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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. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
S aureus
1%
Stable and unstable prinzmetal
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

2. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
ACE inhibitor
Left -->right
Sudden cardiac death

3. What is an Aschoff body?
1-3 days
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Squat in response to cyanotic spell
Dilation of all four chambers of the heart

4. What congenital heart defect often is present with infantile coarctation of the aorta?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
PDA
Valve scarring that arises as a consequence of rheumatic fever
Reactive histiocyte with caterpillar nucleus

5. Which coronary artery supplies the anterior wall and anterior septum?
Regurg vs stenosis
Stable angina
LAD
Pump failure

6. What is migratory polyarthritis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Harmartoma
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

7. What congenital heart defect does indomethacin tx?
Atherosclerosis of coronary arteries
Aortic stenosis
PDA
20 min

8. What is the most common cause of myocarditis?
Systolic ejection click followed by crescendo - decrescendo murmur
Ostium primum
Coxsackie A or B
Open blocked vessels

9. What are the sx of PDA at birth?
Asymptomatic
Anterior wall of LV and anterior septum
IV drug users
Open blocked vessels

10. What are the minor critera of the Jones criteria?
Tetralogy of fallot
LAD
Ventricle
Nonspecific - eg fever and elevated ESR

11. Is scar tissue or myocardium stronger?
Autoimmune pericarditis 6-8 wks post MI
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Infectious
Myocardium

12. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
LV dilation and eccentric hypertrophy
Chronic ischemic heart disease
Thickening of chrodae tendinae and cusps - mitral stenosis
Aschoff bodies

13. What shunt does tetralogy of fallot produce?
Pump failure
Right -->left
S epidermidis
4-7 days macrophage infiltration

14. When does the heart have dark discoloration post MI?
Endocarditis of prosthetic valves
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ostium secundum (90%)
4-24 hours

15. Holosystolic blowing murmur that increases w/expiration?
Elevated ASO anti - DNase B titers
Rhadbomyoma - benign
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Mitral regurg

16. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
3-8 wks
Prinzmetal angina
Doxorubicin - cocaine
Regurg vs stenosis

17. What is the leading cause of death in the US?
Ischemic heart disease
Intercostal arteries enlarged due to collateral circulation
Prophylactic abx during dental procedures
Infantile coarctation of the aorta PDA

18. What bug causes acute rheumatic fever?
Endocardial fibroelastosis
Systolic dysfx leading to biventricular CHF
Group A beta - hemolytic streptococci
2-3%

19. Opening snap followed by diastolic rumble.
Holosystolic blowing murmur
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral stenosis

20. How does dilated cardiomyopathy cause LHF?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Stretched muscle loses contractility
VSD
Prinzmetal angina

21. With what disease is Libman - Sacks endocarditis associated?
Loss of fx
Circumflex
SLE
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

22. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal stable and unstable
Stretched muscle loses contractility
RHF

23. Systolic ejection click followed by crescendo - decrescendo murmur.
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Rhadbomyoma - benign
Aortic stenosis
Atherosclerosis of coronary arteries

24. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Hemosiderin laden macrophages
Pulsating nail bed
Coronary artery vasospasm

25. What makes the MV prolapse murmur louder? Why?
NG or Ca channel blocker
Squatting - increased systemic resistence decreases LV emptying
Myxoma - benign
Prophylactic abx during dental procedures

26. What is the murmur of mitral regurg?
Holosystolic blowing murmur
PDA
R-->L
RCA

27. What cardiac enzyme is useful for detecting reinfarction?
Fibrosis and dystrophic calcification
1%
CK- MB
Streptococcus bovis/

28. What does chronic ischemic heart disease progress to?
CHF
Coexisting mitral stenosis and fusion of commisures exist
Bacterial endocarditis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

29. In which chamber of the heart are cardiac myxomas found?
Preductal - post aortic arch
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
Atherosclerosis of coronary arteries
LA

30. At what point in development do congenital heart defects arise?
Aortic stenosis
3-8 wks
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
RBC damaged while crossing the calcified valve causing schistocytes

31. What causes mitral valve prolapse?
Shunt
Myxoid degeneration
Coronary artery vasospasm
Tuberous sclerosis

32. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
LAD
ASD - R-->L
1-3 days out
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

33. What are the laboratory findings of bacterial endocarditis?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Cyanosis - RV hypertrophy - polycythemia - clubbing
Circumflex
Positive blood cultures anemia of chronic disease

34. What gross and microscopic changes occur 1-3 weeks after an MI?
Turner syndrome
Congested central veins
Red border granulation tissue
Tuberous sclerosis

35. With what disease is infantile coarctation of the aorta associated?
Increased blood in right heart delays closure of P valve
Turner syndrome
Valve replacement AFTER the onset of complications
Day 1-7

36. What type of endocarditis is associated with SLE?
3-8 wks
ASD - R-->L
Ostium secundum (90%)
Libman - Sacks endocarditis

37. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Streptococcus viridans
PDA
Ostium secundum (90%)
Backward LHF pulm htn and RHF - afib and associated mural thombis

38. What is dilated cardiomyopathy?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
IV drug users
Dilation of all four chambers of the heart
Rhabdomyoma

39. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
LHF
Slow HR - decreasing O2 demand and risk for arrhythmia
Decreased forward perfusion pulmonary congestion

40. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Ostium secundum (90%)
RCA
SLE
Dressler syndrome

41. What is the characteristic finding on CXR in tetralogy of fallot?
When a bacterial protein resembles a protein in human tissue
Boot shaped heart
4-7 days macrophage infiltration
Streptococcus viridans

42. What are the cancers that most commonly metastasize to the heart?
Red border granulation tissue
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Breast and lung carcinoma - melanoma - lymphoma
Membrane damage

43. What is the most common cause of aortic stenosis?
Wear and tear
Type I
Endocardial fibroelastosis (rare)
R-->L

44. What is the etiology of S viridans endocarditis?
VSD
Months out fibrosis
Low voltage EKG w/diminished QRS amplitude
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

45. With what disease is transposition of the great vessels associated?
Osler nodes (ouch - ouch Osler)
Maternal diabetes
Small vegetations along the line of closure
Myxoma - benign

46. What is the tx for mitral valve prolapse?
Valve replacement
Left -->right
ST- segment depression
Atria and RV

47. What valves are most commonly involved in chronic rheumatic heart disease?
Pump failure
ST- segment elevation
Mitral mitral+aortic
ASD - R-->L

48. What drugs can cause dilated cardiomyopathy?
Bicuspid aortic valve
Preductal - post aortic arch
Doxorubicin - cocaine
Chest pain <20 min brought on by exertion or emotional stress

49. What is a common complication of cardiac metastasis?
Decreases LV dilation by decreasing volume
Pericardial effusion due to pericardial involvement
Infectious endocarditis - arrythmias - severe mitral regurg no
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

50. What is the tx for LHF?
Indomethacin - decreases PGE
ACE inhibitor
Low voltage EKG w/diminished QRS amplitude
Large - destructive vegetations