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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 aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Prinzmetal
Aneurysm - mural thrombus - Dressler syndrome
Stable angina

2. What causes the dependent pitting edema in RHF?
Right to left
Right -->left
Increased hydrostatic pressure
Wear and tear

3. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic 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
Bacterial endocarditis
NG or Ca channel blocker
Heart can't fill

4. When do troponin levels rise - peak - and return to normal?
LAD
Migratory polyarthritis
Circumflex
2-4 hours - 24 hours - 7-10 days

5. What is dilated cardiomyopathy?
Spontaneous
Rhabdomyoma
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Dilation of all four chambers of the heart

6. What is the most common tumor of the heart?
LAD
Increased hydrostatic pressure
Metastasis
Inability to fill ventricles

7. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
ASD - R-->L
Valve replacement once LV dysfx develops
Mid - systolic click followed by regurgitation murmur

8. What does rupture of a papillary muscle cause?
Mitral insufficiency
CK- MB
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Atherosclerosis of coronary arteries

9. How does ischemia cause LHF?
Preductal - post aortic arch
Loss of fx
Small vegetations along the line of closure
Annular - non pruritic rash w/erythematous borders trunks and limbs

10. Low voltage EKG w/diminished QRS amplitude.
Sterile vegetations on mitral valve along lines of closure
Restrictive cardiomyopathy
Bicuspid aortic valve
Aneurysm - mural thrombus - Dressler syndrome

11. What shunt does tetralogy of fallot produce?
Right -->left
Nonspecific - eg fever and elevated ESR
When a bacterial protein resembles a protein in human tissue
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

12. Which artery is most often occluded in an MI?
Group A beta - hemolytic streptococci
Decrease preload -->lowers myocardial stress
Infectious endocarditis - arrythmias - severe mitral regurg no
LAD

13. What does Libman - Sacks endocarditis cause?
Mitral regurg
1-3 days out
Split S2 on auscultation
Harmartoma

14. What is the basic principle of CHF?
Infantile coarctation of the aorta
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Limits thrombosis
Pump failure

15. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Louder - increased systemic resistence decreases LV emptying
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rhabdomyoma

16. What is the gross and microscopic appearance of cardiac myxomas?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Intercostal arteries enlarged due to collateral circulation
Gelatinous - abundant ground substance
Fibrosis and dystrophic calcification

17. What side of the heart do carcinoid tumors affect? Why?
Decreased forward perfusion pulmonary congestion
CHF
Right side - serotonin and other secretory products detoxified in the lung
Elevated ASO anti - DNase B titers

18. What are the forward and backward sx of LHF?
Small - nondestructive vegetations (subacute endocarditis)
ST- segment depression
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
Ventricles cannot pump

19. Turner syndrome is associated with which congenital heart defect?
Group A beta - hemolytic streptococci
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S viridans
Infantile coarctation of the aorta

20. What type of vegetations does Strep viridans cause?
Subendocardial
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Small - nondestructive vegetations (subacute endocarditis)
Decreased forward perfusion pulmonary congestion

21. How does hypertension cause LHF?

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22. With what disease is transposition of the great vessels associated?
Maternal diabetes
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Elevated ASO anti - DNase B titers

23. What drug relieves stable angina?
White scar fibrosis
Reactive histiocyte with caterpillar nucleus
Blood vessels coming in from normal tissue
Nitroglycerin

24. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Transesophageal echo
Aschoff bodies
Mitral valve prolapse
Squatting - increased systemic resistence decreases LV emptying

25. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Ventricle
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Large - destructive vegetations

26. What generally causes ischemic heart disease?
RCA
Atherosclerosis of coronary arteries
LA
Chronic rheumatic heart disease

27. Holosystolic blowing murmur that increases w/expiration?
Fetal alcohol syndrome
Aneurysm - mural thrombus - Dressler syndrome
Ventricles cannot pump
Mitral regurg

28. Which vasculitis can cause MI?
Right side - serotonin and other secretory products detoxified in the lung
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S aureus
Kawasaki disease

29. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Ventricular arrhythmia
ACE inhibitor
Ischemic heart disease

30. What heart sound manifest with an ASD?
Turner syndrome
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
Rhadbomyoma - benign
Split S2 on auscultation

31. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Myocarditis
Cardiogenic shock - CHF - arrhythmia
Adult coarctation of the aorta
Right -->left

32. In what pt population does S aureus commonly cause valvular disease?
Boot shaped heart
IV drug users
Sudden cardiac death
Aschoff bodies

33. How does reperfusion injury occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Sterile vegetations on mitral valve along lines of closure
Thickening of chrodae tendinae and cusps - mitral stenosis

34. 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.
Holosystolic blowing murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
RBC damaged while crossing the calcified valve causing schistocytes
Stable angina

35. How does restrictive cardiomyopathy present?
Prinzmetal stable and unstable
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
Congestive heart failure
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

36. What causes acute endocarditis?
Large vegetations of S aureus
AD mutation in sarcomere proteins
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Right -->left

37. What are the major criteria of the Jones criteria?
>70%
RCA
Coronary artery vasospasm - emboli - vasculitis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

38. What is the characteristic murmur of aortic stenosis?
Holosystolic machine like murmur
Systolic ejection click followed by crescendo - decrescendo murmur
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myocarditis in acute rheumatic heart fever

39. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
RCA
Infectious endocarditis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

40. In which chamber of the heart are rhabdomyomas found?
Aschoff bodies
Autoimmune pericarditis 6-8 wks post MI
Ventricle
Infantile coarctation of the aorta PDA

41. What type of shunt dose PDA cause?
Pump failure
Months out fibrosis
S epidermidis
Left -->right

42. What is systolic dysfx?
Nitroglycerin
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Ventricles cannot pump
Streptococcus viridans

43. What complications occur 4-7 days post MI?
Low voltage EKG w/diminished QRS amplitude
LAD
Rupture of free wall - IV septum - or papillary muscle
ST- segment depression

44. How does aortic regurg affect the heart chambers?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
LV dilation and eccentric hypertrophy
Tuberous sclerosis

45. What are the sx of aortic regurg?
Congestive heart failure
Hypertophy of RV atrophy of LV
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
PDA

46. Opening snap followed by diastolic rumble.
Ischemic heart disease
Dark discoloration coagulative necrosis
Mitral stenosis
Circumflex

47. What does a biopsy of hypertrophic cardiomyopathy look like?
Loeffler syndrome
Sterile vegetations on surface and undersurface on mitral valve
Small vegetations along the line of closure
Myofiber hypertrophy with disarray

48. What are the clinical features of RHF?
ST- segment elevation
Split S2 on auscultation
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

49. What are the tx for MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Tricuspid
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Congenital rubella

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

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