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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 tumor of the heart?
Heart transplant
ST- segment elevation
Metastasis
IV drug users

2. What type of vegetations form in nonbacterial thrombotic endocarditis?
Type I
Fibrinous pericarditis
Sterile vegetations on mitral valve along lines of closure
Holosystolic machine like murmur

3. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Osler nodes (ouch - ouch Osler)
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Valve scarring that arises as a consequence of rheumatic fever
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

4. When does the heart have a yellow pallor post MI?
L->R
Erythematous nontender lesions on palms and soles.
Reperfusion injury
Day 1-7

5. What is the tx for mitral valve prolapse?
Right -->left
Mitral regurgitation due to vegetations
Valve replacement
Dressler syndrome

6. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Sterile vegetations on mitral valve along lines of closure
When a bacterial protein resembles a protein in human tissue
Annular - non pruritic rash w/erythematous borders trunks and limbs

7. What is the tx for LHF?
ACE inhibitor
Left -->right
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Left -->right

8. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Tuberous sclerosis
Migratory polyarthritis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

9. What is the tx for VSD?
Right to left
Surgical closure small defects may close spontaneously
1-3 days out
Hypertrophic cardiomyopathy

10. What are the laboratory findings of bacterial endocarditis?
Mitral regurg
Loeffler syndrome
Shunt - PGE to maintain PDA until surgical repair can be performed
Positive blood cultures anemia of chronic disease

11. What gross and microscopic changes occur 1-3 weeks after an MI?
Atria and RV
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Red border granulation tissue
Limits thrombosis

12. In what pt population does S aureus commonly cause valvular disease?
Large vegetations of S aureus
Squatting - expiration
Myocarditis
IV drug users

13. What is the effect of mitral regurg on the heart?
Endocardial fibroelastosis
Volume overload and LHF
Stable and unstable prinzmetal
Adult coarctation of the aorta

14. What causes prinzmetal angina?
Libman - Sacks endocarditis
Coronary artery vasospasm
Pulsating nail bed
Within the first day

15. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Sterile vegetations on mitral valve along lines of closure
Breast and lung carcinoma - melanoma - lymphoma
PDA
RCA

16. What two things cause coronary artery vasospasm?
Posterior wall of LV - posterior septum - papillary muscles
Prinzmetal angina - cocaine
Heart transplant
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

17. What effect does aortic stenosis have on the chambers of the heart?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Concentric LV hypertophy
Migratory polyarthritis
Turner syndrome

18. What is the most common cause of endocarditis in IV drug users?
Sterile vegetations on surface and undersurface on mitral valve
PDA
Yellow pallor neutrophils
S aureus

19. When would arrhythmia occur after MI?
Within the first day
Decrease preload -->lowers myocardial stress
Prinzmetal angina
Myocardium

20. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Shunt
Heart can't fill
Large - destructive vegetations
Regurg vs stenosis

21. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Systemic venous congestion
Holosystolic blowing murmur
Aschoff bodies
Sterile vegetations on surface and undersurface on mitral valve

22. In which pts does S viridans cause endocarditits?
Endocardial fibroelastosis
Louder - increased systemic resistence decreases LV emptying
Pts w/previously damaged valves
MI

23. Tender lesions on fingers or toes.
Positive blood cultures anemia of chronic disease
Rhabdomyoma
Left -->right
Osler nodes (ouch - ouch Osler)

24. What complication occurs 1-3 days post MI?
Squatting - increased systemic resistence decreases LV emptying
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Fibrinous pericarditis
Limits thrombosis

25. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Prophylactic abx during dental procedures
Split S2 on auscultation
Myxoma - benign

26. Which chambers of the heart are generally spared in an MI?
Reactive histiocyte with caterpillar nucleus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Atria and RV
Loeffler syndrome

27. What structures are susceptible to rupture post MI?
PDA
Papillary muscle - free wall - IV septum
Pulsating nail bed
CK- MB

28. What type of shunt does a VSD cause?
L->R
Infectious
Tetralogy of fallot
Nonbacterial thrombotic endocarditis (marantic endocarditis)

29. What type of valvular vegetations does S aureus cause?
ST- segment depression
Large - destructive vegetations
Streptococcus viridans
Ventricles cannot pump

30. How does restrictive cardiomyopathy present?
Congestive heart failure
Adult coarctation of the aorta
Loss of LV fx
Valve replacement

31. What congenital heart defect does indomethacin tx?
Troponin I
PDA
LA
Tricuspid

32. What gross and microscopic changes occur months after an MI?
Minimizes ischemia
White scar fibrosis
Reversible
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

33. Boot - shaped heart on x- ray?
White scar fibrosis
Fibrinous pericarditis
Coexisting mitral stenosis and fusion of commisures exist
Tetralogy of fallot

34. When do CK- MB levels rise - peak - and return to normal?
Chronic rheumatic heart disease
4-6 hours - 24 hours - 72 hours
ST- segment depression
Pancarditis

35. What is endocardial fibroelastosis? In what population is it found?
Increased blood in right heart delays closure of P valve
Nitroglycerin
Dense layer of elastic and fibrotic tissue in the endocardium - children
White scar fibrosis

36. What type of vegetations does Strep viridans cause?
VSD
Transesophageal echo
Small - nondestructive vegetations (subacute endocarditis)
Hemosiderin laden macrophages

37. Is injury due angina reversible or irreversible?
Left -->right
Endocardial fibroelastosis (rare)
Reversible
Breast and lung carcinoma - melanoma - lymphoma

38. What are complications of dilated cardiomyopathy?
R-->L
Mitral and tricuspid regurg - arrhythmia
Mitral mitral+aortic
AD mutation in sarcomere proteins

39. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
White scar fibrosis
Mitral regurg
Pericardial effusion due to pericardial involvement
Contraction band necrosis

40. What type of shunt does transposition of the great vessels cause?
Congestive heart failure
Mitral mitral+aortic
R-->L
Bicuspid aortic valve

41. Which angina(s) show ST elevation on EKG? ST depression?
Trisomy 21
Cardiogenic shock - CHF - arrhythmia
Prinzmetal stable and unstable
RCA

42. With what disease is Libman - Sacks endocarditis associated?
Chest pain <20 min brought on by exertion or emotional stress
SLE
Posterior wall of LV - posterior septum - papillary muscles
PDA

43. What is the most common type of endocarditis?
Libman - Sacks endocarditis
Coronary artery vasospasm
Infectious
Dilation of all four chambers of the heart

44. How do nitrates tx MI?
Adult coarctation of the aorta
Decrease preload -->lowers myocardial stress
S epidermidis
Mitral and tricuspid regurg - arrhythmia

45. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Sudden cardiac death
RCA

46. What is the most common form of cardiomyopathy?
Prinzmetal
NG or Ca channel blocker
Dilated
Squatting - expiration

47. What is the most common cause of aortic stenosis?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
MI
Wear and tear
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

48. What are the causes of restrictive cardiomyopathy in adults?
Sterile vegetations on mitral valve along lines of closure
Annular - non pruritic rash w/erythematous borders trunks and limbs
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Reperfusion injury

49. What are the sx of cardiac myxoma?
Fetal alcohol syndrome
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

50. Pericarditis 6-8 wks post MI.
Dressler syndrome
Circumflex
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
NG or Ca channel blocker