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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 clinical features of endocarditis? What causes each feature?
1-3 days out
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
Tricuspid
Intercostal arteries enlarged due to collateral circulation

2. Ostium primum ASD is associated with what congenital disorder?
Inability to fill ventricles
Plump fibroblasts - collagen - blood vessels
S viridans
Trisomy 21

3. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
R-->L
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Troponin I

4. What type of shunt does ASD cause?
Reactive histiocyte with caterpillar nucleus
Left -->right
1-3 days out
Chest pain <20 min brought on by exertion or emotional stress

5. What is endocardial fibroelastosis? In what population is it found?
Adult coarctation of the aorta
Dense layer of elastic and fibrotic tissue in the endocardium - children
Right side - serotonin and other secretory products detoxified in the lung
MI

6. What type of shunt dose PDA cause?
LHF
Eisenmenger syndrome
Left -->right
VSD

7. What are the tx for MI?
Breast and lung carcinoma - melanoma - lymphoma
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Rupture of free wall - IV septum - or papillary muscle

8. What is the foundation of a scar?
Maternal diabetes
Reperfusion injury
Granulation tissue
Yellow pallor neutrophils

9. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
Valve replacement once LV dysfx develops
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
1-3 days

10. What valves are most commonly involved in chronic rheumatic heart disease?
When a bacterial protein resembles a protein in human tissue
RCA
Prinzmetal angina
Mitral mitral+aortic

11. With what congenital heart defect is ADULT coarctation of the aorta associated?
Loss of LV fx
Metastasis
Bicuspid aortic valve
Aschoff bodies

12. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
LAD
RCA
Adult coarctation of the aorta
Papillary muscle - free wall - IV septum

13. What type of shunt does a VSD cause?
Limits thrombosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
L->R
Reperfusion injury

14. What are Osler nodes?
Tender lesions on fingers or toes.
Left -->right
Prinzmetal angina - cocaine
Sterile vegetations on mitral valve along lines of closure

15. What are the sx of cardiac myxoma?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Day 1-7
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

16. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Decrease in blood flow to an organ
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Loss of LV fx

17. When do troponin levels rise - peak - and return to normal?
CK- MB
Granulation tissue
2-4 hours - 24 hours - 7-10 days
Infantile coarctation of the aorta

18. How does adult coarctation of the aorta present?
Congenital rubella
Concentric LV hypertophy
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

19. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Aortic regurg
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Decreased forward perfusion pulmonary congestion

20. Why would cardiac enzymes continue to increase after the initial MI?
Limits thrombosis
Valve replacement
Atherosclerosis of coronary arteries
Reperfusion injury

21. What causes notching of the ribs in adult coarctation of the aorta?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Fetal alcohol syndrome
Decreases LV dilation by decreasing volume
Intercostal arteries enlarged due to collateral circulation

22. What type of collagen is involved in fibrosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
PDA
Mitral and tricuspid regurg - arrhythmia
Type I

23. What areas of the heart does the LAD supply?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
ASD - R-->L
Anterior wall of LV and anterior septum
Shunt

24. Where is the coarctation in infantile coarctation of the aorta?
LHF
Valve replacement once LV dysfx develops
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Preductal - post aortic arch

25. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Atria and RV
Ventricles cannot pump
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

26. In which chamber of the heart are rhabdomyomas found?
Ventricle
Squatting - expiration
LAD
Tuberous sclerosis

27. What type of shunt does transposition of the great vessels cause?
Granulation tissue
Left -->right
R-->L
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

28. What are other (not atherosclerotic) causes of MI?
Pts w/previously damaged valves
Stable angina
Myocarditis
Coronary artery vasospasm - emboli - vasculitis

29. Why are cardiac enzymes elevated after an MI?
Membrane damage
2-3%
Mitral and tricuspid regurg - arrhythmia
Transposition of the great vessels

30. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral regurg
Mid - systolic click followed by regurgitation murmur
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

31. When would arrhythmia occur after MI?
Restrictive cardiomyopathy
Thickening of chrodae tendinae and cusps - mitral stenosis
Within the first day
Left -->right

32. What congenital heart defect often is present with infantile coarctation of the aorta?
Mitral regurgitation due to vegetations
PDA
Stable and unstable prinzmetal
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

33. What causes wear and tear aortic stenosis?
Within the first day
PDA
Congenital rubella
Fibrosis and dystrophic calcification

34. What causes prinzmetal angina?
Coronary artery vasospasm
ACE inhibitor
Heart transplant
Endocardial fibroelastosis (rare)

35. What type of shunt does truncus arteriosus cause?
Squatting - increased systemic resistence decreases LV emptying
Subendocardial
R-->L
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

36. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Right -->left
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
1-3 days

37. What are the four defects in tetralogy of fallot?
Opening snap followed by diastolic rumble
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Atherosclerosis of coronary arteries
Myocarditis

38. What are the cancers that most commonly metastasize to the heart?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
4-6 hours - 24 hours - 72 hours
Breast and lung carcinoma - melanoma - lymphoma
Bacterial endocarditis

39. What is the most common cause of myocarditis?
Coxsackie A or B
Loss of fx
20 min
Tuberous sclerosis

40. What is the leading cause of death in the US?
Reperfusion injury
Ischemic heart disease
Metastasis
Streptococcus viridans

41. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Group A beta - hemolytic streptococci
Ventricular arrhythmia
Shunt - PGE to maintain PDA until surgical repair can be performed

42. What is the most common form of cardiomyopathy?
Dilated
1-3 days out
Within the first day
Loss of fx

43. What is a water - hammer pulse?
Coxsackie A or B
Rhadbomyoma - benign
Bounding pulse
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

44. Infects predamaged valves after transient bacteremia?
1%
S viridans
Low voltage EKG w/diminished QRS amplitude
Surgical closure small defects may close spontaneously

45. What effect does dilated cardiomyopathy have on the heart?
Sterile vegetations on mitral valve along lines of closure
45%
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Systolic dysfx leading to biventricular CHF

46. What two things cause coronary artery vasospasm?
CHF
Subendocardial
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Prinzmetal angina - cocaine

47. What are Janeway lesions?
Streptococcus bovis/
Aneurysm - mural thrombus - Dressler syndrome
Trisomy 21
Erythematous nontender lesions on palms and soles.

48. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Inability to maintain systemic pressure w/lack of O2 to vital organs
Cardiogenic shock - CHF - arrhythmia
Months out fibrosis

49. How does transmural MI/ischemia present on EKG?
When a bacterial protein resembles a protein in human tissue
Fibrinous pericarditis
ST- segment elevation
Infantile coarctation of the aorta

50. How do ACE inhibitors tx MI?
Rhadbomyoma - benign
Membrane damage
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decreases LV dilation by decreasing volume