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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. How do ACE inhibitors tx MI?
R-->L
Decreases LV dilation by decreasing volume
Ischemic heart disease
Libman - Sacks endocarditis

2. What is diastolic dysfx?
LV dilation and eccentric hypertrophy
Nonbacterial thrombotic endocarditis (marantic endocarditis)
PDA
Inability to fill ventricles

3. What type of shunt does a VSD cause?
Squat in response to cyanotic spell
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
L->R
Hypercoagulable state or underlying adenocarcinoma

4. What type of tumor is a rhabdomyoma?
>70%
Harmartoma
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Ostium secundum (90%)

5. Poor myocardial fx due to chronic ischemic damage?
Boot shaped heart
Spontaneous
Chronic ischemic heart disease
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

6. What does Libman - Sacks endocarditis cause?
Fetal alcohol syndrome
Myocardium
Mitral regurg
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

7. What are Osler nodes?
Tender lesions on fingers or toes.
4-7 days
Infectious endocarditis - arrythmias - severe mitral regurg no
Breast and lung carcinoma - melanoma - lymphoma

8. What is a complication of chronic rheumatic heart disease?
Large - destructive vegetations
2-4 hours - 24 hours - 7-10 days
Infectious endocarditis
Ehlers - Danlow and Marfan syndrome

9. What is cardiogenic shock?
Volume overload and LHF
Inability to maintain systemic pressure w/lack of O2 to vital organs
45%
Coxsackie A or B

10. What is the tx for LHF?
Myocardium
Atria and RV
20 min
ACE inhibitor

11. What coronary arterysupplies the lateral wall of the LV?
Prinzmetal angina - cocaine
Rupture of free wall - IV septum - or papillary muscle
Circumflex
Decrease in blood flow to an organ

12. When does the heart have a yellow pallor post MI?
Endocardial fibroelastosis
Within the first day
Day 1-7
Intercostal arteries enlarged due to collateral circulation

13. What valves are involved in rhuematic endocarditis?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Regurg vs stenosis
Reversible
Mitral mitral+aortic

14. What is the most comon cause of aortic regurg? What are the other causes?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Doxorubicin - cocaine
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

15. In what pt population does S aureus commonly cause valvular disease?
PDA
Pedunculated mass in the LA that causes syncope due to obstruction of MV
IV drug users
Heart transplant

16. Myofiber hypertrophy with disarray.
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
3-8 wks
White scar fibrosis
Hypertrophic cardiomyopathy

17. What are the forward and backward sx of LHF?
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
>70%
Ventricle
S epidermidis

18. What increases the volume of mitral regurg murmur?
Day 1-7
Squatting - expiration
Degree of pulmonary artery stenosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

19. What is dilated cardiomyopathy?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Endocardial fibroelastosis (rare)
Dilation of all four chambers of the heart
LAD

20. What heart sound manifest with an ASD?
Split S2 on auscultation
When a bacterial protein resembles a protein in human tissue
Preductal - post aortic arch
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

21. Which chambers of the heart are generally spared in an MI?
Nitroglycerin
Atria and RV
Increased blood in right heart delays closure of P valve
CHF

22. What is an important complication of ASD?
Paradoxical emboli
LA
Reperfusion injury
Type I

23. What is the most common congenital heart defect?
VSD
Type I
Congenital rubella
Troponin I

24. Which artery is most often occluded in an MI?
Hypertrophic cardiomyopathy
Systemic venous congestion
Chronic rheumatic heart disease
LAD

25. What are the clinical features of RHF?
Infectious endocarditis
Coronary artery vasospasm - emboli - vasculitis
Myocarditis in acute rheumatic heart fever
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

26. What is an Aschoff body?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Cardiogenic shock - CHF - arrhythmia
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

27. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
1-3 days
When a bacterial protein resembles a protein in human tissue
Chronic rheumatic heart disease

28. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Maternal diabetes
Sudden cardiac death
Mitral regurg

29. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Harmartoma
Myxoma - benign
1%

30. What causes mitral valve prolapse?
Libman - Sacks endocarditis
Myxoid degeneration
Mitral insufficiency
Reperfusion injury

31. Why are cardiac enzymes elevated after an MI?
Membrane damage
S viridans
Group A beta - hemolytic streptococci
3-8 wks

32. Ostium primum ASD is associated with what congenital disorder?
Troponin I
Open blocked vessels
Trisomy 21
Positive blood cultures anemia of chronic disease

33. When do macrophagess infiltrate the myocardium post MI?
Opening snap followed by diastolic rumble
Posterior wall of LV - posterior septum - papillary muscles
4-7 days
Loss of fx

34. What is the most common cause of mitral stenosis?
Transesophageal echo
Chronic rheumatic heart disease
LA dilation
Systolic ejection click followed by crescendo - decrescendo murmur

35. What side of the heart do carcinoid tumors affect? Why?
R-->L
Ventricular arrhythmia
Backward LHF pulm htn and RHF - afib and associated mural thombis
Right side - serotonin and other secretory products detoxified in the lung

36. How do you tx prinzmetal angina?
Right side - serotonin and other secretory products detoxified in the lung
Decrease preload -->lowers myocardial stress
NG or Ca channel blocker
Large vegetations of S aureus

37. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Hypertrophic cardiomyopathy
Day 1-7
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Subendocardial

38. Dilated cardiomyopathy is a late complication of what illness?
4-6 hours - 24 hours - 72 hours
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Low voltage EKG w/diminished QRS amplitude
Myocarditis

39. How does dilated cardiomyopathy cause LHF?
Anitschow cell
Tender lesions on fingers or toes.
Prinzmetal stable and unstable
Stretched muscle loses contractility

40. With what congenital heart defect is ADULT coarctation of the aorta associated?
Endocardial fibroelastosis (rare)
Bicuspid aortic valve
Loss of LV fx
Janeway lesions

41. What bug causes acute rheumatic fever?
Rhabdomyoma
Libman - Sacks endocarditis
Group A beta - hemolytic streptococci
PGE

42. What drug relieves stable angina?
Pts w/previously damaged valves
Infectious endocarditis - arrythmias - severe mitral regurg no
Nitroglycerin
Bicuspid aortic valve

43. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Reversible
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Day 1-7

44. Which congenital heart defect is associated with maternal diabetes?
Myofiber hypertrophy with disarray
Transposition of the great vessels
Erythematous nontender lesions on palms and soles.
Endocardial fibroelastosis

45. What type of shunt results in cyanosis at birth?
Bicuspid aortic valve
AD mutation in sarcomere proteins
Right to left
MI

46. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
PDA
Paradoxical emboli
4-7 days macrophage infiltration
Sudden cardiac death

47. What causes microangiopathic hemolytic anemia in aortic stenosis?
Group A beta - hemolytic streptococci
RBC damaged while crossing the calcified valve causing schistocytes
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Day 1-7

48. Which congenital heart defect is associated with congenital rubella?
Mitral regurg
RCA
Papillary muscle - free wall - IV septum
PDA

49. What is the only Jones criteria that doesn't resolve with time?
Myocardium
NG or Ca channel blocker
CHF
Pancarditis

50. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Large vegetations of S aureus
Right side - serotonin and other secretory products detoxified in the lung
Bounding pulse