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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 type of shunt does transposition of the great vessels cause?
Thickening of chrodae tendinae and cusps - mitral stenosis
Chest pain <20 min brought on by exertion or emotional stress
1-3 days out
R-->L

2. What is a water - hammer pulse?
Bounding pulse
Myofiber hypertrophy with disarray
Aortic regurg
Dressler syndrome

3. What increases the risk for chronic rheumatic heart disease?
Cardiogenic shock - CHF - arrhythmia
Troponin I
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

4. With what disease is Libman - Sacks endocarditis associated?
Type I
Mitral valve prolapse
SLE
4-24 hours

5. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Backward LHF pulm htn and RHF - afib and associated mural thombis
Pancarditis
Heart can't fill

6. What is systolic dysfx?
Mitral mitral+aortic
Right -->left
Systemic venous congestion
Ventricles cannot pump

7. What always follows necrosis?
4-24 hours
Papillary muscle - free wall - IV septum
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Acute inflammation

8. What gross and microscopic changes occur months after an MI?
Endocardial fibroelastosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
White scar fibrosis
Right to left

9. What is the gold standard blood marker for MI?
Contraction band necrosis - reperfusion injury
2-4 hours - 24 hours - 7-10 days
Troponin I
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

10. What are Osler nodes?
Aschoff bodies
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Congested central veins
Tender lesions on fingers or toes.

11. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Tricuspid
Split S2 on auscultation
LHF

12. What is the etiology of S viridans endocarditis?
Congested central veins
1-3 days out
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

13. What are the clinical features of RHF?
Prinzmetal stable and unstable
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Right side - serotonin and other secretory products detoxified in the lung
Sterile vegetations on mitral valve along lines of closure

14. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Rupture of free wall - IV septum - or papillary muscle
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Inability to maintain systemic pressure w/lack of O2 to vital organs
PDA

15. Dilated cardiomyopathy is a late complication of what illness?
Decrease in blood flow to an organ
Dilated
Myocarditis
Limits thrombosis

16. What effect does aortic regurg have on the pulse pressure? Why?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Sudden cardiac death
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
1%

17. What does chronic ischemic heart disease progress to?
CHF
LA dilation
Infectious endocarditis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

18. In which chamber of the heart are cardiac myxomas found?
Mitral and tricuspid regurg - arrhythmia
1-3 days out
LA
Ischemic heart disease

19. How does subendocardial MI/ischemia present on EKG?
VSD
1%
Papillary muscle - free wall - IV septum
ST- segment depression

20. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Myofiber hypertrophy with disarray
Friction rub and chest pain
Fetal alcohol syndrome

21. What is chronic rheumatic heart disease?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
S epidermidis
Valve scarring that arises as a consequence of rheumatic fever
Volume overload and LHF

22. What are the major criteria of the Jones criteria?
Cardiac tamponade
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
CK- MB
VSD

23. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Mitral stenosis
Squatting - expiration
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

24. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Nonspecific - eg fever and elevated ESR
Increased hydrostatic pressure
Myocardium

25. What coronary arterysupplies the lateral wall of the LV?
Fibrinous pericarditis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Circumflex
Fibrosis and dystrophic calcification

26. What two things happen when a blocked vessel is opened after an MI?
Congestive heart failure
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Contraction band necrosis - reperfusion injury
PGE

27. What is the most common cause of RHF? What are others?
Paradoxical emboli
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Concentric LV hypertophy
45%

28. What congenital heart defect presents later in life with lower extremity cyanosis?
Membrane damage
Infectious
PDA
Gelatinous - abundant ground substance

29. What are the HACEK organisms? With what condition are they associated?
Prinzmetal
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Transesophageal echo
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

30. What is the foundation of a scar?
PDA
Granulation tissue
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

31. What conditions can cause nonbacterial thrombotic endocarditis?
1-3 days out
S aureus
Hypercoagulable state or underlying adenocarcinoma
Squat in response to cyanotic spell

32. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Anterior wall of LV and anterior septum
RHF
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ehlers - Danlow and Marfan syndrome

33. What is the most common congenital heart defect?
VSD
4-7 days
Dressler syndrome
ST- segment depression

34. How does reperfusion injury occur?
Aneurysm - mural thrombus - Dressler syndrome
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Atria and RV
Heart can't fill

35. What increases the volume of mitral regurg murmur?
Squatting - expiration
ASD - R-->L
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infectious endocarditis - arrythmias - severe mitral regurg no

36. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Type I
Opening snap followed by diastolic rumble
Aortic regurg

37. When do macrophagess infiltrate the myocardium post MI?
3-8 wks
Mitral mitral+aortic
Squatting - increased systemic resistence decreases LV emptying
4-7 days

38. Where is the coarctation in infantile coarctation of the aorta?
LA
Positive blood cultures anemia of chronic disease
Preductal - post aortic arch
CHF

39. Which congenital heart defect is associated with congenital rubella?
Prinzmetal stable and unstable
Decreased forward perfusion pulmonary congestion
PDA
Systolic dysfx leading to biventricular CHF

40. How does contraction band necrosis occur?
Tetralogy of fallot
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Dilated
RCA

41. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Regurg vs stenosis
Infectious endocarditis - arrythmias - severe mitral regurg no
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

42. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Transposition of the great vessels
Increased blood in right heart delays closure of P valve
Ventricular arrhythmia

43. What is an important complication of ASD?
Prophylactic abx during dental procedures
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Paradoxical emboli
Infectious endocarditis - arrythmias - severe mitral regurg no

44. What causes an early - blowing diastolic murmur?
Aortic regurg
Cardiogenic shock - CHF - arrhythmia
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Chronic rheumatic heart disease

45. What are the causes of restrictive cardiomyopathy in adults?
Months out fibrosis
Shunt
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

46. What causes a mid - systolic click followed by a regurgitation murmur?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
S epidermidis
Mitral valve prolapse
Open blocked vessels

47. What are the clinical features of RHF due to?
PGE
Reperfusion injury
IV drug users
Systemic venous congestion

48. What is the rate of mitral valve prolapse in the US?
Prinzmetal angina - cocaine
S aureus
LAD
2-3%

49. What is the characteristic finding on CXR in tetralogy of fallot?
First 4 hours
Boot shaped heart
Increased hydrostatic pressure
Pericarditits

50. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Bacterial endocarditis
Surgical closure small defects may close spontaneously
Hemosiderin laden macrophages