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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 causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Anterior wall of LV and anterior septum
Cyanosis - RV hypertrophy - polycythemia - clubbing

2. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Positive blood cultures anemia of chronic disease
ACE inhibitor
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
>60 years - bicuspid aortic valve

3. What makes the MV prolapse murmur louder? Why?
CHF
Atria and RV
ACE inhibitor
Squatting - increased systemic resistence decreases LV emptying

4. What gross and microscopic changes occur 4-24 hours after an MI?
IV drug users
Infectious endocarditis
Infantile coarctation of the aorta
Dark discoloration coagulative necrosis

5. What effect does dilated cardiomyopathy have on the heart?
Loeffler syndrome
Endocardial fibroelastosis
Systolic dysfx leading to biventricular CHF
VSD

6. What generally causes ischemic heart disease?
Increased blood in right heart delays closure of P valve
Prinzmetal angina
Bounding pulse
Atherosclerosis of coronary arteries

7. L- to - R shunt switching to R- to - L shunt.
Opening snap followed by diastolic rumble
Mitral regurg
Eisenmenger syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

8. What is the murmur of mitral valve prolapse?
Aneurysm - mural thrombus - Dressler syndrome
Mid - systolic click followed by regurgitation murmur
Systolic dysfx leading to biventricular CHF
AD mutation in sarcomere proteins

9. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Reactive histiocyte with caterpillar nucleus
Doxorubicin - cocaine
ASD - R-->L
Group A beta - hemolytic streptococci

10. What iis the tx for aortic regurg?
Ostium secundum (90%)
Valve replacement once LV dysfx develops
Circumflex
Elevated ASO anti - DNase B titers

11. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Dilated
Aschoff bodies
Increased blood in right heart delays closure of P valve
Infectious

12. What causes a mid - systolic click followed by a regurgitation murmur?
Valve replacement once LV dysfx develops
S aureus
Mitral valve prolapse
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

13. How does hypertension cause LHF?

14. Is scar tissue or myocardium stronger?
Circumflex
Minimizes ischemia
Myocardium
Infantile coarctation of the aorta

15. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Pump failure
Anitschow cell
Contraction band necrosis - reperfusion injury
Louder - increased systemic resistence decreases LV emptying

16. What complication occurs 1-3 days post MI?
LHF
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Fibrinous pericarditis
PDA

17. Is injury due angina reversible or irreversible?
VSD
Contraction band necrosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Reversible

18. What are the complications that occur months after an MI?
RCA
Aneurysm - mural thrombus - Dressler syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Decrease in blood flow to an organ

19. What type of shunt does transposition of the great vessels cause?
Valve scarring that arises as a consequence of rheumatic fever
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
R-->L
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

20. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Squatting - expiration
20 min
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
1-3 days

21. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Squatting - increased systemic resistence decreases LV emptying
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Split S2 on auscultation

22. What is the leading cause of death in the US?
S aureus
Hypertrophic cardiomyopathy
Ischemic heart disease
Fibrosis and dystrophic calcification

23. What are the sx of pericardiits?
Large vegetations of S aureus
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Right side - serotonin and other secretory products detoxified in the lung
Friction rub and chest pain

24. EKG for stable angina?
ST- segment depression
RCA
LHF
Anitschow cell

25. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Large vegetations of S aureus
Sudden cardiac death
Mitral insufficiency

26. What are the sx of right - to - left shunt?
Atherosclerosis of coronary arteries
Inability to fill ventricles
Sterile vegetations on mitral valve along lines of closure
Cyanosis - RV hypertrophy - polycythemia - clubbing

27. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Paradoxical emboli
Mitral regurgitation due to vegetations
Janeway lesions

28. What are the sx of cardiac myxoma?
Ostium secundum (90%)
Metastasis
MI
Pedunculated mass in the LA that causes syncope due to obstruction of MV

29. What are the Jones criteria?
Decrease in blood flow to an organ
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Pedunculated mass in the LA that causes syncope due to obstruction of MV

30. What is the rate of congenital heart defects?
1%
Chronic rheumatic heart disease
Months out fibrosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

31. How do you tx prinzmetal angina?
Membrane damage
Metastasis
Trisomy 21
NG or Ca channel blocker

32. What is the most comon cause of aortic regurg? What are the other causes?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Prinzmetal stable and unstable
Squatting - expiration

33. What are complications of dilated cardiomyopathy?
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
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral and tricuspid regurg - arrhythmia
Coronary artery vasospasm - emboli - vasculitis

34. When is an MI patent at highest risk for fibrionous pericarditis?
Infectious endocarditis
Subendocardial
1-3 days out
Valve replacement AFTER the onset of complications

35. What is an Aschoff body?
Libman - Sacks endocarditis
Dilated
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
SLE

36. At what point in development do congenital heart defects arise?
Mitral and tricuspid regurg - arrhythmia
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
2-4 hours - 24 hours - 7-10 days
3-8 wks

37. Opening snap followed by diastolic rumble.
Mitral stenosis
PGE
Membrane damage
Aschoff bodies

38. Sudden death in a young athlete.
20 min
Ventricle
Harmartoma
Hypertrophic cardiomyopathy

39. With what disease is transposition of the great vessels associated?
Right side - serotonin and other secretory products detoxified in the lung
Aneurysm - mural thrombus - Dressler syndrome
Valve replacement
Maternal diabetes

40. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Aortic stenosis
ST- segment depression
RCA
Nonspecific - eg fever and elevated ESR

41. How does transmural MI/ischemia present on EKG?
Boot shaped heart
Reactive histiocyte with caterpillar nucleus
ST- segment elevation
Rhadbomyoma - benign

42. What is the tx for mitral valve prolapse?
Rhabdomyoma
Valve replacement
Kawasaki disease
Right side - serotonin and other secretory products detoxified in the lung

43. Lower extremity cyanosis later in life - holostystolic machine like murmur.
S epidermidis
PDA
Troponin I
Dressler syndrome

44. Which vasculitis can cause MI?
Decreases LV dilation by decreasing volume
Kawasaki disease
Circumflex
Small vegetations along the line of closure

45. What is the gold standard blood marker for MI?
Troponin I
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
LV dilation and eccentric hypertrophy
Congenital rubella

46. How does Eisenmeger syndrome occur?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Inability to fill ventricles
Posterior wall of LV - posterior septum - papillary muscles
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

47. How long after pharyngitis does acute rheumatic fever occur?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Aortic stenosis
Limits thrombosis
2-3 weeks

48. What is endocardial fibroelastosis? In what population is it found?
Myocarditis in acute rheumatic heart fever
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decreased forward perfusion pulmonary congestion

49. What compensatory mechanism do tetralogy of fallot pts learn?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Squat in response to cyanotic spell
Prinzmetal angina - cocaine
Myocardium

50. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
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
Dilation of all four chambers of the heart
Contraction band necrosis