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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 effect does transposition of the great vessels have on the ventricles?
RBC damaged while crossing the calcified valve causing schistocytes
Blood vessels coming in from normal tissue
Hypertophy of RV atrophy of LV
Asymptomatic

2. What type of vegetations form in nonbacterial thrombotic endocarditis?
Increased blood in right heart delays closure of P valve
RCA
Sterile vegetations on mitral valve along lines of closure
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

3. What is the gold standard blood marker for MI?
Troponin I
Coronary artery vasospasm - emboli - vasculitis
Hypertrophic cardiomyopathy
Prinzmetal angina

4. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Regurg vs stenosis
Bounding pulse
Louder - increased systemic resistence decreases LV emptying
Intercostal arteries enlarged due to collateral circulation

5. What complications occur 4-7 days post MI?
Ostium primum
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Rupture of free wall - IV septum - or papillary muscle
Hemosiderin laden macrophages

6. What causes prinzmetal angina?
Contraction band necrosis - reperfusion injury
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Coronary artery vasospasm
Myxoid degeneration

7. What compensatory mechanism do tetralogy of fallot pts learn?
Shunt - PGE to maintain PDA until surgical repair can be performed
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Yellow pallor neutrophils
Squat in response to cyanotic spell

8. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Autoimmune pericarditis 6-8 wks post MI
Open blocked vessels
First 4 hours

9. How does asprin/heparin tx MI?
Eisenmenger syndrome
Limits thrombosis
Adult coarctation of the aorta
Rhabdomyoma

10. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Small - nondestructive vegetations (subacute endocarditis)
Decreased forward perfusion pulmonary congestion
Stable angina

11. What is the characteristic murmur of aortic stenosis?
2-3%
Systolic ejection click followed by crescendo - decrescendo murmur
Aortic regurg
Regurg vs stenosis

12. What makes the MV prolapse murmur louder? Why?
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
Janeway lesions
Sterile vegetations on surface and undersurface on mitral valve
Squatting - increased systemic resistence decreases LV emptying

13. What are the major criteria of the Jones criteria?
Migratory polyarthritis
Chronic ischemic heart disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

14. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Metastasis
Months out fibrosis
Rhabdomyoma

15. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Mitral valve prolapse
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Pulsating nail bed

16. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
VSD
Regurg vs stenosis
Valve scarring that arises as a consequence of rheumatic fever
Open blocked vessels

17. What are the cancers that most commonly metastasize to the heart?
Concentric LV hypertophy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Breast and lung carcinoma - melanoma - lymphoma
MI

18. What is a complication of chronic rheumatic heart disease?
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
Chronic ischemic heart disease
Cardiac tamponade
Infectious endocarditis

19. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Low voltage EKG w/diminished QRS amplitude
Anitschow cell
Bacterial endocarditis
Systemic venous congestion

20. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Tender lesions on fingers or toes.
Hypertrophic cardiomyopathy
Holosystolic blowing murmur

21. What is the most common form of cardiomyopathy?
Dilated
Type I
Concentric LV hypertophy
PGE

22. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Transesophageal echo
Colon cancer
Minimizes ischemia
Stretched muscle loses contractility

23. What are the sx of aortic regurg?
Loeffler syndrome
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Ostium primum
Valve replacement AFTER the onset of complications

24. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Myocardium
Atherosclerosis of coronary arteries
Prophylactic abx during dental procedures

25. Large vegetations on tricuspid valve?
S aureus
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
LA dilation

26. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pulsating nail bed
Yellow pallor neutrophils

27. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Wear and tear
Months out fibrosis
S aureus

28. With what disease is transposition of the great vessels associated?
Hemosiderin laden macrophages
Aneurysm - mural thrombus - Dressler syndrome
Maternal diabetes
Restrictive cardiomyopathy

29. What type of shunt dose PDA cause?
Contraction band necrosis
Left -->right
RCA
Blood vessels coming in from normal tissue

30. What is the most common cause of mitral stenosis?
Left -->right
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Chronic rheumatic heart disease
Breast and lung carcinoma - melanoma - lymphoma

31. How does aortic regurg affect the heart chambers?
Endocardial fibroelastosis (rare)
LV dilation and eccentric hypertrophy
Decrease preload -->lowers myocardial stress
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

32. What are the sx of PDA at birth?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Concentric LV hypertophy
Asymptomatic
Cyanosis - RV hypertrophy - polycythemia - clubbing

33. What is the rate of congenital heart defects?
Cardiogenic shock - CHF - arrhythmia
PDA
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
1%

34. Tx for PDA?
>60 years - bicuspid aortic valve
Squatting - increased systemic resistence decreases LV emptying
Systolic dysfx leading to biventricular CHF
Indomethacin - decreases PGE

35. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Louder - increased systemic resistence decreases LV emptying
Valve replacement AFTER the onset of complications
Holosystolic blowing murmur

36. How does MI cause LHF?
Loss of LV fx
CK- MB
Decreased forward perfusion pulmonary congestion
Infectious endocarditis

37. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Adult coarctation of the aorta
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

38. What is the only Jones criteria that doesn't resolve with time?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Holosystolic machine like murmur
Pancarditis
Maternal diabetes

39. L- to - R shunt switching to R- to - L shunt.
Squat in response to cyanotic spell
Surgical closure small defects may close spontaneously
Yellow pallor neutrophils
Eisenmenger syndrome

40. What is the characteristic murmurr of mitral stenosis?
CK- MB
Opening snap followed by diastolic rumble
Decreased forward perfusion pulmonary congestion
Bacterial endocarditis

41. What is the most common cause of endocarditis in IV drug users?
S aureus
Atria and RV
Rhadbomyoma - benign
Pericardial effusion due to pericardial involvement

42. What type of shunt does a VSD cause?
ST- segment elevation
LAD
L->R
Split S2 on auscultation

43. When do troponin levels rise - peak - and return to normal?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Squatting - expiration
Cardiogenic shock - CHF - arrhythmia
2-4 hours - 24 hours - 7-10 days

44. What increases the risk for chronic rheumatic heart disease?
Contraction band necrosis
Fibrinous pericarditis
Prinzmetal angina - cocaine
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

45. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Granulation tissue
Shunt
1-3 days out

46. Which angina(s) show ST elevation on EKG? ST depression?
Preductal - post aortic arch
L->R
Mitral stenosis
Prinzmetal stable and unstable

47. How do nitrates tx MI?
Systolic dysfx leading to biventricular CHF
Decrease preload -->lowers myocardial stress
R-->L
Nonbacterial thrombotic endocarditis (marantic endocarditis)

48. What endocarditis is commonly found in patients with colon cancer?
Stretched muscle loses contractility
Streptococcus bovis/
Libman - Sacks endocarditis
Transesophageal echo

49. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Plump fibroblasts - collagen - blood vessels
PGE
1-3 days
PDA

50. What are Janeway lesions?
Hemosiderin laden macrophages
Erythematous nontender lesions on palms and soles.
Migratory polyarthritis
Ventricle