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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 % of MIs involve the LAD?
Infectious endocarditis
45%
Ostium secundum (90%)
MI

2. What is the basic principle of CHF?
Decrease in blood flow to an organ
Contraction band necrosis
Pump failure
Increased blood in right heart delays closure of P valve

3. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Ischemic heart disease
RBC damaged while crossing the calcified valve causing schistocytes

4. What valves are most commonly involved in chronic rheumatic heart disease?
Aortic regurg
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Coxsackie A or B
Mitral mitral+aortic

5. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
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
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Stretched muscle loses contractility
Restrictive cardiomyopathy

6. What is the tx for mitral valve prolapse?
Valve replacement
45%
First 4 hours
Stable angina

7. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Aortic stenosis
Cardiogenic shock - CHF - arrhythmia
Bacterial endocarditis

8. What are the causes of restrictive cardiomyopathy in adults?
Myocarditis
PDA
Mitral regurgitation due to vegetations
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

9. What causes the split S2 in ASD?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Pericarditits
Sterile vegetations on mitral valve along lines of closure
Increased blood in right heart delays closure of P valve

10. Boot - shaped heart on x- ray?
Limits thrombosis
Tetralogy of fallot
Rhabdomyoma
Tender lesions on fingers or toes.

11. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Left -->right
Degree of pulmonary artery stenosis
Aschoff bodies

12. What is the most common type of endocarditis?
ST- segment depression
Infectious
Papillary muscle - free wall - IV septum
Ischemic heart disease

13. What is the rate of congenital heart defects?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
1%
Infectious
Right -->left

14. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
MI
Bicuspid aortic valve
Janeway lesions

15. Sudden death in a young athlete.
Right side - serotonin and other secretory products detoxified in the lung
Mitral regurg
Coxsackie A or B
Hypertrophic cardiomyopathy

16. How do ACE inhibitors tx MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Blood vessels coming in from normal tissue
Decreases LV dilation by decreasing volume
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

17. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Nonspecific - eg fever and elevated ESR
Sterile vegetations on mitral valve along lines of closure
Troponin I

18. What is chronic rheumatic heart disease?
Stretched muscle loses contractility
Inability to maintain systemic pressure w/lack of O2 to vital organs
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Valve scarring that arises as a consequence of rheumatic fever

19. Which artery is most often occluded in an MI?
LAD
Elevated ASO anti - DNase B titers
Kawasaki disease
Fibrosis and dystrophic calcification

20. What is the murmur of mitral valve prolapse?
2-3 weeks
Mid - systolic click followed by regurgitation murmur
Stable and unstable prinzmetal
Ventricles cannot pump

21. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Squatting - expiration
Decrease in blood flow to an organ
RCA
Aortic regurg

22. With what virus is PDA associated?
Congenital rubella
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Libman - Sacks endocarditis
Chest pain <20 min brought on by exertion or emotional stress

23. Which coronary artery supplies the anterior wall and anterior septum?
Pancarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Heart transplant
LAD

24. How does asprin/heparin tx MI?
Limits thrombosis
Infectious endocarditis - arrythmias - severe mitral regurg no
Chest pain <20 min brought on by exertion or emotional stress
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

25. What is the most common cause of mitral stenosis?
Transposition of the great vessels
VSD
Sterile vegetations on surface and undersurface on mitral valve
Chronic rheumatic heart disease

26. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
3-8 wks
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Breast and lung carcinoma - melanoma - lymphoma

27. Which chambers of the heart are generally spared in an MI?
Contraction band necrosis
Atria and RV
Friction rub and chest pain
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

28. What congenital heart defect does indomethacin tx?
PDA
CK- MB
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

29. What is the rate of mitral valve prolapse in the US?
Coxsackie A or B
Chest pain <20 min brought on by exertion or emotional stress
2-3%
Infectious

30. What are Osler nodes?
Tender lesions on fingers or toes.
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
S epidermidis
Surgical closure small defects may close spontaneously

31. Vegetations on surface and undersurface of mitral valve.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Libman - Sacks endocarditis
4-7 days
Elevated ASO anti - DNase B titers

32. What always follows necrosis?
Cyanosis - RV hypertrophy - polycythemia - clubbing
LV dilation and eccentric hypertrophy
Acute inflammation
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

33. What causes wear and tear aortic stenosis?
Mitral mitral+aortic
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
PDA
Fibrosis and dystrophic calcification

34. What are the clinical features of endocarditis? What causes each feature?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Reactive histiocyte with caterpillar nucleus
Systolic dysfx leading to biventricular CHF
Rhabdomyoma

35. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
4-7 days macrophage infiltration
Erythematous nontender lesions on palms and soles.
Chronic rheumatic heart disease

36. Which congenital heart defect is associated with maternal diabetes?
CK- MB
Aortic stenosis
Transposition of the great vessels
Fibrosis and dystrophic calcification

37. What is molecular mimicry?
Elevated ASO anti - DNase B titers
ST- segment depression
RCA
When a bacterial protein resembles a protein in human tissue

38. How does O2 tx MI?
Mitral mitral+aortic
Minimizes ischemia
Inability to maintain systemic pressure w/lack of O2 to vital organs
Shunt

39. What artery is the 2nd most often occluded in an MI?
SLE
RCA
Myofiber hypertrophy with disarray
Blood vessels coming in from normal tissue

40. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
CHF
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Valve replacement
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

41. In what pt population does S aureus commonly cause valvular disease?
Squatting - increased systemic resistence decreases LV emptying
IV drug users
Yellow pallor macrophages
Positive blood cultures anemia of chronic disease

42. How does ischemia cause LHF?
Bicuspid aortic valve
Mitral regurg
Loss of fx
Pedunculated mass in the LA that causes syncope due to obstruction of MV

43. What is the cause of restrictive cardiomyopathy in children?
Colon cancer
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Endocardial fibroelastosis (rare)
Degree of pulmonary artery stenosis

44. How does MI cause LHF?
Loss of LV fx
LV dilation and eccentric hypertrophy
Infectious endocarditis
Janeway lesions

45. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Shunt - PGE to maintain PDA until surgical repair can be performed
Volume overload and LHF
PDA

46. What are the sx of hypertrophic cardiomyopathy?
LA
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aschoff bodies
PDA

47. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Loss of fx
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Endocardial fibroelastosis

48. What structures are susceptible to rupture post MI?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Papillary muscle - free wall - IV septum
Pericardial effusion due to pericardial involvement
Holosystolic blowing murmur

49. What are heart failure cells?
Aortic regurg
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Loss of fx
Hemosiderin laden macrophages

50. What maintains patency of the PDA?
PGE
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Harmartoma
Increased hydrostatic pressure