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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 artery is the 2nd most often occluded in an MI?
Prinzmetal angina
RCA
Nonspecific - eg fever and elevated ESR
Pancarditis

2. Erythematous nontender lesions on palms and soles.
Squatting - increased systemic resistence decreases LV emptying
L->R
LV dilation and eccentric hypertrophy
Janeway lesions

3. What type of shunt results in cyanosis at birth?
Right to left
>60 years - bicuspid aortic valve
Inability to fill ventricles
LV dilation and eccentric hypertrophy

4. How does subendocardial MI/ischemia present on EKG?
Prinzmetal stable and unstable
ST- segment depression
LA
4-7 days

5. What makes the MV prolapse murmur louder? Why?
Holosystolic blowing murmur
Squatting - increased systemic resistence decreases LV emptying
Right -->left
Ventricle

6. What generally causes ischemic heart disease?
Colon cancer
1-3 days
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Atherosclerosis of coronary arteries

7. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
CHF
R-->L
Migratory polyarthritis
Doxorubicin - cocaine

8. What drugs can cause dilated cardiomyopathy?
Transposition of the great vessels
LA
Minimizes ischemia
Doxorubicin - cocaine

9. How does squating decrease hypoxemia in tetralogy of fallot?
Stretched muscle loses contractility
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Bacterial endocarditis

10. What maintains patency of the PDA?
Turner syndrome
Bounding pulse
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
PGE

11. At what point in development do congenital heart defects arise?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
3-8 wks
White scar fibrosis

12. How does transmural MI/ischemia present on EKG?
Reperfusion injury
ST- segment elevation
LA dilation
Hypertophy of RV atrophy of LV

13. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Left -->right
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Louder - increased systemic resistence decreases LV emptying

14. What % of MIs involve the LAD?
IV drug users
45%
Myocardium
Holosystolic machine like murmur

15. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Dressler syndrome
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Coxsackie A or B

16. How does restrictive cardiomyopathy cause LHF?

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17. With what congenital heart defect is ADULT coarctation of the aorta associated?
Circumflex
Sudden cardiac death
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Bicuspid aortic valve

18. What tests show prior group A beta - hemolytic strep infection?
Decreases LV dilation by decreasing volume
Elevated ASO anti - DNase B titers
Transesophageal echo
20 min

19. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Systolic ejection click followed by crescendo - decrescendo murmur
Months out fibrosis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

20. What is cardiogenic shock?
Prinzmetal angina
Bacterial endocarditis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Decreased forward perfusion pulmonary congestion

21. In what pt population does S aureus commonly cause valvular disease?
Reperfusion injury
4-7 days
PDA
IV drug users

22. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Large - destructive vegetations
4-24 hours
Yellow pallor neutrophils
MI

23. In transposition of the great vessels - What is required for survival? How is this achieved?
Nitroglycerin
Pericardial effusion due to pericardial involvement
Shunt - PGE to maintain PDA until surgical repair can be performed
Fetal alcohol syndrome

24. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
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
Atherosclerosis of coronary arteries
Adult coarctation of the aorta
Coronary artery vasospasm

25. What is the rate of mitral valve prolapse in the US?
2-3%
Mitral regurg
>70%
Yellow pallor neutrophils

26. What are the complications of aortic stenosis?
PDA
Infantile coarctation of the aorta PDA
Yellow pallor neutrophils
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

27. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Libman - Sacks endocarditis
Paradoxical emboli
Dressler syndrome

28. What causes angina and syncope in aortic stenosis?

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29. EKG for stable angina?
When a bacterial protein resembles a protein in human tissue
Minimizes ischemia
ST- segment depression
Valve scarring that arises as a consequence of rheumatic fever

30. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Harmartoma
Contraction band necrosis - reperfusion injury
LHF
Chronic rheumatic heart disease

31. How do nitrates tx MI?
MI
Harmartoma
Decrease preload -->lowers myocardial stress
CK- MB

32. What shunt does tetralogy of fallot produce?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Migratory polyarthritis
Heart transplant
Right -->left

33. What is the cause of the red border around granulation tissue?
LHF
Blood vessels coming in from normal tissue
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

34. What heart sound manifest with an ASD?
1%
LAD
Split S2 on auscultation
Opening snap followed by diastolic rumble

35. How does Eisenmeger syndrome occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Rhadbomyoma - benign
Myofiber hypertrophy with disarray
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

36. How does adult coarctation of the aorta present?
PDA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Slow HR - decreasing O2 demand and risk for arrhythmia
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

37. With what disease is Libman - Sacks endocarditis associated?
SLE
ACE inhibitor
Fetal alcohol syndrome
Right to left

38. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
RHF
Stable and unstable prinzmetal
Chronic ischemic heart disease

39. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Subendocardial
Ostium primum
Colon cancer
S epidermidis

40. With what virus is PDA associated?
Congenital rubella
Concentric LV hypertophy
Congested central veins
Autoimmune pericarditis 6-8 wks post MI

41. Which coronary artery supplies the anterior wall and anterior septum?
Reversible
Systolic ejection click followed by crescendo - decrescendo murmur
Myofiber hypertrophy with disarray
LAD

42. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Breast and lung carcinoma - melanoma - lymphoma
When a bacterial protein resembles a protein in human tissue
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

43. What does nonbacterial thrombotic endocarditis cause?
Months out fibrosis
Mitral regurg
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
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

44. What structures are susceptible to rupture post MI?
Mitral and tricuspid regurg - arrhythmia
Papillary muscle - free wall - IV septum
RCA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

45. What coronary arterysupplies the lateral wall of the LV?
1-3 days
Tender lesions on fingers or toes.
Circumflex
Wear and tear

46. How does dilated cardiomyopathy cause LHF?
Doxorubicin - cocaine
Stretched muscle loses contractility
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Coxsackie A or B

47. What causes microangiopathic hemolytic anemia in aortic stenosis?
Ostium primum
Hypertrophic cardiomyopathy
Slow HR - decreasing O2 demand and risk for arrhythmia
RBC damaged while crossing the calcified valve causing schistocytes

48. How does O2 tx MI?
Minimizes ischemia
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Chronic ischemic heart disease
Slow HR - decreasing O2 demand and risk for arrhythmia

49. What is the most common type of endocarditis?
Concentric LV hypertophy
RCA
Infectious
Ischemic heart disease

50. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Minimizes ischemia
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture