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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. Friction rub and chest pain.
Plump fibroblasts - collagen - blood vessels
Pericarditits
LV dilation and eccentric hypertrophy
Harmartoma

2. Holosystolic blowing murmur that increases w/expiration?
Cardiac tamponade
Mitral regurg
Tuberous sclerosis
Louder - increased systemic resistence decreases LV emptying

3. What are the sx of right - to - left shunt?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Cyanosis - RV hypertrophy - polycythemia - clubbing
Papillary muscle - free wall - IV septum
4-24 hours

4. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Sterile vegetations on surface and undersurface on mitral valve
20 min
Decrease preload -->lowers myocardial stress
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

5. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Bacterial endocarditis
Blood vessels coming in from normal tissue
Decreases LV dilation by decreasing volume

6. What is the only Jones criteria that doesn't resolve with time?
Libman - Sacks endocarditis
Coronary artery vasospasm
RCA
Pancarditis

7. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Congestive heart failure
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Systemic venous congestion

8. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
First 4 hours
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Decrease preload -->lowers myocardial stress

9. Is scar tissue or myocardium stronger?
Limits thrombosis
Myocardium
Trisomy 21
Yellow pallor neutrophils

10. Ostium primum ASD is associated with what congenital disorder?
Autoimmune pericarditis 6-8 wks post MI
Trisomy 21
Pericardial effusion due to pericardial involvement
PGE

11. What type of ischemia does stable angina cause?
Subendocardial
Breast and lung carcinoma - melanoma - lymphoma
Split S2 on auscultation
Prinzmetal angina - cocaine

12. What is the gold standard blood marker for MI?
Reperfusion injury
Sterile vegetations on surface and undersurface on mitral valve
Opening snap followed by diastolic rumble
Troponin I

13. What is the tx for LHF?
Inability to fill ventricles
ACE inhibitor
Aneurysm - mural thrombus - Dressler syndrome
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

14. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Breast and lung carcinoma - melanoma - lymphoma
Libman - Sacks endocarditis
Colon cancer
Nonbacterial thrombotic endocarditis (marantic endocarditis)

15. Which vasculitis can cause MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Kawasaki disease
Prinzmetal
IV drug users

16. What effect does aortic stenosis have on the chambers of the heart?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Prinzmetal stable and unstable
Concentric LV hypertophy
Type I

17. What is systolic dysfx?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Coronary artery vasospasm - emboli - vasculitis
Ventricles cannot pump
Heart can't fill

18. What causes angina and syncope in aortic stenosis?

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19. When is an MI patent at highest risk for fibrionous pericarditis?
PDA
Ventricles cannot pump
Red border granulation tissue
1-3 days out

20. Myofiber hypertrophy with disarray.
Endocarditis of prosthetic valves
Sudden cardiac death
Hypertrophic cardiomyopathy
VSD

21. What gross and microscopic changes occur 4-7 days after an MI?
Prinzmetal angina - cocaine
Yellow pallor macrophages
Systolic dysfx leading to biventricular CHF
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

22. Opening snap followed by diastolic rumble.
Mitral stenosis
Kawasaki disease
Annular - non pruritic rash w/erythematous borders trunks and limbs
Ventricles cannot pump

23. What creates the immune reaction in acute rhuematic fever?

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24. Are most congenital heart defects spontaneous or inherited?
Spontaneous
Prinzmetal angina - cocaine
Mid - systolic click followed by regurgitation murmur
Trisomy 21

25. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Hemosiderin laden macrophages
Myxoma - benign

26. Erythematous nontender lesions on palms and soles.
Janeway lesions
Tuberous sclerosis
Right to left
Bicuspid aortic valve

27. What are the sx of aortic regurg?
Tender lesions on fingers or toes.
ACE inhibitor
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Reperfusion injury

28. What causes notching of the ribs in adult coarctation of the aorta?
Restrictive cardiomyopathy
Intercostal arteries enlarged due to collateral circulation
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Bacterial endocarditis

29. What is a common complication of cardiac metastasis?
Infectious endocarditis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Pericardial effusion due to pericardial involvement
Libman - Sacks endocarditis

30. How do you prevent S viridans endocarditis?
Stable angina
Prophylactic abx during dental procedures
Dilation of all four chambers of the heart
Small - nondestructive vegetations (subacute endocarditis)

31. What are the complications that occur months after an MI?
4-7 days
IV drug users
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Aneurysm - mural thrombus - Dressler syndrome

32. How does dilated cardiomyopathy cause LHF?
Reperfusion injury
VSD
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Stretched muscle loses contractility

33. How does squating decrease hypoxemia in tetralogy of fallot?
LAD
Mid - systolic click followed by regurgitation murmur
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

34. What are the laboratory findings of bacterial endocarditis?
Ostium secundum (90%)
Anterior wall of LV and anterior septum
Pump failure
Positive blood cultures anemia of chronic disease

35. What compensatory mechanism do tetralogy of fallot pts learn?
Stable and unstable prinzmetal
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Squat in response to cyanotic spell
ST- segment elevation

36. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Troponin I
LHF
Day 1-7

37. What congenital heart defect presents later in life with lower extremity cyanosis?
Large - destructive vegetations
PDA
Left -->right
Mitral regurg

38. How does Eisenmeger syndrome occur?
Valve scarring that arises as a consequence of rheumatic fever
Loss of fx
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
Friction rub and chest pain

39. What does chronic ischemic heart disease progress to?
CHF
Valve scarring that arises as a consequence of rheumatic fever
Months out fibrosis
Infantile coarctation of the aorta

40. What tests show prior group A beta - hemolytic strep infection?
Endocardial fibroelastosis (rare)
Elevated ASO anti - DNase B titers
LHF
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

41. In what pt population does S aureus commonly cause valvular disease?
LA
Troponin I
Dark discoloration coagulative necrosis
IV drug users

42. What heart sound manifest with an ASD?
Preductal - post aortic arch
Split S2 on auscultation
Heart transplant
Membrane damage

43. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Preductal - post aortic arch
Erythematous nontender lesions on palms and soles.
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

44. What is the cause of the red border around granulation tissue?
LA
Systolic dysfx leading to biventricular CHF
Blood vessels coming in from normal tissue
Transesophageal echo

45. How do nitrates tx MI?
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
Valve replacement AFTER the onset of complications
Autoimmune pericarditis 6-8 wks post MI
Decrease preload -->lowers myocardial stress

46. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Transesophageal echo
Degree of pulmonary artery stenosis
LHF
Aortic regurg

47. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Inability to fill ventricles
VSD
Aschoff bodies

48. What causes unstable angina?
Ostium primum
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
L->R
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

49. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Endocardial fibroelastosis
Stable angina
Myxoma - benign
Shunt

50. Which angina is relieved by Ca channel blockers?
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
S aureus
Prinzmetal
Valve replacement once LV dysfx develops