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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 effect does squatting have on the murmur of mitral valve prolapse? Why?
Hypertrophic cardiomyopathy
Wear and tear
Opening snap followed by diastolic rumble
Louder - increased systemic resistence decreases LV emptying

2. When does the heart have dark discoloration post MI?
L->R
Infectious endocarditis
LAD
4-24 hours

3. What is the foundation of a scar?
Granulation tissue
2-3 weeks
Chest pain <20 min brought on by exertion or emotional stress
Day 1-7

4. What is the most common type of ASD? What %?
RCA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Ostium secundum (90%)
Infantile coarctation of the aorta

5. In which chamber of the heart are rhabdomyomas found?
Mitral stenosis
Ventricle
Congestive heart failure
Atria and RV

6. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Holosystolic blowing murmur
Posterior wall of LV - posterior septum - papillary muscles
Stable and unstable prinzmetal

7. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Erythematous nontender lesions on palms and soles.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Chest pain <20 min brought on by exertion or emotional stress
Chronic rheumatic heart disease

8. What coronary artery supplies the mitral valve papillary muscles?
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
RCA
R-->L
Increased blood in right heart delays closure of P valve

9. Tx for PDA?
1%
Turner syndrome
Ischemic heart disease
Indomethacin - decreases PGE

10. What are the two effects of ATII?
S viridans
Aortic regurg
White scar fibrosis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

11. What are the HACEK organisms? With what condition are they associated?
Ventricle
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Systolic ejection click followed by crescendo - decrescendo murmur
Nitroglycerin

12. When does the heart have a yellow pallor post MI?
Congenital rubella
Day 1-7
L->R
Ostium primum

13. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Migratory polyarthritis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Coronary artery vasospasm

14. Holosystolic blowing murmur that increases w/expiration?
Erythematous nontender lesions on palms and soles.
Endocardial fibroelastosis (rare)
Mitral regurg
Prinzmetal angina

15. What are the forward and backward sx of LHF?
Chronic ischemic heart disease
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
Opening snap followed by diastolic rumble
Rupture of free wall - IV septum - or papillary muscle

16. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
>60 years - bicuspid aortic valve
Congestive heart failure
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

17. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Ostium primum
RHF
Concentric LV hypertophy
Heart can't fill

18. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Small vegetations along the line of closure
1-3 days
Pancarditis

19. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Reversible
Slow HR - decreasing O2 demand and risk for arrhythmia
Mitral valve prolapse

20. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Louder - increased systemic resistence decreases LV emptying
Infectious
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

21. What is the classic EKG finding of restrictive cardiomyopathy?
Libman - Sacks endocarditis
Mitral regurg
Valve replacement
Low voltage EKG w/diminished QRS amplitude

22. What is cardiogenic shock?
Chronic rheumatic heart disease
Fibrosis and dystrophic calcification
Kawasaki disease
Inability to maintain systemic pressure w/lack of O2 to vital organs

23. When is an MI patent at highest risk for fibrionous pericarditis?
R-->L
1-3 days out
Hypertophy of RV atrophy of LV
Shunt - PGE to maintain PDA until surgical repair can be performed

24. How does adult coarctation of the aorta present?
Mitral regurgitation due to vegetations
Myofiber hypertrophy with disarray
VSD
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

25. Infects predamaged valves after transient bacteremia?
Tricuspid
ACE inhibitor
S viridans
Wear and tear

26. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Congestive heart failure
RCA
Coexisting mitral stenosis and fusion of commisures exist
Chronic rheumatic heart disease

27. What are the clinical features of LHF due to?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Decreased forward perfusion pulmonary congestion
Right to left
RHF

28. What compensatory mechanism do tetralogy of fallot pts learn?
Reperfusion injury
Squat in response to cyanotic spell
LAD
ST- segment elevation

29. What is the etiology of S viridans endocarditis?
Nitroglycerin
Kawasaki disease
Right side - serotonin and other secretory products detoxified in the lung
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

30. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Aortic stenosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Low voltage EKG w/diminished QRS amplitude

31. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Increased hydrostatic pressure
Large - destructive vegetations
LV dilation and eccentric hypertrophy

32. What are the Jones criteria?
Restrictive cardiomyopathy
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Ventricular arrhythmia
Paradoxical emboli

33. How does stable angina present?
Hypertophy of RV atrophy of LV
RCA
Chronic rheumatic heart disease
Chest pain <20 min brought on by exertion or emotional stress

34. When do macrophagess infiltrate the myocardium post MI?
Spontaneous
ST- segment depression
4-7 days
Ehlers - Danlow and Marfan syndrome

35. How long after pharyngitis does acute rheumatic fever occur?
Mid - systolic click followed by regurgitation murmur
2-3 weeks
Stretched muscle loses contractility
Nitroglycerin

36. Erythematous nontender lesions on palms and soles.
Plump fibroblasts - collagen - blood vessels
Anitschow cell
Janeway lesions
Subendocardial

37. What type of vegetations form in nonbacterial thrombotic endocarditis?
S viridans
Thickening of chrodae tendinae and cusps - mitral stenosis
Chest pain <20 min brought on by exertion or emotional stress
Sterile vegetations on mitral valve along lines of closure

38. What are the sx of aortic regurg?
Infectious endocarditis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Valve replacement once LV dysfx develops
Mitral and tricuspid regurg - arrhythmia

39. What is the most common cause of myocarditis?
Thickening of chrodae tendinae and cusps - mitral stenosis
Decreased forward perfusion pulmonary congestion
Eisenmenger syndrome
Coxsackie A or B

40. What are the major criteria of the Jones criteria?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Ventricles cannot pump
Rhadbomyoma - benign

41. What is the cause of restrictive cardiomyopathy in children?
Regurg vs stenosis
S viridans
20 min
Endocardial fibroelastosis (rare)

42. Opening snap followed by diastolic rumble.
Decreased forward perfusion pulmonary congestion
Right side - serotonin and other secretory products detoxified in the lung
1%
Mitral stenosis

43. What are the sx of cardiac myxoma?
LAD
Mitral and tricuspid regurg - arrhythmia
Libman - Sacks endocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

44. What valves are involved in rhuematic endocarditis?
Prinzmetal stable and unstable
Nitroglycerin
Contraction band necrosis - reperfusion injury
Mitral mitral+aortic

45. What is Dressler syndrome? When does it occur?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Autoimmune pericarditis 6-8 wks post MI
Type I
Within the first day

46. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
SLE
Chronic ischemic heart disease

47. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Bacterial endocarditis
Heart can't fill
LHF
Fetal alcohol syndrome

48. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Hypercoagulable state or underlying adenocarcinoma
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Myocarditis
Adult coarctation of the aorta

49. What heart sound manifest with an ASD?
PDA
1-3 days
Split S2 on auscultation
Reversible

50. How does hypertension cause LHF?

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