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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 effect does aortic stenosis have on the chambers of the heart?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Concentric LV hypertophy
Maternal diabetes
VSD

2. Which angina(s) show ST elevation on EKG? ST depression?
>60 years - bicuspid aortic valve
Prinzmetal stable and unstable
Sterile vegetations on mitral valve along lines of closure
Aneurysm - mural thrombus - Dressler syndrome

3. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
CHF
Valve replacement AFTER the onset of complications
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Transposition of the great vessels

4. What type of endocarditis is associated with SLE?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Libman - Sacks endocarditis
Opening snap followed by diastolic rumble
Chronic ischemic heart disease

5. What areas of the heart does the RCA supply?
LA
Decreases LV dilation by decreasing volume
Low voltage EKG w/diminished QRS amplitude
Posterior wall of LV - posterior septum - papillary muscles

6. What gross and microscopic changes occur 4-7 days after an MI?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Yellow pallor macrophages
Coronary artery vasospasm
Pulsating nail bed

7. How do ACE inhibitors tx MI?
Decrease in blood flow to an organ
Myocarditis
Surgical closure small defects may close spontaneously
Decreases LV dilation by decreasing volume

8. What is the major cause of MI?
Aortic stenosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Transesophageal echo
Circumflex

9. How does MI cause LHF?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Loeffler syndrome
Loss of LV fx
Dense layer of elastic and fibrotic tissue in the endocardium - children

10. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Backward LHF pulm htn and RHF - afib and associated mural thombis
Months out fibrosis

11. How does restrictive cardiomyopathy present?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Congestive heart failure
Cardiac tamponade
1%

12. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
L->R
Blood vessels coming in from normal tissue
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

13. What makes the MV prolapse murmur louder? Why?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Tricuspid
Prinzmetal angina
Squatting - increased systemic resistence decreases LV emptying

14. With what congenital heart defect is ADULT coarctation of the aorta associated?
Hemosiderin laden macrophages
Bicuspid aortic valve
Nonspecific - eg fever and elevated ESR
Small - nondestructive vegetations (subacute endocarditis)

15. What is the gold standard blood marker for MI?
Troponin I
Hypercoagulable state or underlying adenocarcinoma
Hypertrophic cardiomyopathy
3-8 wks

16. What is an important complication of ASD?
CK- MB
Eisenmenger syndrome
Gelatinous - abundant ground substance
Paradoxical emboli

17. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Bicuspid aortic valve
Anitschow cell
Fetal alcohol syndrome

18. What is the classic EKG finding of restrictive cardiomyopathy?
Nitroglycerin
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1-3 days
Low voltage EKG w/diminished QRS amplitude

19. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Circumflex
Small vegetations along the line of closure
Osler nodes (ouch - ouch Osler)
Degree of pulmonary artery stenosis

20. What is the most common tumor of the heart?
Prinzmetal angina - cocaine
Subendocardial
Metastasis
Myxoid degeneration

21. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Atherosclerosis of coronary arteries
Infectious
Maternal diabetes

22. What type of vegetations are associated with Libman - Sacks endocarditis?
Valve scarring that arises as a consequence of rheumatic fever
Sterile vegetations on surface and undersurface on mitral valve
Reperfusion injury
Doxorubicin - cocaine

23. What are the clinical features of endocarditis? What causes each feature?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
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
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
2-4 hours - 24 hours - 7-10 days

24. What is the definition of ischemia?
S viridans
Decrease in blood flow to an organ
NG or Ca channel blocker
R-->L

25. What type of ASD is associated w/Down syndrome?
Low voltage EKG w/diminished QRS amplitude
RCA
Mid - systolic click followed by regurgitation murmur
Ostium primum

26. How do nitrates tx MI?
Libman - Sacks endocarditis
MI
Decrease preload -->lowers myocardial stress
Streptococcus viridans

27. What is the foundation of a scar?
Granulation tissue
Nitroglycerin
Tetralogy of fallot
Doxorubicin - cocaine

28. What is the most common cause of dilated cardiomyopathy? What are other causes?
Yellow pallor neutrophils
Kawasaki disease
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reversible

29. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Bacterial endocarditis
Squatting - expiration
Reperfusion injury

30. What typically causes hypertrophic cardiomyopathy?
Mitral regurg
Months out fibrosis
AD mutation in sarcomere proteins
LA dilation

31. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Sudden cardiac death
Prophylactic abx during dental procedures
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

32. What are the clinical features of LHF due to?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Prinzmetal
Decreased forward perfusion pulmonary congestion
Infantile coarctation of the aorta PDA

33. What congenital heart defect is associated with fetal alcohol syndrome?
Infectious
4-7 days macrophage infiltration
Paradoxical emboli
VSD

34. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Myofiber hypertrophy with disarray
>60 years - bicuspid aortic valve
Regurg vs stenosis
Holosystolic blowing murmur

35. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Plump fibroblasts - collagen - blood vessels
Aneurysm - mural thrombus - Dressler syndrome
Asymptomatic
Aortic regurg

36. What is Dressler syndrome? When does it occur?
Shunt
Autoimmune pericarditis 6-8 wks post MI
Troponin I
Streptococcus bovis/

37. Which vasculitis can cause MI?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Mitral valve prolapse
Kawasaki disease
ST- segment depression

38. In which pts does S viridans cause endocarditits?
Congestive heart failure
Cyanosis - RV hypertrophy - polycythemia - clubbing
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pts w/previously damaged valves

39. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
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

40. What is the murmur of mitral regurg?
Holosystolic blowing murmur
ASD - R-->L
Prinzmetal angina - cocaine
When a bacterial protein resembles a protein in human tissue

41. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
White scar fibrosis
Pericarditits
Inability to maintain systemic pressure w/lack of O2 to vital organs

42. What is molecular mimicry?
Chronic rheumatic heart disease
Hypertrophic cardiomyopathy
When a bacterial protein resembles a protein in human tissue
Heart transplant

43. What are the HACEK organisms? With what condition are they associated?
1-3 days
Congenital rubella
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Chest pain <20 min brought on by exertion or emotional stress

44. What cardiac disease is associated with tuberous sclerosis?
LAD
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
Pancarditis
Rhabdomyoma

45. What effect does chronic rheumatic heart disease have the mitral valve?
Shunt - PGE to maintain PDA until surgical repair can be performed
Endocarditis of prosthetic valves
Gelatinous - abundant ground substance
Thickening of chrodae tendinae and cusps - mitral stenosis

46. How does contraction band necrosis occur?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
CK- MB
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Transesophageal echo

47. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Rupture of free wall - IV septum - or papillary muscle
Prinzmetal angina - cocaine
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

48. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Streptococcus bovis/
Pts w/previously damaged valves
Pump failure

49. What type of collagen is involved in fibrosis?
Type I
IV drug users
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Circumflex

50. What is the main cause of MV regurg? What are other causes?
45%
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Low voltage EKG w/diminished QRS amplitude
1-3 days out