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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 causes mitral valve prolapse?
Doxorubicin - cocaine
Myxoid degeneration
ST- segment depression
Sterile vegetations on surface and undersurface on mitral valve

2. What are the sx of hypertrophic cardiomyopathy?
Hypertophy of RV atrophy of LV
20 min
Acute inflammation
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

3. With what developmental disorder is VSD associated?
Prophylactic abx during dental procedures
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rupture of free wall - IV septum - or papillary muscle
Fetal alcohol syndrome

4. What are Janeway lesions?
Endocardial fibroelastosis
Erythematous nontender lesions on palms and soles.
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
White scar fibrosis

5. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Right to left
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
Congestive heart failure

6. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Decrease in blood flow to an organ
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aschoff bodies
Fetal alcohol syndrome

7. What congenital heart defect is associated with fetal alcohol syndrome?
Squatting - increased systemic resistence decreases LV emptying
VSD
Myocarditis
Concentric LV hypertophy

8. What conditions can cause nonbacterial thrombotic endocarditis?
2-3 weeks
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Hypercoagulable state or underlying adenocarcinoma
Myocarditis

9. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Ventricular arrhythmia
Nitroglycerin
Ischemic heart disease
Inability to maintain systemic pressure w/lack of O2 to vital organs

10. What is the etiology of S viridans endocarditis?
3-8 wks
Posterior wall of LV - posterior septum - papillary muscles
Shunt
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

11. What is endocardial fibroelastosis? In what population is it found?
Mitral and tricuspid regurg - arrhythmia
Dense layer of elastic and fibrotic tissue in the endocardium - children
Type I
Volume overload and LHF

12. What causes prinzmetal angina?
Chronic ischemic heart disease
When a bacterial protein resembles a protein in human tissue
Coronary artery vasospasm
Ventricle

13. What is the murmur of mitral regurg?
Contraction band necrosis - reperfusion injury
Months out fibrosis
MI
Holosystolic blowing murmur

14. What is Dressler syndrome? When does it occur?
CHF
Regurg vs stenosis
Autoimmune pericarditis 6-8 wks post MI
RHF

15. What areas of the heart does the LAD supply?
2-3 weeks
Endocardial fibroelastosis (rare)
Congested central veins
Anterior wall of LV and anterior septum

16. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
L->R
4-6 hours - 24 hours - 72 hours
Bacterial endocarditis

17. What causes unstable angina?
Doxorubicin - cocaine
Pericardial effusion due to pericardial involvement
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
S epidermidis

18. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Prinzmetal angina
Squatting - expiration
Aortic regurg
Autoimmune pericarditis 6-8 wks post MI

19. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Infectious endocarditis - arrythmias - severe mitral regurg no
Bacterial endocarditis
LA
Aortic stenosis

20. What is the most common cause of endocarditis in IV drug users?
Squat in response to cyanotic spell
S aureus
Dark discoloration coagulative necrosis
Asymptomatic

21. What is the tx for VSD?
ASD - R-->L
Coronary artery vasospasm - emboli - vasculitis
Surgical closure small defects may close spontaneously
Open blocked vessels

22. Dilated cardiomyopathy is a late complication of what illness?
Mitral mitral+aortic
Inability to maintain systemic pressure w/lack of O2 to vital organs
Myocarditis
Myxoma - benign

23. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
1-3 days
Aneurysm - mural thrombus - Dressler syndrome
Myxoid degeneration

24. What are other (not atherosclerotic) causes of MI?
Left -->right
Decrease in blood flow to an organ
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Coronary artery vasospasm - emboli - vasculitis

25. What are the sx of cardiac myxoma?
Fibrinous pericarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Asymptomatic
Dense layer of elastic and fibrotic tissue in the endocardium - children

26. With what condition are rhabdomyomas associated?
Infectious
Tuberous sclerosis
Ischemic heart disease
Myocarditis in acute rheumatic heart fever

27. What tests show prior group A beta - hemolytic strep infection?
Squat in response to cyanotic spell
Elevated ASO anti - DNase B titers
Ostium primum
Circumflex

28. What type of ischemia does stable angina cause?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Anitschow cell
Subendocardial
Chronic ischemic heart disease

29. What are the minor critera of the Jones criteria?
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
Ischemic heart disease
Nonspecific - eg fever and elevated ESR
Troponin I

30. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Nitroglycerin
Chronic ischemic heart disease
Rhadbomyoma - benign

31. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Papillary muscle - free wall - IV septum
PDA
Ventricles cannot pump
Aortic regurg

32. How does stable angina present?
Myxoma - benign
Chest pain <20 min brought on by exertion or emotional stress
Papillary muscle - free wall - IV septum
RBC damaged while crossing the calcified valve causing schistocytes

33. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Circumflex
>60 years - bicuspid aortic valve
Pulsating nail bed
Hypertophy of RV atrophy of LV

34. What is an important complication of ASD?
Paradoxical emboli
>60 years - bicuspid aortic valve
Gelatinous - abundant ground substance
Troponin I

35. What structures are susceptible to rupture post MI?
Nonspecific - eg fever and elevated ESR
Ostium primum
Breast and lung carcinoma - melanoma - lymphoma
Papillary muscle - free wall - IV septum

36. What complication occurs 1-3 days post MI?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Shunt
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Fibrinous pericarditis

37. What is the major cause of MI?
Troponin I
Bicuspid aortic valve
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Small vegetations along the line of closure

38. What type of shunt dose PDA cause?
PDA
Low voltage EKG w/diminished QRS amplitude
Left -->right
Open blocked vessels

39. Is scar tissue or myocardium stronger?
Posterior wall of LV - posterior septum - papillary muscles
Thickening of chrodae tendinae and cusps - mitral stenosis
Myocardium
Low voltage EKG w/diminished QRS amplitude

40. What complications occur 4-7 days post MI?
ACE inhibitor
Rupture of free wall - IV septum - or papillary muscle
Ventricles cannot pump
Cardiac tamponade

41. What is dilated cardiomyopathy?
Hypertrophic cardiomyopathy
Systolic ejection click followed by crescendo - decrescendo murmur
Dilation of all four chambers of the heart
Limits thrombosis

42. What is the most common cause of aortic stenosis?
When a bacterial protein resembles a protein in human tissue
Streptococcus viridans
PDA
Wear and tear

43. Holosystolic blowing murmur that increases w/expiration?
Elevated ASO anti - DNase B titers
Ostium secundum (90%)
Gelatinous - abundant ground substance
Mitral regurg

44. What type of tumor is a rhabdomyoma?
Infectious endocarditis - arrythmias - severe mitral regurg no
LA
Harmartoma
Adult coarctation of the aorta

45. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
1-3 days
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Ostium primum

46. What are the sx of aortic regurg?
Pericardial effusion due to pericardial involvement
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Libman - Sacks endocarditis

47. Dense layer of elastic and fibrotic tissue in the endocardium.
Mitral mitral+aortic
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small - nondestructive vegetations (subacute endocarditis)
Endocardial fibroelastosis

48. What is the most comon cause of aortic regurg? What are the other causes?
Eisenmenger syndrome
1-3 days out
Acute inflammation
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

49. Tender lesions on fingers or toes.
Mitral and tricuspid regurg - arrhythmia
Osler nodes (ouch - ouch Osler)
RCA
Loeffler syndrome

50. What causes wear and tear aortic stenosis?
Day 1-7
Fibrosis and dystrophic calcification
Fibrinous pericarditis
Mitral insufficiency