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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. In what pt population does S aureus commonly cause valvular disease?
Volume overload and LHF
Ostium secundum (90%)
IV drug users
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

2. What causes endocarditis of prosthetic valves?
RBC damaged while crossing the calcified valve causing schistocytes
ASD - R-->L
SLE
S epidermidis

3. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
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
IV drug users
4-7 days

4. What two things happen when a blocked vessel is opened after an MI?
Streptococcus viridans
LV dilation and eccentric hypertrophy
Posterior wall of LV - posterior septum - papillary muscles
Contraction band necrosis - reperfusion injury

5. Large vegetations on tricuspid valve?
Dilation of all four chambers of the heart
Maternal diabetes
S aureus
Mitral regurg

6. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Day 1-7
Cardiogenic shock - CHF - arrhythmia
Shunt

7. What cardiac enzyme is useful for detecting reinfarction?
Decreased forward perfusion pulmonary congestion
CK- MB
Harmartoma
Colon cancer

8. How does subendocardial MI/ischemia present on EKG?
Months out fibrosis
Open blocked vessels
Loss of fx
ST- segment depression

9. How do ACE inhibitors tx MI?
Right to left
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Decreases LV dilation by decreasing volume
Volume overload and LHF

10. How does aortic regurg affect the heart chambers?
Metastasis
LV dilation and eccentric hypertrophy
Ventricular arrhythmia
Systemic venous congestion

11. With what virus is PDA associated?
Pts w/previously damaged valves
Congenital rubella
Nitroglycerin
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

12. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
VSD
Rhabdomyoma
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

13. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Doxorubicin - cocaine
Mitral regurg
Pericarditits

14. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Infectious endocarditis - arrythmias - severe mitral regurg no
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
VSD

15. Tender lesions on fingers or toes.
Hemosiderin laden macrophages
Elevated ASO anti - DNase B titers
Stable and unstable prinzmetal
Osler nodes (ouch - ouch Osler)

16. What is the rate of congenital heart defects?
Granulation tissue
Bacterial endocarditis
1%
Pump failure

17. What does nonbacterial thrombotic endocarditis cause?
RCA
Sterile vegetations on surface and undersurface on mitral valve
Mitral regurg
LAD

18. What increases the volume of mitral regurg murmur?
Split S2 on auscultation
Squatting - expiration
Left -->right
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

19. What are the clinical features of LHF due to?
Asymptomatic
Decreased forward perfusion pulmonary congestion
Endocardial fibroelastosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. Opening snap followed by diastolic rumble.
Dilated
Left -->right
Mitral stenosis
Friction rub and chest pain

21. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Rhabdomyoma
Chronic rheumatic heart disease
Split S2 on auscultation

22. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
LAD
Infectious
4-6 hours - 24 hours - 72 hours

23. What type of endocarditis is associated with SLE?
Myocarditis
Libman - Sacks endocarditis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Valve replacement

24. What are the complications that occur months after an MI?
Within the first day
Transposition of the great vessels
Aneurysm - mural thrombus - Dressler syndrome
VSD

25. What are the laboratory findings of bacterial endocarditis?
Infectious endocarditis
45%
Endocardial fibroelastosis (rare)
Positive blood cultures anemia of chronic disease

26. What is the 1day-1wk -1mo mneumonic for MI?
Group A beta - hemolytic streptococci
RBC damaged while crossing the calcified valve causing schistocytes
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Slow HR - decreasing O2 demand and risk for arrhythmia

27. What causes mitral valve prolapse?
Myxoid degeneration
Myofiber hypertrophy with disarray
Limits thrombosis
Hypercoagulable state or underlying adenocarcinoma

28. What type of shunt does truncus arteriosus cause?
R-->L
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Holosystolic machine like murmur
Breast and lung carcinoma - melanoma - lymphoma

29. What is the rate of mitral valve prolapse in the US?
Prinzmetal
Mitral insufficiency
Group A beta - hemolytic streptococci
2-3%

30. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Valve replacement AFTER the onset of complications
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
S aureus

31. What is cardiogenic shock?
Limits thrombosis
Atria and RV
2-3 weeks
Inability to maintain systemic pressure w/lack of O2 to vital organs

32. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nitroglycerin
Gelatinous - abundant ground substance
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

33. What is a water - hammer pulse?
Aortic stenosis
Bounding pulse
Mitral mitral+aortic
Left -->right

34. What is the leading cause of death in the US?
Pump failure
Ischemic heart disease
Valve replacement AFTER the onset of complications
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

35. When does the heart have dark discoloration post MI?
Minimizes ischemia
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Congestive heart failure
4-24 hours

36. What is the most common type of endocarditis?
Minimizes ischemia
Atria and RV
Reversible
Infectious

37. What % of MIs involve the LAD?
LAD
Myofiber hypertrophy with disarray
45%
IV drug users

38. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Hemosiderin laden macrophages
Shunt
MI

39. What are the complications of mitral valve prolapse? Are they common?
Spontaneous
Day 1-7
Infectious endocarditis - arrythmias - severe mitral regurg no
Cardiac tamponade

40. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Kawasaki disease
Mitral valve prolapse
Sudden cardiac death
Positive blood cultures anemia of chronic disease

41. How does O2 tx MI?
Minimizes ischemia
Libman - Sacks endocarditis
Ostium secundum (90%)
Indomethacin - decreases PGE

42. Low voltage EKG w/diminished QRS amplitude.
Aortic regurg
Left -->right
When a bacterial protein resembles a protein in human tissue
Restrictive cardiomyopathy

43. What are the sx of cardiac myxoma?
Tuberous sclerosis
Restrictive cardiomyopathy
Right side - serotonin and other secretory products detoxified in the lung
Pedunculated mass in the LA that causes syncope due to obstruction of MV

44. What is molecular mimicry?
When a bacterial protein resembles a protein in human tissue
PGE
Ehlers - Danlow and Marfan syndrome
Ischemic heart disease

45. What are heart failure cells?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Hemosiderin laden macrophages
Valve replacement
Nitroglycerin

46. What congenital heart defect does indomethacin tx?
Holosystolic blowing murmur
PDA
Membrane damage
4-7 days

47. How does ischemia cause LHF?
2-3 weeks
Infectious endocarditis
Loss of fx
Prophylactic abx during dental procedures

48. How does restrictive cardiomyopathy present?
Squatting - increased systemic resistence decreases LV emptying
Small - nondestructive vegetations (subacute endocarditis)
Congestive heart failure
Colon cancer

49. What complication occurs 1-3 days post MI?
Stretched muscle loses contractility
Valve replacement once LV dysfx develops
Fibrinous pericarditis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

50. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Reactive histiocyte with caterpillar nucleus
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Migratory polyarthritis
Subendocardial