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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 cardiac enzyme is useful for detecting reinfarction?
Systolic dysfx leading to biventricular CHF
Regurg vs stenosis
CK- MB
RCA

2. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LA
Myofiber hypertrophy with disarray
2-4 hours - 24 hours - 7-10 days

3. What does nonbacterial thrombotic endocarditis cause?
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
Mitral regurg
Turner syndrome
Mitral stenosis

4. What is dilated cardiomyopathy?
Pulsating nail bed
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Fibrosis and dystrophic calcification
Dilation of all four chambers of the heart

5. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Fibrinous pericarditis
Bacterial endocarditis
Acute inflammation
VSD

6. What does Libman - Sacks endocarditis cause?
Mitral regurg
Atherosclerosis of coronary arteries
Colon cancer
Subendocardial

7. What does rupture of the IV septum cause?
Shunt
Infectious endocarditis - arrythmias - severe mitral regurg no
Bacterial endocarditis
Sudden cardiac death

8. Tender lesions on fingers or toes.
Loss of LV fx
Atria and RV
Tetralogy of fallot
Osler nodes (ouch - ouch Osler)

9. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
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
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
Backward LHF pulm htn and RHF - afib and associated mural thombis

10. What creates the immune reaction in acute rhuematic fever?

11. How do nitrates tx MI?
RBC damaged while crossing the calcified valve causing schistocytes
Mitral stenosis
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
Decrease preload -->lowers myocardial stress

12. What type of collagen is involved in fibrosis?
Type I
Asymptomatic
Endocarditis of prosthetic valves
Hemosiderin laden macrophages

13. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Autoimmune pericarditis 6-8 wks post MI
Degree of pulmonary artery stenosis
Louder - increased systemic resistence decreases LV emptying
Aschoff bodies

14. How do ACE inhibitors tx MI?
Breast and lung carcinoma - melanoma - lymphoma
Decreases LV dilation by decreasing volume
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
4-7 days

15. What maintains patency of the PDA?
>70%
Decrease preload -->lowers myocardial stress
PGE
Congested central veins

16. What valves are most commonly involved in chronic rheumatic heart disease?
Stretched muscle loses contractility
Mitral mitral+aortic
Valve scarring that arises as a consequence of rheumatic fever
Nonbacterial thrombotic endocarditis (marantic endocarditis)

17. What is the most common cause of infectious endocarditis?
L->R
Mitral regurg
LA
Streptococcus viridans

18. What causes an early - blowing diastolic murmur?
Valve replacement once LV dysfx develops
Decreased forward perfusion pulmonary congestion
Aortic regurg
Indomethacin - decreases PGE

19. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Stable angina
RCA
Restrictive cardiomyopathy
Inability to maintain systemic pressure w/lack of O2 to vital organs

20. What type of vegetations does Strep viridans cause?
Cardiogenic shock - CHF - arrhythmia
Thickening of chrodae tendinae and cusps - mitral stenosis
ST- segment depression
Small - nondestructive vegetations (subacute endocarditis)

21. When do troponin levels rise - peak - and return to normal?
Chronic ischemic heart disease
2-4 hours - 24 hours - 7-10 days
Bounding pulse
Mitral insufficiency

22. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Dilated
Myxoma - benign
Decreases LV dilation by decreasing volume

23. What are the four defects in tetralogy of fallot?
Reversible
RBC damaged while crossing the calcified valve causing schistocytes
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

24. What is the most common cause of death during the acute phase of rheumatic fever?
LA dilation
Myocardium
Decrease preload -->lowers myocardial stress
Myocarditis

25. What is a water - hammer pulse?
Bounding pulse
Opening snap followed by diastolic rumble
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Dilated

26. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Acute inflammation
1-3 days

27. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Hemosiderin laden macrophages
Myocarditis in acute rheumatic heart fever
First 4 hours

28. What is the effect of mitral regurg on the heart?
ST- segment depression
Contraction band necrosis
Tricuspid
Volume overload and LHF

29. What % of MIs involve the LAD?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
RCA
Myofiber hypertrophy with disarray
45%

30. What effect does dilated cardiomyopathy have on the heart?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Mitral valve prolapse
Acute inflammation
Systolic dysfx leading to biventricular CHF

31. What is the most common tumor of the heart?
Metastasis
Mitral insufficiency
45%
Valve scarring that arises as a consequence of rheumatic fever

32. What is the classic EKG finding of restrictive cardiomyopathy?
45%
Low voltage EKG w/diminished QRS amplitude
Infectious endocarditis - arrythmias - severe mitral regurg no
Shunt - PGE to maintain PDA until surgical repair can be performed

33. What cardiac disease is associated with tuberous sclerosis?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Rhabdomyoma
Atria and RV
Ischemic heart disease

34. What type of shunt does ASD cause?
Left -->right
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ischemic heart disease
LA dilation

35. EKG for stable angina?
Group A beta - hemolytic streptococci
Osler nodes (ouch - ouch Osler)
Turner syndrome
ST- segment depression

36. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Day 1-7
Congestive heart failure
Months out fibrosis

37. How does hypertension cause LHF?

38. How does MI cause LHF?
Prinzmetal
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Papillary muscle - free wall - IV septum
Loss of LV fx

39. What are the sx of aortic regurg?
Type I
Shunt - PGE to maintain PDA until surgical repair can be performed
Inability to fill ventricles
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

40. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
1-3 days out
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Nitroglycerin

41. What is the murmur of mitral valve prolapse?
Chronic ischemic heart disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Mid - systolic click followed by regurgitation murmur
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

42. Poor myocardial fx due to chronic ischemic damage?
PDA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Chronic ischemic heart disease
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

43. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Mitral valve prolapse
Endocardial fibroelastosis
Reperfusion injury
Hemosiderin laden macrophages

44. Why would cardiac enzymes continue to increase after the initial MI?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Reperfusion injury
LAD
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

45. In which pts does S viridans cause endocarditits?
Opening snap followed by diastolic rumble
Pts w/previously damaged valves
Troponin I
Dilation of all four chambers of the heart

46. What are the two effects of ATII?
Mid - systolic click followed by regurgitation murmur
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Libman - Sacks endocarditis
Small vegetations along the line of closure

47. With what disease is Libman - Sacks endocarditis associated?
LHF
Infectious
SLE
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

48. What causes mitral valve prolapse?
Increased blood in right heart delays closure of P valve
Myxoid degeneration
>60 years - bicuspid aortic valve
Limits thrombosis

49. How do you tx prinzmetal angina?
Squatting - expiration
Shunt
45%
NG or Ca channel blocker

50. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Hypertophy of RV atrophy of LV
Within the first day
Coexisting mitral stenosis and fusion of commisures exist