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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 are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Endocardial fibroelastosis (rare)
Atria and RV

2. What is the rate of mitral valve prolapse in the US?
Day 1-7
2-3%
4-6 hours - 24 hours - 72 hours
Concentric LV hypertophy

3. What are the clinical features of RHF due to?
CK- MB
Troponin I
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Systemic venous congestion

4. What congenital heart defect does indomethacin tx?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Rupture of free wall - IV septum - or papillary muscle
2-3%
PDA

5. What are the four defects in tetralogy of fallot?
White scar fibrosis
Contraction band necrosis - reperfusion injury
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Prinzmetal angina - cocaine

6. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Regurg vs stenosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

7. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Aortic regurg
Shunt

8. How does MI cause LHF?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Small - nondestructive vegetations (subacute endocarditis)
Loss of LV fx
Prinzmetal angina - cocaine

9. What increases the risk for chronic rheumatic heart disease?
Anterior wall of LV and anterior septum
Breast and lung carcinoma - melanoma - lymphoma
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
S viridans

10. What is an important complication of ASD?
Paradoxical emboli
Chest pain <20 min brought on by exertion or emotional stress
Heart transplant
Rhadbomyoma - benign

11. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
Loeffler syndrome
LA dilation
Nitroglycerin

12. With what disease is Libman - Sacks endocarditis associated?
SLE
CK- MB
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Prinzmetal angina

13. What are the HACEK organisms? With what condition are they associated?
Indomethacin - decreases PGE
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Eisenmenger syndrome
Reactive histiocyte with caterpillar nucleus

14. What is Dressler syndrome? When does it occur?
Hemosiderin laden macrophages
Autoimmune pericarditis 6-8 wks post MI
Right side - serotonin and other secretory products detoxified in the lung
Libman - Sacks endocarditis

15. What does rupture of the LV free wall cause?
Small - nondestructive vegetations (subacute endocarditis)
Fibrosis and dystrophic calcification
Cardiac tamponade
Heart transplant

16. What are the tx for MI?
Nonspecific - eg fever and elevated ESR
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Valve scarring that arises as a consequence of rheumatic fever

17. What are Osler nodes?
Minimizes ischemia
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Tender lesions on fingers or toes.
Asymptomatic

18. What are other (not atherosclerotic) causes of MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Coronary artery vasospasm - emboli - vasculitis
Right -->left
Chest pain <20 min brought on by exertion or emotional stress

19. What are the complications of mitral valve prolapse? Are they common?
LV dilation and eccentric hypertrophy
Aschoff bodies
ST- segment elevation
Infectious endocarditis - arrythmias - severe mitral regurg no

20. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Aortic stenosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
When a bacterial protein resembles a protein in human tissue

21. What causes unstable angina?
Systemic venous congestion
Endocardial fibroelastosis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Doxorubicin - cocaine

22. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Louder - increased systemic resistence decreases LV emptying
Months out fibrosis
Prinzmetal angina
Harmartoma

23. How does reperfusion injury occur?
Reperfusion injury
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
2-4 hours - 24 hours - 7-10 days
Shunt - PGE to maintain PDA until surgical repair can be performed

24. What are Janeway lesions?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Myocarditis
Migratory polyarthritis
Erythematous nontender lesions on palms and soles.

25. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Months out fibrosis
Volume overload and LHF
Prinzmetal angina

26. Which congenital heart defect is associated with maternal diabetes?
Coronary artery vasospasm - emboli - vasculitis
Heart transplant
Transposition of the great vessels
Rhabdomyoma

27. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Prophylactic abx during dental procedures
Ostium primum
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Bacterial endocarditis

28. What type of shunt does a VSD cause?
Ischemic heart disease
L->R
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Coxsackie A or B

29. What are the complications of aortic stenosis?
Mitral regurg
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Cyanosis - RV hypertrophy - polycythemia - clubbing
Preductal - post aortic arch

30. Turner syndrome is associated with which congenital heart defect?
Aschoff bodies
Coexisting mitral stenosis and fusion of commisures exist
Fetal alcohol syndrome
Infantile coarctation of the aorta

31. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Ischemic heart disease
Hypercoagulable state or underlying adenocarcinoma
Reperfusion injury
Aschoff bodies

32. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
R-->L
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
PDA

33. In which pts does S viridans cause endocarditits?
Small - nondestructive vegetations (subacute endocarditis)
Pts w/previously damaged valves
Limits thrombosis
Large - destructive vegetations

34. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Transesophageal echo
4-7 days macrophage infiltration
Rhadbomyoma - benign
Right -->left

35. How does restrictive cardiomyopathy present?
Endocardial fibroelastosis
ST- segment depression
Troponin I
Congestive heart failure

36. What is the murmur of mitral valve prolapse?
Prinzmetal angina
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Mid - systolic click followed by regurgitation murmur
Osler nodes (ouch - ouch Osler)

37. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Low voltage EKG w/diminished QRS amplitude
Aortic regurg
Stable angina
PDA

38. What is the major cause of MI?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RHF
Nitroglycerin
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

39. Why are cardiac enzymes elevated after an MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Membrane damage
Janeway lesions
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

40. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Spontaneous
Dilated
Endocardial fibroelastosis

41. What is the most common valve infected by S aureus?
Surgical closure small defects may close spontaneously
Colon cancer
Tricuspid
2-3 weeks

42. What are heart failure cells?
Ventricles cannot pump
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral stenosis
Hemosiderin laden macrophages

43. What is the etiology of S viridans endocarditis?
S aureus
Reperfusion injury
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
4-24 hours

44. When does the heart have dark discoloration post MI?
4-24 hours
AD mutation in sarcomere proteins
Reactive histiocyte with caterpillar nucleus
White scar fibrosis

45. Low voltage EKG w/diminished QRS amplitude.
Positive blood cultures anemia of chronic disease
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Restrictive cardiomyopathy

46. What are the causes of LHF?
Blood vessels coming in from normal tissue
VSD
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Reversible

47. When do CK- MB levels rise - peak - and return to normal?
S epidermidis
Sterile vegetations on surface and undersurface on mitral valve
4-6 hours - 24 hours - 72 hours
Eisenmenger syndrome

48. When would arrhythmia occur after MI?
Decrease in blood flow to an organ
Stretched muscle loses contractility
Within the first day
Hypertrophic cardiomyopathy

49. What causes mitral valve prolapse?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Myxoid degeneration
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
Libman - Sacks endocarditis

50. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
R-->L
Dark discoloration coagulative necrosis