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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 gross and microscopic appearance of cardiac myxomas?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Split S2 on auscultation
Gelatinous - abundant ground substance
1%

2. Where is the coarctation in infantile coarctation of the aorta?
20 min
Troponin I
Preductal - post aortic arch
Pericardial effusion due to pericardial involvement

3. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Dressler syndrome

4. What is the main cause of MV regurg? What are other causes?
R-->L
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Sterile vegetations on surface and undersurface on mitral valve
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

5. How does Eisenmeger syndrome occur?
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
Mitral valve prolapse
R-->L
Plump fibroblasts - collagen - blood vessels

6. What effect does mitral stenosis have on the heart chambers?
Chest pain <20 min brought on by exertion or emotional stress
Low voltage EKG w/diminished QRS amplitude
Valve scarring that arises as a consequence of rheumatic fever
LA dilation

7. How does stable angina present?
Dressler syndrome
Chest pain <20 min brought on by exertion or emotional stress
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
PGE

8. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Aortic regurg
Mitral mitral+aortic
Loeffler syndrome

9. What valves are most commonly involved in chronic rheumatic heart disease?
Aneurysm - mural thrombus - Dressler syndrome
Mitral mitral+aortic
Chronic rheumatic heart disease
Systolic dysfx leading to biventricular CHF

10. Turner syndrome is associated with which congenital heart defect?
Granulation tissue
4-6 hours - 24 hours - 72 hours
Infantile coarctation of the aorta
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

11. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Heart transplant
Ventricle
Nonbacterial thrombotic endocarditis (marantic endocarditis)

12. What is cardiogenic shock?
Paradoxical emboli
Reversible
Inability to maintain systemic pressure w/lack of O2 to vital organs
Hypertrophic cardiomyopathy

13. Dense layer of elastic and fibrotic tissue in the endocardium.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
S aureus
Endocardial fibroelastosis
Tender lesions on fingers or toes.

14. How does squating decrease hypoxemia in tetralogy of fallot?
Rhadbomyoma - benign
IV drug users
4-7 days
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

15. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Erythematous nontender lesions on palms and soles.
Bacterial endocarditis
Indomethacin - decreases PGE

16. How does subendocardial MI/ischemia present on EKG?
S aureus
Valve replacement
Prinzmetal
ST- segment depression

17. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
L->R
Infantile coarctation of the aorta

18. What is the most common cause of endocarditis in IV drug users?
S epidermidis
Opening snap followed by diastolic rumble
L->R
S aureus

19. Boot - shaped heart on x- ray?
Doxorubicin - cocaine
Inability to fill ventricles
Tetralogy of fallot
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. What type of shunt does a VSD cause?
L->R
Limits thrombosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Myocardium

21. What causes angina and syncope in aortic stenosis?

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22. What are the clinical features of LHF due to?
Rhadbomyoma - benign
Dark discoloration coagulative necrosis
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Decreased forward perfusion pulmonary congestion

23. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Intercostal arteries enlarged due to collateral circulation
Squatting - increased systemic resistence decreases LV emptying

24. With what endocarditis is S epidermidis associated?
Harmartoma
Endocarditis of prosthetic valves
Infectious endocarditis
>70%

25. What is the tx for VSD?
Surgical closure small defects may close spontaneously
S viridans
Fibrinous pericarditis
Congestive heart failure

26. What is the leading cause of death in the US?
Hemosiderin laden macrophages
LHF
PDA
Ischemic heart disease

27. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
Pericardial effusion due to pericardial involvement
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

28. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Hypercoagulable state or underlying adenocarcinoma
Tuberous sclerosis
Reperfusion injury

29. What type of shunt does ASD cause?
2-3 weeks
Endocardial fibroelastosis (rare)
Left -->right
Increased hydrostatic pressure

30. What % stenosis causes stable angina?
Congestive heart failure
Mitral valve prolapse
>70%
Coexisting mitral stenosis and fusion of commisures exist

31. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Dressler syndrome
Infantile coarctation of the aorta
MI
Migratory polyarthritis

32. What congenital heart defect does indomethacin tx?
20 min
PDA
Thickening of chrodae tendinae and cusps - mitral stenosis
Slow HR - decreasing O2 demand and risk for arrhythmia

33. How does dilated cardiomyopathy cause LHF?
Minimizes ischemia
Stretched muscle loses contractility
Ehlers - Danlow and Marfan syndrome
Wear and tear

34. What is the most common cause of aortic stenosis?
Asymptomatic
Decreased forward perfusion pulmonary congestion
Streptococcus viridans
Wear and tear

35. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Shunt - PGE to maintain PDA until surgical repair can be performed
Bicuspid aortic valve
2-4 hours - 24 hours - 7-10 days

36. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Atherosclerosis of coronary arteries
Bacterial endocarditis
Bounding pulse
>60 years - bicuspid aortic valve

37. What is the tx for LHF?
ACE inhibitor
Bicuspid aortic valve
Cardiogenic shock - CHF - arrhythmia
Chronic ischemic heart disease

38. What congenital heart defect presents later in life with lower extremity cyanosis?
Turner syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral stenosis
PDA

39. What does rupture of the IV septum cause?
Mitral regurg
Aortic stenosis
Degree of pulmonary artery stenosis
Shunt

40. Why are cardiac enzymes elevated after an MI?
Myxoma - benign
Doxorubicin - cocaine
Membrane damage
Yellow pallor macrophages

41. Why would cardiac enzymes continue to increase after the initial MI?
Kawasaki disease
Reperfusion injury
Thickening of chrodae tendinae and cusps - mitral stenosis
Myocarditis in acute rheumatic heart fever

42. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
RHF
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
VSD
ASD - R-->L

43. What is the characteristic finding on CXR in tetralogy of fallot?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Boot shaped heart
Rhabdomyoma
Limits thrombosis

44. What is the most common form of cardiomyopathy?
Dilated
Right to left
Split S2 on auscultation
1%

45. Is injury due angina reversible or irreversible?
Reversible
Myofiber hypertrophy with disarray
Infectious endocarditis - arrythmias - severe mitral regurg no
Circumflex

46. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Degree of pulmonary artery stenosis
Systolic ejection click followed by crescendo - decrescendo murmur

47. How does hypertension cause LHF?

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48. What is the most common cause of mitral stenosis?
Intercostal arteries enlarged due to collateral circulation
Volume overload and LHF
Reactive histiocyte with caterpillar nucleus
Chronic rheumatic heart disease

49. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
Dilated
ASD - R-->L
Prinzmetal angina - cocaine

50. What are the four defects in tetralogy of fallot?
Asymptomatic
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
ACE inhibitor
Minimizes ischemia