress
S epidermidis
Trisomy 21

14. What gross and microscopic changes occur months after an MI?
Fibrinous pericarditis
White scar fibrosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Hypercoagulable state or underlying adenocarcinoma

15. What causes an early - blowing diastolic murmur?
Doxorubicin - cocaine
Aortic regurg
Circumflex
Congenital rubella

16. Are most congenital heart defects spontaneous or inherited?
Squatting - increased systemic resistence decreases LV emptying
Spontaneous
Atria and RV
4-24 hours

17. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Months out fibrosis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

18. 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
Hypertrophic cardiomyopathy
Dilation of all four chambers of the heart
Nonbacterial thrombotic endocarditis (marantic endocarditis)

19. What type of tumor is a rhabdomyoma?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Harmartoma
Myocardium
Thickening of chrodae tendinae and cusps - mitral stenosis

20. Is scar tissue or myocardium stronger?
CHF
Myocardium
Right side - serotonin and other secretory products detoxified in the lung
Yellow pallor neutrophils

21. What type of shunt does ASD cause?
When a bacterial protein resembles a protein in human tissue
Left -->right
Blood vessels coming in from normal tissue
Increased hydrostatic pressure

22. Which vasculitis can cause MI?
Kawasaki disease
Chronic ischemic heart disease
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

23. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Coronary artery vasospasm - emboli - vasculitis
Louder - increased systemic resistence decreases LV emptying
When a bacterial protein resembles a protein in human tissue

24. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Systemic venous congestion
Fibrinous pericarditis
Decreases LV dilation by decreasing volume

25. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Low voltage EKG w/diminished QRS amplitude
CK- MB
Aortic regurg

26. Erythematous nontender lesions on palms and soles.
Paradoxical emboli
Systolic ejection click followed by crescendo - decrescendo murmur
S epidermidis
Janeway lesions

27. What is a water - hammer pulse?
Bounding pulse
Contraction band necrosis - reperfusion injury
Adult coarctation of the aorta
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

28. What type of shunt dose PDA cause?
Pericardial effusion due to pericardial involvement
Rupture of free wall - IV septum - or papillary muscle
Left -->right
Chronic rheumatic heart disease

29. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
Blood vessels coming in from normal tissue
Decrease in blood flow to an organ
Volume overload and LHF

30. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Spontaneous
Prinzmetal
Congenital rubella

31. What is the most common cause of endocarditis in IV drug users?
S aureus
Prinzmetal
Bounding pulse
Mitral valve prolapse

32. What drug relieves stable angina?
Mitral regurg
Nitroglycerin
Shunt - PGE to maintain PDA until surgical repair can be performed
Contraction band necrosis

33. What is an Aschoff body?
Ostium primum
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Volume overload and LHF
Pericarditits

34. What are the causes of restrictive cardiomyopathy in adults?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Mitral regurgitation due to vegetations
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

35. What artery is the 2nd most often occluded in an MI?
1-3 days out
RCA
Ventricular arrhythmia
4-7 days

36. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Infantile coarctation of the aorta PDA
Myofiber hypertrophy with disarray
Reactive histiocyte with caterpillar nucleus

37. What does rupture of the LV free wall cause?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Transposition of the great vessels
Cardiac tamponade
Contraction band necrosis - reperfusion injury

38. How does stable angina present?
LHF
Decreases LV dilation by decreasing volume
Sterile vegetations on surface and undersurface on mitral valve
Chest pain <20 min brought on by exertion or emotional stress

39. With what endocarditis is S epidermidis associated?
S aureus
Endocarditis of prosthetic valves
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Fibrinous pericarditis

40. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
LA
Positive blood cultures anemia of chronic disease
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

41. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
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
Ostium primum
Degree of pulmonary artery stenosis

42. What side of the heart do carcinoid tumors affect? Why?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Dense layer of elastic and fibrotic tissue in the endocardium - children
Tetralogy of fallot
Right side - serotonin and other secretory products detoxified in the lung

43. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Stable and unstable prinzmetal
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Holosystolic machine like murmur

44. What heart sound manifest with an ASD?
Split S2 on auscultation
Streptococcus bovis/
20 min
Valve replacement

45. How does restrictive cardiomyopathy cause LHF?

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46. Lower extremity cyanosis in infants? In adults?
Streptococcus viridans
Coexisting mitral stenosis and fusion of commisures exist
Infantile coarctation of the aorta PDA
Valve replacement AFTER the onset of complications

47. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Intercostal arteries enlarged due to collateral circulation
Papillary muscle - free wall - IV septum
Plump fibroblasts - collagen - blood vessels

48. What are the four defects in tetralogy of fallot?
RHF
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Aortic regurg
Tetralogy of fallot

49. What iis the tx for aortic regurg?
Papillary muscle - free wall - IV septum
Holosystolic machine like murmur
Day 1-7
Valve replacement once LV dysfx develops

50. What type of shunt does a VSD cause?
Concentric LV hypertophy
L->R
Contraction band necrosis
PDA