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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. EKG for stable angina?
Gelatinous - abundant ground substance
Dense layer of elastic and fibrotic tissue in the endocardium - children
Contraction band necrosis
ST- segment depression

2. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
Cyanosis - RV hypertrophy - polycythemia - clubbing
Dilated
Spontaneous

3. Erythematous nontender lesions on palms and soles.
Membrane damage
Janeway lesions
Split S2 on auscultation
LA dilation

4. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Dilated
Mitral stenosis
Anitschow cell
Membrane damage

5. What are other (not atherosclerotic) causes of MI?
S aureus
Stable and unstable prinzmetal
Granulation tissue
Coronary artery vasospasm - emboli - vasculitis

6. What is the cause of the red border around granulation tissue?
Shunt - PGE to maintain PDA until surgical repair can be performed
Blood vessels coming in from normal tissue
Shunt
ASD - R-->L

7. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Endocarditis of prosthetic valves
Bounding pulse
Aneurysm - mural thrombus - Dressler syndrome

8. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Adult coarctation of the aorta
Pericardial effusion due to pericardial involvement
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

9. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Systemic venous congestion
Mid - systolic click followed by regurgitation murmur
Ostium primum
ASD - R-->L

10. What is a complication of chronic rheumatic heart disease?
Reversible
Infectious endocarditis
Metastasis
Mitral regurg

11. What two things happen when a blocked vessel is opened after an MI?
Infantile coarctation of the aorta
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Contraction band necrosis - reperfusion injury
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

12. What complications occur 4-7 days post MI?
Loeffler syndrome
Rhabdomyoma
Rupture of free wall - IV septum - or papillary muscle
Congested central veins

13. What are the clinical features of RHF due to?
Myocarditis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Pts w/previously damaged valves
Systemic venous congestion

14. Sudden death in a young athlete.
Mitral mitral+aortic
Chronic rheumatic heart disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Hypertrophic cardiomyopathy

15. What causes the dependent pitting edema in RHF?
Shunt - PGE to maintain PDA until surgical repair can be performed
Concentric LV hypertophy
Increased hydrostatic pressure
RCA

16. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Months out fibrosis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
PDA

17. What are the laboratory findings of bacterial endocarditis?
Preductal - post aortic arch
Positive blood cultures anemia of chronic disease
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Contraction band necrosis

18. What is the most common cause of death during the acute phase of rheumatic fever?
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
Myocarditis
Infectious endocarditis - arrythmias - severe mitral regurg no
Chronic ischemic heart disease

19. What is cardiogenic shock?
Transposition of the great vessels
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Inability to maintain systemic pressure w/lack of O2 to vital organs
LAD

20. What are Janeway lesions?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Systolic ejection click followed by crescendo - decrescendo murmur
Prinzmetal stable and unstable
Erythematous nontender lesions on palms and soles.

21. What is the main cause of MV regurg? What are other causes?
RHF
PDA
Systolic ejection click followed by crescendo - decrescendo murmur
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

22. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
>60 years - bicuspid aortic valve
Loss of fx
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

23. When does the heart have dark discoloration post MI?
Mid - systolic click followed by regurgitation murmur
First 4 hours
4-24 hours
Surgical closure small defects may close spontaneously

24. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Endocarditis of prosthetic valves
Coronary artery vasospasm - emboli - vasculitis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

25. What are the sx of cardiac myxoma?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Membrane damage
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

26. What valves are involved in rhuematic endocarditis?
Squat in response to cyanotic spell
Harmartoma
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Mitral mitral+aortic

27. What is the rate of mitral valve prolapse in the US?
Months out fibrosis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Dilation of all four chambers of the heart
2-3%

28. How does dilated cardiomyopathy cause LHF?
2-3 weeks
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Elevated ASO anti - DNase B titers
Stretched muscle loses contractility

29. What endocarditis is commonly found in patients with colon cancer?
20 min
Harmartoma
Breast and lung carcinoma - melanoma - lymphoma
Streptococcus bovis/

30. What effect does chronic rheumatic heart disease have the mitral valve?
Endocarditis of prosthetic valves
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Thickening of chrodae tendinae and cusps - mitral stenosis
Pancarditis

31. When do troponin levels rise - peak - and return to normal?
Ventricles cannot pump
Hypertrophic cardiomyopathy
3-8 wks
2-4 hours - 24 hours - 7-10 days

32. What is a water - hammer pulse?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Decrease preload -->lowers myocardial stress
Bounding pulse

33. What are the sx of PDA at birth?
Dilated
Squatting - increased systemic resistence decreases LV emptying
Asymptomatic
RCA

34. What disesase has Aschoff bodies?
Cardiac tamponade
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
Myocarditis in acute rheumatic heart fever
Nitroglycerin

35. Are most congenital heart defects spontaneous or inherited?
RCA
Spontaneous
Infectious endocarditis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

36. Friction rub and chest pain.
Hypertrophic cardiomyopathy
Split S2 on auscultation
White scar fibrosis
Pericarditits

37. Myofiber hypertrophy with disarray.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
20 min
Hypertrophic cardiomyopathy
Fibrosis and dystrophic calcification

38. Large vegetations on tricuspid valve?
S aureus
Hypertrophic cardiomyopathy
Infectious endocarditis - arrythmias - severe mitral regurg no
Fibrosis and dystrophic calcification

39. How do you prevent S viridans endocarditis?
Decrease preload -->lowers myocardial stress
Regurg vs stenosis
Prophylactic abx during dental procedures
Heart can't fill

40. What is the most common type of ASD? What %?
Tricuspid
Hemosiderin laden macrophages
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Ostium secundum (90%)

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

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42. What complication occurs 1-3 days post MI?
Kawasaki disease
Fibrinous pericarditis
Months out fibrosis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

43. What are the causes of LHF?
Months out fibrosis
Aortic stenosis
Large - destructive vegetations
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

44. How do ACE inhibitors tx MI?
Decreased forward perfusion pulmonary congestion
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Decreases LV dilation by decreasing volume
Fetal alcohol syndrome

45. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Osler nodes (ouch - ouch Osler)
Mitral and tricuspid regurg - arrhythmia
2-4 hours - 24 hours - 7-10 days

46. What causes wear and tear aortic 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
Mitral and tricuspid regurg - arrhythmia
Fibrosis and dystrophic calcification
Autoimmune pericarditis 6-8 wks post MI

47. Lower extremity cyanosis in infants? In adults?
Sterile vegetations on mitral valve along lines of closure
Pericardial effusion due to pericardial involvement
Infantile coarctation of the aorta PDA
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

48. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
Right side - serotonin and other secretory products detoxified in the lung
ACE inhibitor
Systolic dysfx leading to biventricular CHF

49. How does ischemia cause LHF?
Loss of fx
Dilation of all four chambers of the heart
Bacterial endocarditis
Asymptomatic

50. With what virus is PDA associated?
Congenital rubella
Granulation tissue
PDA
Prophylactic abx during dental procedures