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Cardiac

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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 congenital heart defect is associated with fetal alcohol syndrome?
Squat in response to cyanotic spell
Mid - systolic click followed by regurgitation murmur
Myocardium
VSD

2. What is the etiology of S viridans endocarditis?
Surgical closure small defects may close spontaneously
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
RHF
4-7 days

3. What type of vegetations are associated with Libman - Sacks endocarditis?
Tender lesions on fingers or toes.
Degree of pulmonary artery stenosis
Sterile vegetations on surface and undersurface on mitral valve
Elevated ASO anti - DNase B titers

4. Tx for PDA?
Indomethacin - decreases PGE
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
R-->L
SLE

5. What heart sound manifest with an ASD?
Split S2 on auscultation
L->R
Osler nodes (ouch - ouch Osler)
Gelatinous - abundant ground substance

6. What is the most common cause of RHF? What are others?
RHF
Aortic regurg
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Anterior wall of LV and anterior septum

7. What are the HACEK organisms? With what condition are they associated?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Systolic dysfx leading to biventricular CHF
MI

8. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Hemosiderin laden macrophages
Loss of fx
Blood vessels coming in from normal tissue

9. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Coronary artery vasospasm - emboli - vasculitis
Blood vessels coming in from normal tissue
Tender lesions on fingers or toes.

10. What are the complications of mitral valve prolapse? Are they common?
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
Infectious endocarditis - arrythmias - severe mitral regurg no
Restrictive cardiomyopathy
Acute inflammation

11. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
4-6 hours - 24 hours - 72 hours
Papillary muscle - free wall - IV septum
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

12. What is the gold standard blood marker for MI?
Troponin I
4-7 days macrophage infiltration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Loss of fx

13. What is the JOneS mneumonic?
Rhabdomyoma
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
Asymptomatic

14. What is diastolic dysfx?
Months out fibrosis
Inability to fill ventricles
Aortic stenosis
Positive blood cultures anemia of chronic disease

15. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
S epidermidis
Infectious endocarditis
Systemic venous congestion

16. When do CK- MB levels rise - peak - and return to normal?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Erythematous nontender lesions on palms and soles.
4-6 hours - 24 hours - 72 hours
PGE

17. What type of shunt results in cyanosis at birth?
Right to left
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Chronic rheumatic heart disease
2-3 weeks

18. What is a Quincke pulse?
Endocarditis of prosthetic valves
Valve replacement once LV dysfx develops
4-24 hours
Pulsating nail bed

19. What complications occur within 4 hrs post MI?
Heart can't fill
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Cardiogenic shock - CHF - arrhythmia
Coxsackie A or B

20. Dilated cardiomyopathy is a late complication of what illness?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Chest pain <20 min brought on by exertion or emotional stress
Myocarditis
Pericardial effusion due to pericardial involvement

21. Which angina(s) show ST elevation on EKG? ST depression?
Tricuspid
Prinzmetal stable and unstable
Reperfusion injury
Shunt - PGE to maintain PDA until surgical repair can be performed

22. What effect does mitral stenosis have on the heart chambers?
Months out fibrosis
LA dilation
NG or Ca channel blocker
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

23. What causes the nutmeg color in nutmeg liver?
Janeway lesions
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Congested central veins
4-7 days macrophage infiltration

24. How does transmural MI/ischemia present on EKG?
Myocarditis
Regurg vs stenosis
Chronic rheumatic heart disease
ST- segment elevation

25. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
S epidermidis
Heart transplant
Posterior wall of LV - posterior septum - papillary muscles
Anitschow cell

26. What is migratory polyarthritis?
Ostium primum
Ventricular arrhythmia
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

27. What are the forward and backward sx of LHF?
Rupture of free wall - IV septum - or papillary muscle
LAD
Shunt - PGE to maintain PDA until surgical repair can be performed
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

28. What are the sx of PDA at birth?
Large vegetations of S aureus
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Asymptomatic
Intercostal arteries enlarged due to collateral circulation

29. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Systolic ejection click followed by crescendo - decrescendo murmur
Transposition of the great vessels
Infectious

30. Which congenital heart defect is associated with maternal diabetes?
Nitroglycerin
Turner syndrome
Transposition of the great vessels
Ostium secundum (90%)

31. When does the heart have a yellow pallor post MI?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Day 1-7
Intercostal arteries enlarged due to collateral circulation
Months out fibrosis

32. What maintains patency of the PDA?
PGE
Type I
Indomethacin - decreases PGE
Trisomy 21

33. What are the clinical features of RHF due to?
Aneurysm - mural thrombus - Dressler syndrome
Infantile coarctation of the aorta
Systemic venous congestion
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

34. What is endocardial fibroelastosis? In what population is it found?
AD mutation in sarcomere proteins
Holosystolic blowing murmur
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Dense layer of elastic and fibrotic tissue in the endocardium - children

35. What are other (not atherosclerotic) causes of MI?
LAD
Months out fibrosis
Coronary artery vasospasm - emboli - vasculitis
VSD

36. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Cardiogenic shock - CHF - arrhythmia
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Group A beta - hemolytic streptococci
Stable and unstable prinzmetal

37. What type of shunt does a VSD cause?
Holosystolic machine like murmur
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
L->R
Inability to maintain systemic pressure w/lack of O2 to vital organs

38. What type of ASD is associated w/Down syndrome?
Coexisting mitral stenosis and fusion of commisures exist
Indomethacin - decreases PGE
L->R
Ostium primum

39. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Reperfusion injury
Myxoma - benign
Intercostal arteries enlarged due to collateral circulation

40. What is the murmur of mitral valve prolapse?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Decreases LV dilation by decreasing volume
Yellow pallor macrophages
Mid - systolic click followed by regurgitation murmur

41. With what developmental disorder is VSD associated?
Posterior wall of LV - posterior septum - papillary muscles
Months out fibrosis
Fetal alcohol syndrome
Limits thrombosis

42. What are the four defects in tetralogy of fallot?
LA dilation
Loss of LV fx
Shunt
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

43. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
4-7 days
Nitroglycerin
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

44. Pericarditis 6-8 wks post MI.
Cardiac tamponade
S epidermidis
MI
Dressler syndrome

45. What is chronic rheumatic heart disease?
Thickening of chrodae tendinae and cusps - mitral stenosis
Ventricles cannot pump
Valve scarring that arises as a consequence of rheumatic fever
Tuberous sclerosis

46. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Months out fibrosis
ACE inhibitor
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

47. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Coronary artery vasospasm - emboli - vasculitis
Congenital rubella
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

48. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Holosystolic blowing murmur
Heart can't fill
Mitral regurg

49. What are the complications of mitral stenosis?
Left -->right
Backward LHF pulm htn and RHF - afib and associated mural thombis
Concentric LV hypertophy
Squatting - expiration

50. What is the most common cause of infectious endocarditis?
Streptococcus viridans
3-8 wks
Autoimmune pericarditis 6-8 wks post MI
Hypertophy of RV atrophy of LV