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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. How does hypertension cause LHF?

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2. What are heart failure cells?
Migratory polyarthritis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral mitral+aortic
Hemosiderin laden macrophages

3. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Cardiogenic shock - CHF - arrhythmia
Aortic regurg
MI
Stable and unstable prinzmetal

4. What valves are involved in rhuematic endocarditis?
Aortic regurg
Intercostal arteries enlarged due to collateral circulation
Mitral mitral+aortic
Spontaneous

5. What is the major cause of MI?
AD mutation in sarcomere proteins
Mitral regurgitation due to vegetations
CHF
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

6. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Right to left

7. What determines the extent of shunting and cyanosis in tetralogy of fallot?
1%
45%
Pump failure
Degree of pulmonary artery stenosis

8. What does rupture of the LV free wall cause?
Cardiac tamponade
Mitral mitral+aortic
2-3 weeks
LA dilation

9. What is the most common cause of infectious endocarditis?
Mitral insufficiency
Dense layer of elastic and fibrotic tissue in the endocardium - children
Streptococcus viridans
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

10. How does fibrinolysis/angioplasty tx MI?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Open blocked vessels
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Spontaneous

11. What heart sound manifest with an ASD?
Split S2 on auscultation
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Chronic rheumatic heart disease
Months out fibrosis

12. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
1-3 days out
Left -->right
Small - nondestructive vegetations (subacute endocarditis)

13. What are the sx of right - to - left shunt?
LV dilation and eccentric hypertrophy
Cyanosis - RV hypertrophy - polycythemia - clubbing
RCA
1-3 days

14. When do troponin levels rise - peak - and return to normal?
Increased blood in right heart delays closure of P valve
Harmartoma
Membrane damage
2-4 hours - 24 hours - 7-10 days

15. What congenital heart defect is associated with fetal alcohol syndrome?
Infectious endocarditis
Myocarditis
Holosystolic blowing murmur
VSD

16. What always follows necrosis?
Heart transplant
Right to left
Acute inflammation
Louder - increased systemic resistence decreases LV emptying

17. How do you prevent S viridans endocarditis?
Mitral regurg
Rhabdomyoma
Prophylactic abx during dental procedures
Mitral stenosis

18. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Anterior wall of LV and anterior septum
Transesophageal echo
Granulation tissue

19. What imaging test is useful for detecting lesions on valves?
Opening snap followed by diastolic rumble
Reactive histiocyte with caterpillar nucleus
Transesophageal echo
Sterile vegetations on mitral valve along lines of closure

20. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Hypertrophic cardiomyopathy
Sudden cardiac death
Reperfusion injury
2-3 weeks

21. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
S epidermidis
Anitschow cell
Mitral insufficiency

22. In which chamber of the heart are rhabdomyomas found?
Ventricle
Reperfusion injury
PGE
Decrease in blood flow to an organ

23. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Loss of LV fx
Bacterial endocarditis
Myocardium

24. How does restrictive cardiomyopathy cause LHF?

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25. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Mid - systolic click followed by regurgitation murmur
Yellow pallor macrophages
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

26. What is the most common cause of dilated cardiomyopathy? What are other causes?
Nitroglycerin
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
4-7 days macrophage infiltration
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

27. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Infectious
>60 years - bicuspid aortic valve
Tuberous sclerosis

28. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Inability to maintain systemic pressure w/lack of O2 to vital organs
ASD - R-->L

29. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
Infectious endocarditis
Troponin I
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

30. With what endocarditis is S epidermidis associated?
Myocarditis in acute rheumatic heart fever
Endocarditis of prosthetic valves
Small vegetations along the line of closure
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

31. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Mitral mitral+aortic
Dressler syndrome
Doxorubicin - cocaine

32. Sudden death in a young athlete.
S aureus
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Hypertrophic cardiomyopathy
Yellow pallor neutrophils

33. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
When a bacterial protein resembles a protein in human tissue
R-->L
Circumflex

34. What causes a mid - systolic click followed by a regurgitation murmur?
Endocardial fibroelastosis (rare)
Infectious endocarditis
Mitral valve prolapse
Osler nodes (ouch - ouch Osler)

35. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Low voltage EKG w/diminished QRS amplitude
Systolic dysfx leading to biventricular CHF
Pts w/previously damaged valves
Loeffler syndrome

36. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Prophylactic abx during dental procedures
R-->L
Coexisting mitral stenosis and fusion of commisures exist
Mitral and tricuspid regurg - arrhythmia

37. What is the cause of the red border around granulation tissue?
Months out fibrosis
CK- MB
Blood vessels coming in from normal tissue
Hypertophy of RV atrophy of LV

38. What drugs can cause dilated cardiomyopathy?
Type I
Right -->left
Doxorubicin - cocaine
Opening snap followed by diastolic rumble

39. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral mitral+aortic
Decrease in blood flow to an organ

40. What generally causes ischemic heart disease?
VSD
Atherosclerosis of coronary arteries
Low voltage EKG w/diminished QRS amplitude
Adult coarctation of the aorta

41. What are Janeway lesions?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Myocardium
20 min
Erythematous nontender lesions on palms and soles.

42. What causes angina and syncope in aortic stenosis?

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43. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
ST- segment depression
Ventricle
Mitral regurgitation due to vegetations

44. What is the most common congenital heart defect?
Breast and lung carcinoma - melanoma - lymphoma
2-4 hours - 24 hours - 7-10 days
VSD
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

45. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Louder - increased systemic resistence decreases LV emptying
Loss of fx
Decrease in blood flow to an organ

46. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Cardiogenic shock - CHF - arrhythmia
Louder - increased systemic resistence decreases LV emptying
Valve replacement once LV dysfx develops

47. What is the definition of ischemia?
Decrease in blood flow to an organ
Aortic regurg
Large vegetations of S aureus
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

48. What causes endocarditis of prosthetic valves?
S epidermidis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Pts w/previously damaged valves
Endocardial fibroelastosis

49. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
ST- segment elevation
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Low voltage EKG w/diminished QRS amplitude

50. What is the leading cause of death in the US?
Plump fibroblasts - collagen - blood vessels
Infectious endocarditis
ST- segment elevation
Ischemic heart disease