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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 tx for VSD?
Aneurysm - mural thrombus - Dressler syndrome
Aschoff bodies
Erythematous nontender lesions on palms and soles.
Surgical closure small defects may close spontaneously

2. What is the gold standard blood marker for MI?
ASD - R-->L
Heart transplant
Systolic ejection click followed by crescendo - decrescendo murmur
Troponin I

3. What is an Aschoff body?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Right side - serotonin and other secretory products detoxified in the lung
Chronic ischemic heart disease

4. What typically causes hypertrophic cardiomyopathy?
Doxorubicin - cocaine
Opening snap followed by diastolic rumble
AD mutation in sarcomere proteins
Valve replacement AFTER the onset of complications

5. What causes a mid - systolic click followed by a regurgitation murmur?
S aureus
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Colon cancer
Mitral valve prolapse

6. When does the heart have dark discoloration post MI?
Colon cancer
4-24 hours
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Boot shaped heart

7. What is the most common congenital heart defect?
Hypertophy of RV atrophy of LV
Endocarditis of prosthetic valves
4-7 days
VSD

8. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Stable and unstable prinzmetal
Nitroglycerin
Regurg vs stenosis

9. How does O2 tx MI?
SLE
S aureus
Bounding pulse
Minimizes ischemia

10. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Valve scarring that arises as a consequence of rheumatic fever
Ventricles cannot pump
Reperfusion injury
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

11. What are other (not atherosclerotic) causes of MI?
Left -->right
Coronary artery vasospasm - emboli - vasculitis
LV dilation and eccentric hypertrophy
IV drug users

12. What areas of the heart does the LAD supply?
Coexisting mitral stenosis and fusion of commisures exist
Anterior wall of LV and anterior septum
Ventricular arrhythmia
Aneurysm - mural thrombus - Dressler syndrome

13. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Coronary artery vasospasm - emboli - vasculitis
Months out fibrosis
Ostium primum
Tricuspid

14. In transposition of the great vessels - What is required for survival? How is this achieved?
Mitral insufficiency
Myxoid degeneration
Shunt - PGE to maintain PDA until surgical repair can be performed
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

15. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
2-4 hours - 24 hours - 7-10 days
Pump failure
Mitral valve prolapse

16. What are the sx of right - to - left shunt?
Hemosiderin laden macrophages
Minimizes ischemia
Rupture of free wall - IV septum - or papillary muscle
Cyanosis - RV hypertrophy - polycythemia - clubbing

17. What vavular defect results from acute rheumatic fever?
Trisomy 21
Troponin I
Aneurysm - mural thrombus - Dressler syndrome
Mitral regurgitation due to vegetations

18. EKG for stable angina?
Squatting - increased systemic resistence decreases LV emptying
Restrictive cardiomyopathy
ST- segment depression
Prinzmetal stable and unstable

19. Which angina is relieved by Ca channel blockers?
Prinzmetal
Circumflex
S aureus
Type I

20. What is the rate of mitral valve prolapse in the US?
Large - destructive vegetations
ASD - R-->L
2-3%
Myocardium

21. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
S viridans
Coexisting mitral stenosis and fusion of commisures exist
Decrease in blood flow to an organ

22. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Group A beta - hemolytic streptococci
Bacterial endocarditis
Systolic dysfx leading to biventricular CHF

23. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
LA dilation
Dense layer of elastic and fibrotic tissue in the endocardium - children
Decrease in blood flow to an organ

24. What is the leading cause of death in the US?
Left -->right
Inability to maintain systemic pressure w/lack of O2 to vital organs
Ischemic heart disease
Hypertrophic cardiomyopathy

25. How does hypertension cause LHF?

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26. Myofiber hypertrophy with disarray.
Ventricular arrhythmia
Dark discoloration coagulative necrosis
Hypertrophic cardiomyopathy
Limits thrombosis

27. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
2-3%
Turner syndrome
RBC damaged while crossing the calcified valve causing schistocytes

28. When does the heart have a yellow pallor post MI?
Day 1-7
Left -->right
CK- MB
Prophylactic abx during dental procedures

29. What does chronic ischemic heart disease progress to?
20 min
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Thickening of chrodae tendinae and cusps - mitral stenosis
CHF

30. What is the only Jones criteria that doesn't resolve with time?
Increased hydrostatic pressure
Systemic venous congestion
Pancarditis
Bacterial endocarditis

31. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Stable angina
Reperfusion injury
Fibrinous pericarditis

32. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Autoimmune pericarditis 6-8 wks post MI
Dense layer of elastic and fibrotic tissue in the endocardium - children
Circumflex
Prinzmetal angina

33. What does rupture of a papillary muscle cause?
Squatting - increased systemic resistence decreases LV emptying
Mitral insufficiency
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Coexisting mitral stenosis and fusion of commisures exist

34. What are the sx of PDA at birth?
Coexisting mitral stenosis and fusion of commisures exist
Prinzmetal stable and unstable
Asymptomatic
ST- segment depression

35. What is the most common cause of dilated cardiomyopathy? What are other causes?
Left -->right
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Infectious endocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

36. What causes wear and tear aortic stenosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Asymptomatic
Fibrosis and dystrophic calcification
Increased hydrostatic pressure

37. What are the forward and backward sx of LHF?
Holosystolic blowing murmur
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
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Thickening of chrodae tendinae and cusps - mitral stenosis

38. What causes endocarditis of prosthetic valves?
Blood vessels coming in from normal tissue
S epidermidis
Months out fibrosis
Tetralogy of fallot

39. Lower extremity cyanosis later in life - holostystolic machine like murmur.
LHF
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
>60 years - bicuspid aortic valve
PDA

40. Friction rub and chest pain.
Systolic dysfx leading to biventricular CHF
Pericarditits
Mitral valve prolapse
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

41. What causes angina and syncope in aortic stenosis?

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42. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Heart can't fill
Nitroglycerin
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
45%

43. Dilated cardiomyopathy is a late complication of what illness?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Blood vessels coming in from normal tissue
Myocarditis

44. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Holosystolic machine like murmur
Ehlers - Danlow and Marfan syndrome
Harmartoma

45. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Gelatinous - abundant ground substance
Bounding pulse
Doxorubicin - cocaine

46. What increases the volume of mitral regurg murmur?
Loeffler syndrome
Months out fibrosis
Dark discoloration coagulative necrosis
Squatting - expiration

47. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Libman - Sacks endocarditis
Anitschow cell
Tuberous sclerosis

48. What is a Quincke pulse?
Coronary artery vasospasm - emboli - vasculitis
Transesophageal echo
Pulsating nail bed
Aortic regurg

49. Which angina(s) show ST elevation on EKG? ST depression?
Inability to fill ventricles
4-7 days macrophage infiltration
Prinzmetal stable and unstable
Mitral mitral+aortic

50. What type of shunt does truncus arteriosus cause?
2-3 weeks
Streptococcus viridans
Loss of LV fx
R-->L