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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. Systolic ejection click followed by crescendo - decrescendo murmur.
Small vegetations along the line of closure
Aortic stenosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

2. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
S aureus
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Aortic regurg

3. What are the complications of aortic stenosis?
NG or Ca channel blocker
Backward LHF pulm htn and RHF - afib and associated mural thombis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Myocarditis in acute rheumatic heart fever

4. Pericarditis 6-8 wks post MI.
Erythematous nontender lesions on palms and soles.
Dressler syndrome
Elevated ASO anti - DNase B titers
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

5. What are other (not atherosclerotic) causes of MI?
Sterile vegetations on mitral valve along lines of closure
Endocarditis of prosthetic valves
Coronary artery vasospasm - emboli - vasculitis
ST- segment depression

6. What areas of the heart does the LAD supply?
LA
Day 1-7
Anterior wall of LV and anterior septum
Open blocked vessels

7. What creates the immune reaction in acute rhuematic fever?

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8. What congenital heart defect does indomethacin tx?
Streptococcus viridans
PDA
Ischemic heart disease
Opening snap followed by diastolic rumble

9. What does rupture of a papillary muscle cause?
Prinzmetal
Mitral insufficiency
Preductal - post aortic arch
Asymptomatic

10. What is systolic dysfx?
Tricuspid
Ventricles cannot pump
2-3 weeks
Day 1-7

11. How does ischemia cause LHF?
Loss of fx
Stretched muscle loses contractility
1-3 days
Dilated

12. What is the most common cause of myocarditis?
Coronary artery vasospasm
Thickening of chrodae tendinae and cusps - mitral stenosis
Coxsackie A or B
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

13. Which congenital heart defect is associated with congenital rubella?
Myofiber hypertrophy with disarray
Left -->right
PDA
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

14. What is typically the mechanims of sudden cardiac death?
Minimizes ischemia
Ventricular arrhythmia
Right -->left
Pericardial effusion due to pericardial involvement

15. What is the most common congenital heart defect?
VSD
Nitroglycerin
Holosystolic blowing murmur
Myxoma - benign

16. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
AD mutation in sarcomere proteins
Mid - systolic click followed by regurgitation murmur
Inability to fill ventricles

17. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Prinzmetal angina
RHF
Fetal alcohol syndrome
When a bacterial protein resembles a protein in human tissue

18. What is the most common cause of aortic stenosis?
Wear and tear
Hypertophy of RV atrophy of LV
MI
Reactive histiocyte with caterpillar nucleus

19. How does asprin/heparin tx MI?
Pericarditits
Limits thrombosis
PGE
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

20. What is molecular mimicry?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Minimizes ischemia
Papillary muscle - free wall - IV septum
When a bacterial protein resembles a protein in human tissue

21. What is the most common cause of mitral stenosis?
Chest pain <20 min brought on by exertion or emotional stress
Chronic rheumatic heart disease
Decrease preload -->lowers myocardial stress
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

22. What complications occur 4-7 days post MI?
Bicuspid aortic valve
Chronic rheumatic heart disease
Rupture of free wall - IV septum - or papillary muscle
Valve replacement

23. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
2-3%
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

24. What causes wear and tear aortic stenosis?
Ehlers - Danlow and Marfan syndrome
Pericarditits
S aureus
Fibrosis and dystrophic calcification

25. What gross and microscopic changes occur months after an MI?
Wear and tear
PDA
Myxoid degeneration
White scar fibrosis

26. What is the rate of mitral valve prolapse in the US?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Loeffler syndrome
Dense layer of elastic and fibrotic tissue in the endocardium - children
2-3%

27. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Thickening of chrodae tendinae and cusps - mitral stenosis
Degree of pulmonary artery stenosis
LHF

28. What type of valvular vegetations does S aureus cause?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Large - destructive vegetations
>60 years - bicuspid aortic valve
Plump fibroblasts - collagen - blood vessels

29. How does adult coarctation of the aorta present?
Breast and lung carcinoma - melanoma - lymphoma
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Mitral regurg

30. What effect does dilated cardiomyopathy have on the heart?
Turner syndrome
Janeway lesions
ST- segment depression
Systolic dysfx leading to biventricular CHF

31. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Split S2 on auscultation
Streptococcus bovis/
Months out fibrosis

32. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Myocardium
Heart can't fill
Coexisting mitral stenosis and fusion of commisures exist

33. What are the sx of PDA at birth?
1-3 days out
Asymptomatic
Right to left
Tuberous sclerosis

34. What are the clinical features of LHF due to?
Fetal alcohol syndrome
Nitroglycerin
Systolic ejection click followed by crescendo - decrescendo murmur
Decreased forward perfusion pulmonary congestion

35. What causes angina and syncope in aortic stenosis?

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36. What causes notching of the ribs in adult coarctation of the aorta?
Pulsating nail bed
RCA
Autoimmune pericarditis 6-8 wks post MI
Intercostal arteries enlarged due to collateral circulation

37. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
White scar fibrosis
Erythematous nontender lesions on palms and soles.
Ventricles cannot pump
Colon cancer

38. What drugs can cause dilated cardiomyopathy?
Atherosclerosis of coronary arteries
R-->L
NG or Ca channel blocker
Doxorubicin - cocaine

39. What vavular defect results from acute rheumatic fever?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Regurg vs stenosis
Mitral regurgitation due to vegetations
Nonspecific - eg fever and elevated ESR

40. Boot - shaped heart on x- ray?
RCA
Tetralogy of fallot
PGE
Cardiogenic shock - CHF - arrhythmia

41. How does aortic regurg affect the heart chambers?
Loss of fx
LV dilation and eccentric hypertrophy
Prophylactic abx during dental procedures
Mitral valve prolapse

42. What conditions can cause nonbacterial thrombotic endocarditis?
Tender lesions on fingers or toes.
PGE
Hypercoagulable state or underlying adenocarcinoma
Elevated ASO anti - DNase B titers

43. Dilated cardiomyopathy is a late complication of what illness?
Paradoxical emboli
Myocarditis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nonbacterial thrombotic endocarditis (marantic endocarditis)

44. What are heart failure cells?
Within the first day
Bicuspid aortic valve
NG or Ca channel blocker
Hemosiderin laden macrophages

45. What are complications of dilated cardiomyopathy?
Decrease preload -->lowers myocardial stress
Mitral and tricuspid regurg - arrhythmia
Heart transplant
Systolic ejection click followed by crescendo - decrescendo murmur

46. When is an MI pt at greatest risk for cardiogenic shock?
Group A beta - hemolytic streptococci
1-3 days out
First 4 hours
Red border granulation tissue

47. When do macrophagess infiltrate the myocardium post MI?
Congestive heart failure
4-7 days
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Prophylactic abx during dental procedures

48. How does MI cause LHF?
Trisomy 21
LAD
Loss of LV fx
Day 1-7

49. What coronary artery supplies the mitral valve papillary muscles?
Heart can't fill
S aureus
RCA
20 min

50. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Inability to maintain systemic pressure w/lack of O2 to vital organs
Chest pain <20 min brought on by exertion or emotional stress
Metastasis