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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 is the characteristic murmurr of mitral stenosis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Opening snap followed by diastolic rumble
Intercostal arteries enlarged due to collateral circulation
Restrictive cardiomyopathy

2. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Aneurysm - mural thrombus - Dressler syndrome

3. What always follows necrosis?
Turner syndrome
Acute inflammation
Prinzmetal angina - cocaine
Indomethacin - decreases PGE

4. How do you prevent S viridans endocarditis?
Yellow pallor neutrophils
Prophylactic abx during dental procedures
Heart can't fill
Volume overload and LHF

5. What cardiac disease is associated with tuberous sclerosis?
Myocarditis
Rhabdomyoma
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Mid - systolic click followed by regurgitation murmur

6. What complications occur within 4 hrs post MI?
Mitral mitral+aortic
Rhabdomyoma
Cardiogenic shock - CHF - arrhythmia
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

7. How does MI cause LHF?
Loss of LV fx
Friction rub and chest pain
When a bacterial protein resembles a protein in human tissue
Aortic regurg

8. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Pancarditis
Ostium secundum (90%)
Squat in response to cyanotic spell

9. How does Eisenmeger syndrome occur?
Aortic regurg
Hypertrophic cardiomyopathy
Slow HR - decreasing O2 demand and risk for arrhythmia
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

10. What congenital heart defect presents later in life with lower extremity cyanosis?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Mitral regurg
PDA

11. What type of ASD is associated w/Down syndrome?
Asymptomatic
Ostium primum
Hypertophy of RV atrophy of LV
Gelatinous - abundant ground substance

12. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Systolic dysfx leading to biventricular CHF
Prinzmetal angina
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea

13. In what pt population does S aureus commonly cause valvular disease?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Aortic regurg
IV drug users
White scar fibrosis

14. What is molecular mimicry?
2-3 weeks
Maternal diabetes
When a bacterial protein resembles a protein in human tissue
RBC damaged while crossing the calcified valve causing schistocytes

15. What conditions can cause nonbacterial thrombotic endocarditis?
Hypertophy of RV atrophy of LV
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Hypercoagulable state or underlying adenocarcinoma
PDA

16. Sudden death in a young athlete.
Turner syndrome
Systolic dysfx leading to biventricular CHF
Mitral regurg
Hypertrophic cardiomyopathy

17. Which angina is relieved by Ca channel blockers?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Prinzmetal
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Annular - non pruritic rash w/erythematous borders trunks and limbs

18. What is the most common cause of aortic stenosis?
Kawasaki disease
Wear and tear
Transesophageal echo
Aschoff bodies

19. In which chamber of the heart are cardiac myxomas found?
Libman - Sacks endocarditis
AD mutation in sarcomere proteins
Valve scarring that arises as a consequence of rheumatic fever
LA

20. What bug causes acute rheumatic fever?
Membrane damage
Right -->left
Group A beta - hemolytic streptococci
Shunt - PGE to maintain PDA until surgical repair can be performed

21. What side of the heart do carcinoid tumors affect? Why?
Stable and unstable prinzmetal
Shunt
Right side - serotonin and other secretory products detoxified in the lung
Small vegetations along the line of closure

22. What does a biopsy of hypertrophic cardiomyopathy look like?
2-3%
When a bacterial protein resembles a protein in human tissue
Pts w/previously damaged valves
Myofiber hypertrophy with disarray

23. What is diastolic dysfx?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Inability to fill ventricles
Aneurysm - mural thrombus - Dressler syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

24. What determines the extent of shunting and cyanosis in tetralogy of fallot?
VSD
Degree of pulmonary artery stenosis
Right side - serotonin and other secretory products detoxified in the lung
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

25. Turner syndrome is associated with which congenital heart defect?
PDA
Infantile coarctation of the aorta
SLE
VSD

26. What is the rate of mitral valve prolapse in the US?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
2-3%
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
PDA

27. What artery is the 2nd most often occluded in an MI?
Low voltage EKG w/diminished QRS amplitude
Reperfusion injury
RCA
Myxoid degeneration

28. What does rupture of a papillary muscle cause?
Mitral insufficiency
Prinzmetal
Right side - serotonin and other secretory products detoxified in the lung
Myxoma - benign

29. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
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
Sterile vegetations on mitral valve along lines of closure
MI
Kawasaki disease

30. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Metastasis
Myxoid degeneration
Opening snap followed by diastolic rumble

31. What % stenosis causes stable angina?
>70%
Valve replacement
4-7 days
Small vegetations along the line of closure

32. Boot - shaped heart on x- ray?
Holosystolic blowing murmur
Troponin I
Tetralogy of fallot
1%

33. What is eythema marginatum? What parts of the body does it commonly involve?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Months out fibrosis
Annular - non pruritic rash w/erythematous borders trunks and limbs

34. How do nitrates tx MI?
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
3-8 wks
Decrease preload -->lowers myocardial stress
Open blocked vessels

35. What causes mitral valve prolapse?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Small vegetations along the line of closure
Myxoid degeneration
CHF

36. What does rupture of the LV free wall cause?
Cardiac tamponade
Volume overload and LHF
Ehlers - Danlow and Marfan syndrome
Paradoxical emboli

37. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Shunt
Aortic stenosis
Aneurysm - mural thrombus - Dressler syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)

38. What is an Aschoff body?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
LA dilation
Nonspecific - eg fever and elevated ESR
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

39. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Papillary muscle - free wall - IV septum
Ventricular arrhythmia
LA

40. What is the most common cause of death during the acute phase of rheumatic fever?
Pericarditits
Pericardial effusion due to pericardial involvement
Fibrosis and dystrophic calcification
Myocarditis

41. What causes a mid - systolic click followed by a regurgitation murmur?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Mitral valve prolapse
Breast and lung carcinoma - melanoma - lymphoma
Reversible

42. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Turner syndrome
Volume overload and LHF
S viridans

43. What does Libman - Sacks endocarditis cause?
Left -->right
Prophylactic abx during dental procedures
Heart can't fill
Mitral regurg

44. How does hypertension cause LHF?

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45. When does the heart have a yellow pallor post MI?
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
Day 1-7
Months out fibrosis
Decreases LV dilation by decreasing volume

46. What is the gold standard blood marker for MI?
Acute inflammation
Janeway lesions
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Troponin I

47. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Libman - Sacks endocarditis
Coexisting mitral stenosis and fusion of commisures exist
Holosystolic blowing murmur
Streptococcus viridans

48. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Mitral and tricuspid regurg - arrhythmia
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Loss of LV fx

49. How do you tx prinzmetal angina?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LV dilation and eccentric hypertrophy
NG or Ca channel blocker
Bacterial endocarditis

50. What drugs can cause dilated cardiomyopathy?
Thickening of chrodae tendinae and cusps - mitral stenosis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Doxorubicin - cocaine
Troponin I