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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 is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Nonspecific - eg fever and elevated ESR
Holosystolic blowing murmur

2. What is the most common cause of aortic stenosis?
Pts w/previously damaged valves
ST- segment elevation
Wear and tear
Ventricular arrhythmia

3. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
>60 years - bicuspid aortic valve
20 min
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

4. What always follows necrosis?
Acute inflammation
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Small vegetations along the line of closure
Myofiber hypertrophy with disarray

5. What type of tumor is a rhabdomyoma?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal angina
Harmartoma
1-3 days out

6. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
CHF
RHF
Large vegetations of S aureus
Right side - serotonin and other secretory products detoxified in the lung

7. What are the two effects of ATII?
Holosystolic blowing murmur
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Decreased forward perfusion pulmonary congestion
Hypertrophic cardiomyopathy

8. What is the definition of ischemia?
Infantile coarctation of the aorta PDA
Decrease in blood flow to an organ
RCA
CK- MB

9. What causes wear and tear aortic stenosis?
Troponin I
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Fibrosis and dystrophic calcification
Erythematous nontender lesions on palms and soles.

10. What congenital heart defect is associated with fetal alcohol syndrome?
Valve scarring that arises as a consequence of rheumatic fever
Transesophageal echo
VSD
1-3 days out

11. Myofiber hypertrophy with disarray.
Stable angina
Cardiogenic shock - CHF - arrhythmia
Hypertrophic cardiomyopathy
Fibrosis and dystrophic calcification

12. What is the most common congenital heart defect?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
VSD
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Streptococcus viridans

13. What coronary artery supplies the mitral valve papillary muscles?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
RCA

14. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Congestive heart failure
Troponin I

15. What artery is the 2nd most often occluded in an MI?
Heart can't fill
Red border granulation tissue
RCA
PDA

16. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Sterile vegetations on surface and undersurface on mitral valve
Concentric LV hypertophy
Prinzmetal stable and unstable

17. How does Eisenmeger syndrome occur?
Stretched muscle loses contractility
Myocardium
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
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

18. What is the tx for VSD?
Shunt
Ventricles cannot pump
Infectious endocarditis
Surgical closure small defects may close spontaneously

19. What effect does mitral stenosis have on the heart chambers?
Tricuspid
Adult coarctation of the aorta
LA dilation
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Fibrinous pericarditis
Left -->right
Myxoid degeneration

21. Where is the coarctation in infantile coarctation of the aorta?
Mid - systolic click followed by regurgitation murmur
Nonspecific - eg fever and elevated ESR
4-24 hours
Preductal - post aortic arch

22. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Anitschow cell
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Cardiac tamponade

23. What imaging test is useful for detecting lesions on valves?
Myxoma - benign
Transesophageal echo
Mitral regurgitation due to vegetations
Trisomy 21

24. With what disease is transposition of the great vessels associated?
Janeway lesions
Maternal diabetes
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pulsating nail bed

25. Sudden death in a young athlete.
PDA
Congested central veins
RHF
Hypertrophic cardiomyopathy

26. How do you prevent S viridans endocarditis?
Gelatinous - abundant ground substance
Prophylactic abx during dental procedures
Chronic ischemic heart disease
Valve replacement

27. Systolic ejection click followed by crescendo - decrescendo murmur.
CK- MB
Breast and lung carcinoma - melanoma - lymphoma
2-3%
Aortic stenosis

28. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Small vegetations along the line of closure
Osler nodes (ouch - ouch Osler)
Hypertrophic cardiomyopathy

29. What is an Aschoff body?
Subendocardial
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Increased hydrostatic pressure
Pts w/previously damaged valves

30. What causes endocarditis of prosthetic valves?
Posterior wall of LV - posterior septum - papillary muscles
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Loss of fx
S epidermidis

31. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Mitral regurg
Trisomy 21
Months out fibrosis
4-7 days macrophage infiltration

32. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Membrane damage
Tetralogy of fallot
Limits thrombosis

33. What are the sx of PDA at birth?
Transesophageal echo
Asymptomatic
Bicuspid aortic valve
Congestive heart failure

34. How long after pharyngitis does acute rheumatic fever occur?
Mid - systolic click followed by regurgitation murmur
Hypertrophic cardiomyopathy
2-3 weeks
L->R

35. What is the murmur of mitral valve prolapse?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mid - systolic click followed by regurgitation murmur
Rhabdomyoma
ASD - R-->L

36. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
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
Tricuspid
Endocardial fibroelastosis (rare)

37. With what virus is PDA associated?
Day 1-7
RCA
Sterile vegetations on surface and undersurface on mitral valve
Congenital rubella

38. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
>70%
Tetralogy of fallot
Blood vessels coming in from normal tissue

39. What compensatory mechanism do tetralogy of fallot pts learn?
Inability to fill ventricles
Libman - Sacks endocarditis
4-6 hours - 24 hours - 72 hours
Squat in response to cyanotic spell

40. What are the complications of aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Fetal alcohol syndrome
Decreased forward perfusion pulmonary congestion
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

41. What are the complications of mitral stenosis?
Large vegetations of S aureus
Systolic ejection click followed by crescendo - decrescendo murmur
RBC damaged while crossing the calcified valve causing schistocytes
Backward LHF pulm htn and RHF - afib and associated mural thombis

42. What is the tx for aortic stenosis?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Valve replacement AFTER the onset of complications
Large - destructive vegetations
ASD - R-->L

43. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Mitral regurg
Myxoid degeneration

44. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
ASD - R-->L
Chronic rheumatic heart disease
Mitral mitral+aortic

45. How does restrictive cardiomyopathy cause LHF?

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46. What are the laboratory findings of bacterial endocarditis?
Myocarditis in acute rheumatic heart fever
Myxoma - benign
Positive blood cultures anemia of chronic disease
Prinzmetal

47. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Intercostal arteries enlarged due to collateral circulation
Granulation tissue
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

48. Which angina(s) show ST elevation on EKG? ST depression?
Left -->right
Mitral regurg
Mid - systolic click followed by regurgitation murmur
Prinzmetal stable and unstable

49. What is the most common tumor of the heart?
Metastasis
Volume overload and LHF
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
Slow HR - decreasing O2 demand and risk for arrhythmia

50. How do beta blockers tx MI?
Squat in response to cyanotic spell
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Slow HR - decreasing O2 demand and risk for arrhythmia
LHF