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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 most common cause of mitral stenosis?
LAD
Wear and tear
Chronic rheumatic heart disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

2. In transposition of the great vessels - What is required for survival? How is this achieved?
Anterior wall of LV and anterior septum
Streptococcus bovis/
Shunt - PGE to maintain PDA until surgical repair can be performed
Sudden cardiac death

3. Erythematous nontender lesions on palms and soles.
Increased blood in right heart delays closure of P valve
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Janeway lesions
Sterile vegetations on surface and undersurface on mitral valve

4. How does adult coarctation of the aorta present?
S aureus
Decreases LV dilation by decreasing volume
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Holosystolic blowing murmur

5. Are most congenital heart defects spontaneous or inherited?
Surgical closure small defects may close spontaneously
Open blocked vessels
Tender lesions on fingers or toes.
Spontaneous

6. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
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
PDA
Increased blood in right heart delays closure of P valve

7. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Inability to maintain systemic pressure w/lack of O2 to vital organs
Adult coarctation of the aorta
LHF

8. What type of ischemia does stable angina cause?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Subendocardial
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Endocardial fibroelastosis

9. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
Libman - Sacks endocarditis
Ventricular arrhythmia
Friction rub and chest pain

10. How does hypertension cause LHF?

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11. What causes angina and syncope in aortic stenosis?

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12. Dense layer of elastic and fibrotic tissue in the endocardium.
Prinzmetal angina
Troponin I
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
Endocardial fibroelastosis

13. Infects predamaged valves after transient bacteremia?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Decrease in blood flow to an organ
S viridans

14. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Friction rub and chest pain
Bicuspid aortic valve
Adult coarctation of the aorta

15. Is injury due angina reversible or irreversible?
MI
Atherosclerosis of coronary arteries
Reversible
S viridans

16. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Myocarditis
LA
Within the first day

17. When do macrophagess infiltrate the myocardium 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
ST- segment depression
4-7 days
Squat in response to cyanotic spell

18. What type of tumor is a rhabdomyoma?
Harmartoma
Yellow pallor neutrophils
SLE
4-7 days

19. What endocarditis is commonly found in patients with colon cancer?
ST- segment depression
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
>60 years - bicuspid aortic valve
Streptococcus bovis/

20. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Months out fibrosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

21. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Nitroglycerin
Large vegetations of S aureus
Holosystolic machine like murmur

22. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Mitral mitral+aortic
Squatting - increased systemic resistence decreases LV emptying
Heart transplant

23. What structures are susceptible to rupture post MI?
Papillary muscle - free wall - IV septum
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Ventricular arrhythmia
Sterile vegetations on surface and undersurface on mitral valve

24. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
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
Elevated ASO anti - DNase B titers
LV dilation and eccentric hypertrophy

25. What are Osler nodes?
Tender lesions on fingers or toes.
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Degree of pulmonary artery stenosis
RBC damaged while crossing the calcified valve causing schistocytes

26. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Backward LHF pulm htn and RHF - afib and associated mural thombis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

27. What is the most common form of cardiomyopathy?
Dilated
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Inability to fill ventricles
CK- MB

28. Which coronary artery supplies the anterior wall and anterior septum?
ASD - R-->L
Eisenmenger syndrome
LAD
Months out fibrosis

29. What are the causes of restrictive cardiomyopathy in adults?
Dilation of all four chambers of the heart
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Decreased forward perfusion pulmonary congestion

30. What is the tx for dilated cardiomyopathy?
Troponin I
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
RCA
Heart transplant

31. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Nitroglycerin
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Systolic dysfx leading to biventricular CHF
Months out fibrosis

32. What artery is the 2nd most often occluded in an MI?
RCA
Hypertophy of RV atrophy of LV
Ostium secundum (90%)
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

33. What type of valvular vegetations does S aureus cause?
Open blocked vessels
Large - destructive vegetations
Months out fibrosis
Atherosclerosis of coronary arteries

34. What causes heart failure cells?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Volume overload and LHF
Months out fibrosis

35. What is the JOneS mneumonic?
Cardiogenic shock - CHF - arrhythmia
Libman - Sacks endocarditis
Loeffler syndrome
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

36. What is the most common valve infected by S aureus?
Ventricle
Tender lesions on fingers or toes.
2-3%
Tricuspid

37. What is a water - hammer pulse?
Infantile coarctation of the aorta
Atria and RV
Bounding pulse
Breast and lung carcinoma - melanoma - lymphoma

38. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Open blocked vessels
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
1-3 days

39. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Harmartoma
Reperfusion injury
Months out fibrosis
Stable and unstable prinzmetal

40. How does stable angina present?
Elevated ASO anti - DNase B titers
Chest pain <20 min brought on by exertion or emotional stress
Indomethacin - decreases PGE
ST- segment depression

41. What % stenosis causes stable angina?
>70%
Bicuspid aortic valve
Squatting - expiration
Coronary artery vasospasm - emboli - vasculitis

42. What is endocardial fibroelastosis? In what population is it found?
Mid - systolic click followed by regurgitation murmur
First 4 hours
Dense layer of elastic and fibrotic tissue in the endocardium - children
Hemosiderin laden macrophages

43. What increases the volume of mitral regurg murmur?
Intercostal arteries enlarged due to collateral circulation
Squatting - expiration
Mitral regurg
Maternal diabetes

44. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Yellow pallor macrophages
Regurg vs stenosis
ST- segment depression

45. What is an Anitschow cell?
Libman - Sacks endocarditis
Reactive histiocyte with caterpillar nucleus
Friction rub and chest pain
Mitral regurgitation due to vegetations

46. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Tricuspid
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Reperfusion injury
1-3 days out

47. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Open blocked vessels
S epidermidis
Atherosclerosis of coronary arteries

48. What gross and microscopic changes occur 4-7 days after an MI?
Asymptomatic
Pancarditis
PDA
Yellow pallor macrophages

49. What compensatory mechanism do tetralogy of fallot pts learn?
S viridans
Erythematous nontender lesions on palms and soles.
Libman - Sacks endocarditis
Squat in response to cyanotic spell

50. What is the 1day-1wk -1mo mneumonic for MI?
Erythematous nontender lesions on palms and soles.
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
IV drug users
Inability to maintain systemic pressure w/lack of O2 to vital organs