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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 characterizes acute rheumatic fever endocarditiis?
Rhabdomyoma
Membrane damage
Wear and tear
Small vegetations along the line of closure

2. What is the most common cause of aortic stenosis?
Nonspecific - eg fever and elevated ESR
Wear and tear
RCA
Streptococcus bovis/

3. What type of shunt does ASD cause?
Left -->right
Endocarditis of prosthetic valves
Nonspecific - eg fever and elevated ESR
Mitral regurg

4. What is the rate of congenital heart defects?
Decreases LV dilation by decreasing volume
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1%
Loeffler syndrome

5. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Decrease in blood flow to an organ
Fibrinous pericarditis
Regurg vs stenosis

6. Which congenital heart defect is associated with maternal diabetes?
Ostium secundum (90%)
Dilation of all four chambers of the heart
Transposition of the great vessels
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

7. What is the basic principle of CHF?
Volume overload and LHF
Infectious
Pump failure
Bacterial endocarditis

8. Which vasculitis can cause MI?
Myocardium
Kawasaki disease
Day 1-7
Left -->right

9. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Volume overload and LHF
Valve replacement
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

10. How does contraction band necrosis occur?
3-8 wks
Cardiac tamponade
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Intercostal arteries enlarged due to collateral circulation

11. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Prophylactic abx during dental procedures
Open blocked vessels
Loss of LV fx

12. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Holosystolic machine like murmur
Degree of pulmonary artery stenosis
Prinzmetal angina
Harmartoma

13. What bug causes acute rheumatic fever?
Transesophageal echo
Heart transplant
Group A beta - hemolytic streptococci
Left -->right

14. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
ACE inhibitor
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
LHF

15. What causes the nutmeg color in nutmeg liver?
Congested central veins
PDA
Membrane damage
Prinzmetal angina - cocaine

16. What is the effect of mitral regurg on the heart?
Hypertophy of RV atrophy of LV
Volume overload and LHF
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
Valve replacement AFTER the onset of complications

17. What causes mitral valve prolapse?
Turner syndrome
S viridans
Myxoid degeneration
Bacterial endocarditis

18. How do you prevent S viridans endocarditis?
Dilation of all four chambers of the heart
Plump fibroblasts - collagen - blood vessels
Right to left
Prophylactic abx during dental procedures

19. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Prinzmetal angina - cocaine
MI
Contraction band necrosis
Systolic ejection click followed by crescendo - decrescendo murmur

20. In what pt population does S aureus commonly cause valvular disease?
Group A beta - hemolytic streptococci
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
IV drug users
LA

21. How does ischemia cause LHF?
Bounding pulse
Loss of fx
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
LV dilation and eccentric hypertrophy

22. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA
Anterior wall of LV and anterior septum

23. What complications occur 4-7 days post MI?
Increased hydrostatic pressure
Rupture of free wall - IV septum - or papillary muscle
Mitral valve prolapse
Hypercoagulable state or underlying adenocarcinoma

24. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Right -->left
Chronic ischemic heart disease
Nitroglycerin

25. What is Dressler syndrome? When does it occur?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Mitral regurgitation due to vegetations
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Autoimmune pericarditis 6-8 wks post MI

26. How do nitrates tx MI?
Systolic dysfx leading to biventricular CHF
Backward LHF pulm htn and RHF - afib and associated mural thombis
Decrease preload -->lowers myocardial stress
Hemosiderin laden macrophages

27. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Increased blood in right heart delays closure of P valve
Loeffler syndrome
Valve replacement

28. When does the heart have a yellow pallor post MI?
Day 1-7
S aureus
2-4 hours - 24 hours - 7-10 days
Endocarditis of prosthetic valves

29. What shunt does tetralogy of fallot produce?
Infantile coarctation of the aorta PDA
Right -->left
Transposition of the great vessels
Type I

30. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LA
Stable and unstable prinzmetal
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

31. What is the most common cause of death during the acute phase of rheumatic fever?
PDA
Mitral valve prolapse
Myocarditis
4-6 hours - 24 hours - 72 hours

32. With what condition are rhabdomyomas associated?
Endocardial fibroelastosis (rare)
Red border granulation tissue
Tuberous sclerosis
Backward LHF pulm htn and RHF - afib and associated mural thombis

33. What % stenosis causes stable angina?
Heart can't fill
Coronary artery vasospasm
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
>70%

34. What is the most common type of ASD? What %?
White scar fibrosis
Ostium secundum (90%)
Congested central veins
Degree of pulmonary artery stenosis

35. What murmur ccan be heard in PDA?
Valve replacement AFTER the onset of complications
Heart transplant
45%
Holosystolic machine like murmur

36. What is the most common type of endocarditis?
RHF
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Infectious
Stable and unstable prinzmetal

37. What iis the tx for aortic regurg?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Valve replacement once LV dysfx develops
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Concentric LV hypertophy

38. How long after pharyngitis does acute rheumatic fever occur?
ASD - R-->L
Membrane damage
Bounding pulse
2-3 weeks

39. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Spontaneous
Shunt - PGE to maintain PDA until surgical repair can be performed
Coronary artery vasospasm - emboli - vasculitis

40. When do macrophagess infiltrate the myocardium post MI?
4-7 days
1-3 days out
Restrictive cardiomyopathy
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

41. What is a common complication of cardiac metastasis?
Chest pain <20 min brought on by exertion or emotional stress
Pericardial effusion due to pericardial involvement
Mitral regurg
Day 1-7

42. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Concentric LV hypertophy
Atherosclerosis of coronary arteries
Infectious

43. How does reperfusion injury occur?
S aureus
Coronary artery vasospasm - emboli - vasculitis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Mitral regurg

44. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Prinzmetal
Degree of pulmonary artery stenosis
Minimizes ischemia
Nonbacterial thrombotic endocarditis (marantic endocarditis)

45. What cardiac disease is associated with tuberous sclerosis?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Rhabdomyoma
Squatting - expiration
Doxorubicin - cocaine

46. Why would cardiac enzymes continue to increase after the initial MI?
Minimizes ischemia
Reperfusion injury
Group A beta - hemolytic streptococci
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

47. What increases the risk for chronic rheumatic heart disease?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Pulsating nail bed

48. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Concentric LV hypertophy
Prinzmetal angina
Stretched muscle loses contractility

49. What congenital heart defect is associated with fetal alcohol syndrome?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
VSD
Myxoid degeneration
Thickening of chrodae tendinae and cusps - mitral stenosis

50. What % of MIs involve the LAD?
Within the first day
Coronary artery vasospasm
45%
Thickening of chrodae tendinae and cusps - mitral stenosis