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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 is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Acute inflammation
SLE
Minimizes ischemia

2. What is an important complication of ASD?
Trisomy 21
RHF
Paradoxical emboli
Indomethacin - decreases PGE

3. What are Janeway lesions?
PGE
Ostium secundum (90%)
Erythematous nontender lesions on palms and soles.
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

4. How does asprin/heparin tx MI?
1-3 days out
1-3 days
Right side - serotonin and other secretory products detoxified in the lung
Limits thrombosis

5. What are other (not atherosclerotic) causes of MI?
NG or Ca channel blocker
Thickening of chrodae tendinae and cusps - mitral stenosis
Myocarditis
Coronary artery vasospasm - emboli - vasculitis

6. In which chamber of the heart are cardiac myxomas found?
Sterile vegetations on surface and undersurface on mitral valve
LA
RCA
Regurg vs stenosis

7. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Friction rub and chest pain

8. What does rupture of a papillary muscle cause?
Tuberous sclerosis
Hypertophy of RV atrophy of LV
Mitral insufficiency
Yellow pallor neutrophils

9. What causes the dependent pitting edema in RHF?
Coronary artery vasospasm
Stable angina
Prinzmetal
Increased hydrostatic pressure

10. What artery is the 2nd most often occluded in an MI?
Systolic dysfx leading to biventricular CHF
Cardiac tamponade
Libman - Sacks endocarditis
RCA

11. What is dilated cardiomyopathy?
Reperfusion injury
Dilation of all four chambers of the heart
Holosystolic machine like murmur
Small vegetations along the line of closure

12. What heart sound manifest with an ASD?
Split S2 on auscultation
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
R-->L
Troponin I

13. How does restrictive cardiomyopathy cause LHF?

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14. With what disease is infantile coarctation of the aorta associated?
IV drug users
Turner syndrome
>60 years - bicuspid aortic valve
Infantile coarctation of the aorta

15. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

16. What type of vegetations does Strep viridans cause?
>70%
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Subendocardial
Small - nondestructive vegetations (subacute endocarditis)

17. What is the tx for VSD?
Systolic ejection click followed by crescendo - decrescendo murmur
Anterior wall of LV and anterior septum
Surgical closure small defects may close spontaneously
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

18. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
PDA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
ST- segment depression

19. What are the complications of mitral valve prolapse? Are they common?
Left -->right
Infectious endocarditis - arrythmias - severe mitral regurg no
PDA
Anterior wall of LV and anterior septum

20. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Myocarditis in acute rheumatic heart fever
Myxoma - benign
Ventricle

21. What are the sx of aortic regurg?
Mitral and tricuspid regurg - arrhythmia
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Cardiogenic shock - CHF - arrhythmia
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

22. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Bacterial endocarditis
VSD
Migratory polyarthritis

23. Which angina is relieved by Ca channel blockers?
Prinzmetal
Open blocked vessels
Split S2 on auscultation
Mitral regurg

24. What is the JOneS mneumonic?
LV dilation and eccentric hypertrophy
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Myxoma - benign
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

25. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Rhadbomyoma - benign
Colon cancer
Nonspecific - eg fever and elevated ESR
Louder - increased systemic resistence decreases LV emptying

26. Tender lesions on fingers or toes.
Reactive histiocyte with caterpillar nucleus
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Osler nodes (ouch - ouch Osler)

27. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Mitral mitral+aortic
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Hypertrophic cardiomyopathy

28. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Degree of pulmonary artery stenosis
Ventricles cannot pump
Harmartoma

29. How does contraction band necrosis occur?
Pulsating nail bed
Circumflex
Infectious endocarditis - arrythmias - severe mitral regurg no
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

30. What are the causes of restrictive cardiomyopathy in adults?
Preductal - post aortic arch
Infantile coarctation of the aorta
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Contraction band necrosis - reperfusion injury

31. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
MI
Nonspecific - eg fever and elevated ESR
4-24 hours

32. What are the sx of right - to - left shunt?
45%
Backward LHF pulm htn and RHF - afib and associated mural thombis
Colon cancer
Cyanosis - RV hypertrophy - polycythemia - clubbing

33. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Mitral valve prolapse
S aureus
LHF
Cardiac tamponade

34. What are the clinical features of RHF due to?
Systemic venous congestion
ST- segment depression
Pedunculated mass in the LA that causes syncope due to obstruction of MV
1%

35. What is the etiology of S viridans endocarditis?
Reversible
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Systolic dysfx leading to biventricular CHF
SLE

36. What is the tx for dilated cardiomyopathy?
Atherosclerosis of coronary arteries
Endocarditis of prosthetic valves
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Heart transplant

37. When do neutrophils infiltrate the myocardium post MI?
Turner syndrome
SLE
1-3 days
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

38. What is the only Jones criteria that doesn't resolve with time?
RBC damaged while crossing the calcified valve causing schistocytes
Degree of pulmonary artery stenosis
Pancarditis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

39. Which artery is most often occluded in an MI?
LAD
Small vegetations along the line of closure
Sudden cardiac death
Months out fibrosis

40. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Pump failure
R-->L
Degree of pulmonary artery stenosis
Regurg vs stenosis

41. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Pancarditis
Coronary artery vasospasm

42. How does subendocardial MI/ischemia present on EKG?
VSD
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral insufficiency
ST- segment depression

43. Which angina(s) show ST elevation on EKG? ST depression?
2-3 weeks
Prinzmetal stable and unstable
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

44. What drug relieves stable angina?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Nitroglycerin
Valve replacement once LV dysfx develops
Myocarditis in acute rheumatic heart fever

45. Erythematous nontender lesions on palms and soles.
Janeway lesions
Indomethacin - decreases PGE
L->R
Granulation tissue

46. What is cardiogenic shock?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Group A beta - hemolytic streptococci
Inability to maintain systemic pressure w/lack of O2 to vital organs

47. What is the most common cause of dilated cardiomyopathy? What are other causes?
NG or Ca channel blocker
RCA
Group A beta - hemolytic streptococci
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

48. What drugs can cause dilated cardiomyopathy?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Doxorubicin - cocaine
Granulation tissue
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

49. What congenital heart defect is associated with fetal alcohol syndrome?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
1-3 days
VSD
Cardiogenic shock - CHF - arrhythmia

50. Poor myocardial fx due to chronic ischemic damage?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
LA
Coronary artery vasospasm - emboli - vasculitis
Chronic ischemic heart disease