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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 are the causes of LHF?
Degree of pulmonary artery stenosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
4-7 days macrophage infiltration
S viridans

2. What is the most common cause of RHF? What are others?
Valve replacement once LV dysfx develops
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Squatting - increased systemic resistence decreases LV emptying

3. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Mitral stenosis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Increased blood in right heart delays closure of P valve
RHF

4. How does squating decrease hypoxemia in tetralogy of fallot?
Louder - increased systemic resistence decreases LV emptying
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

5. What are the clinical features of RHF due to?
Low voltage EKG w/diminished QRS amplitude
Troponin I
Contraction band necrosis
Systemic venous congestion

6. What congenital heart defect often is present with infantile coarctation of the aorta?
Transposition of the great vessels
Eisenmenger syndrome
Heart transplant
PDA

7. Lower extremity cyanosis in infants? In adults?
3-8 wks
Infantile coarctation of the aorta PDA
Streptococcus bovis/
Pericardial effusion due to pericardial involvement

8. What are the clinical features of endocarditis? What causes each feature?
R-->L
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
Nitroglycerin
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

9. What type of collagen is involved in fibrosis?
Type I
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral regurg
PDA

10. When does the heart have dark discoloration post MI?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Aortic regurg
LHF
4-24 hours

11. What are the clinical features of LHF due to?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Decreased forward perfusion pulmonary congestion
Prophylactic abx during dental procedures
Months out fibrosis

12. With what developmental disorder is VSD associated?
Inability to fill ventricles
Holosystolic machine like murmur
Anitschow cell
Fetal alcohol syndrome

13. What type of vegetations form in nonbacterial thrombotic endocarditis?
IV drug users
Surgical closure small defects may close spontaneously
Congenital rubella
Sterile vegetations on mitral valve along lines of closure

14. What are the sx of PDA at birth?
Spontaneous
Infectious endocarditis
VSD
Asymptomatic

15. What is the most comon cause of aortic regurg? What are the other causes?
Stable and unstable prinzmetal
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Small vegetations along the line of closure
VSD

16. What are the complications of aortic stenosis?
Chronic rheumatic heart disease
Valve replacement once LV dysfx develops
Prinzmetal stable and unstable
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

17. What effect does mitral stenosis have on the heart chambers?
Erythematous nontender lesions on palms and soles.
LA dilation
S aureus
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

18. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Mitral regurg
Aschoff bodies
Tuberous sclerosis
Holosystolic blowing murmur

19. What is the characteristic murmurr of mitral stenosis?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Coronary artery vasospasm
Opening snap followed by diastolic rumble
Sudden cardiac death

20. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Myxoma - benign
Surgical closure small defects may close spontaneously
Open blocked vessels

21. What is the most common cause of death during the acute phase of rheumatic fever?
Mitral regurg
Pump failure
Trisomy 21
Myocarditis

22. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Cyanosis - RV hypertrophy - polycythemia - clubbing
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
Stable and unstable prinzmetal
Aortic stenosis

23. How does Eisenmeger syndrome occur?
Ventricular arrhythmia
Surgical closure small defects may close spontaneously
Granulation tissue
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

24. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
2-4 hours - 24 hours - 7-10 days
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Stable and unstable prinzmetal

25. With what congenital heart defect is ADULT coarctation of the aorta associated?
Increased hydrostatic pressure
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Bicuspid aortic valve
Dilated

26. What is the rate of congenital heart defects?
4-6 hours - 24 hours - 72 hours
1%
Nitroglycerin
Granulation tissue

27. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Aortic regurg
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

28. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
45%
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Holosystolic machine like murmur

29. What is the murmur of mitral valve prolapse?
4-24 hours
LA dilation
Mid - systolic click followed by regurgitation murmur
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

30. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Cardiac tamponade
Cardiogenic shock - CHF - arrhythmia
Rhadbomyoma - benign
Small vegetations along the line of closure

31. What effect does transposition of the great vessels have on the ventricles?
Hemosiderin laden macrophages
Coexisting mitral stenosis and fusion of commisures exist
Hypertophy of RV atrophy of LV
Subendocardial

32. Sudden death in a young athlete.
ASD - R-->L
Hypertrophic cardiomyopathy
Endocardial fibroelastosis
Squat in response to cyanotic spell

33. What are the sx of pericardiits?
Congestive heart failure
VSD
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Friction rub and chest pain

34. Infects predamaged valves after transient bacteremia?
S viridans
Mitral mitral+aortic
CHF
Indomethacin - decreases PGE

35. How does restrictive cardiomyopathy cause LHF?

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36. How do you tx prinzmetal angina?
NG or Ca channel blocker
Streptococcus viridans
Contraction band necrosis - reperfusion injury
Sudden cardiac death

37. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Congenital rubella
Valve replacement
4-7 days macrophage infiltration
Louder - increased systemic resistence decreases LV emptying

38. Which coronary artery supplies the anterior wall and anterior septum?
PDA
Ostium primum
LAD
Dilated

39. What are the four defects in tetralogy of fallot?
Large - destructive vegetations
Mid - systolic click followed by regurgitation murmur
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Indomethacin - decreases PGE

40. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Prinzmetal angina
Right to left
Chest pain <20 min brought on by exertion or emotional stress

41. What type of ischemia does stable angina cause?
Surgical closure small defects may close spontaneously
Subendocardial
Yellow pallor neutrophils
Sterile vegetations on surface and undersurface on mitral valve

42. At what point in development do congenital heart defects arise?
Heart transplant
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ventricle
3-8 wks

43. Low voltage EKG w/diminished QRS amplitude.
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
LAD
20 min
Restrictive cardiomyopathy

44. Where is the coarctation in infantile coarctation of the aorta?
Degree of pulmonary artery stenosis
CK- MB
First 4 hours
Preductal - post aortic arch

45. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Valve replacement once LV dysfx develops
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Heart can't fill

46. How does subendocardial MI/ischemia present on EKG?
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
Aortic stenosis
Tricuspid
ST- segment depression

47. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Systolic ejection click followed by crescendo - decrescendo murmur
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

48. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Autoimmune pericarditis 6-8 wks post MI
Myocarditis in acute rheumatic heart fever

49. Poor myocardial fx due to chronic ischemic damage?
Limits thrombosis
Chronic ischemic heart disease
Months out fibrosis
LA dilation

50. What vavular defect results from acute rheumatic fever?
Contraction band necrosis - reperfusion injury
Increased blood in right heart delays closure of P valve
Mitral regurgitation due to vegetations
Nonbacterial thrombotic endocarditis (marantic endocarditis)