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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. Myofiber hypertrophy with disarray.
Months out fibrosis
Hypertrophic cardiomyopathy
Systolic dysfx leading to biventricular CHF
Decreases LV dilation by decreasing volume

2. How does contraction band necrosis occur?
S aureus
Concentric LV hypertophy
ST- segment depression
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

3. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Dense layer of elastic and fibrotic tissue in the endocardium - children
Coronary artery vasospasm - emboli - vasculitis
Pts w/previously damaged valves

4. How does fibrinolysis/angioplasty tx MI?
Mitral insufficiency
ASD - R-->L
Dressler syndrome
Open blocked vessels

5. What is the tx for VSD?
Paradoxical emboli
Cardiac tamponade
Endocardial fibroelastosis
Surgical closure small defects may close spontaneously

6. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
CHF
Harmartoma
Shunt - PGE to maintain PDA until surgical repair can be performed

7. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Systolic dysfx leading to biventricular CHF
S aureus
Reperfusion injury

8. What causes notching of the ribs in adult coarctation of the aorta?
S epidermidis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myocardium
Intercostal arteries enlarged due to collateral circulation

9. What is the basic principle of CHF?
Nitroglycerin
Pericardial effusion due to pericardial involvement
Harmartoma
Pump failure

10. What is a water - hammer pulse?
Doxorubicin - cocaine
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Bounding pulse
Louder - increased systemic resistence decreases LV emptying

11. What tests show prior group A beta - hemolytic strep infection?
Reactive histiocyte with caterpillar nucleus
Elevated ASO anti - DNase B titers
Infectious endocarditis - arrythmias - severe mitral regurg no
Endocardial fibroelastosis (rare)

12. How do ACE inhibitors tx MI?
Rhadbomyoma - benign
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Decreases LV dilation by decreasing volume
Within the first day

13. What cardiac disease is associated with tuberous sclerosis?
Low voltage EKG w/diminished QRS amplitude
Friction rub and chest pain
Asymptomatic
Rhabdomyoma

14. Are most congenital heart defects spontaneous or inherited?
Reactive histiocyte with caterpillar nucleus
Spontaneous
Aneurysm - mural thrombus - Dressler syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)

15. What is the most common congenital heart defect?
Months out fibrosis
Chronic rheumatic heart disease
Inability to maintain systemic pressure w/lack of O2 to vital organs
VSD

16. What is an Aschoff body?
Myxoma - benign
2-3%
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Indomethacin - decreases PGE

17. What drug relieves stable angina?
4-6 hours - 24 hours - 72 hours
MI
PGE
Nitroglycerin

18. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Degree of pulmonary artery stenosis
LAD
Heart transplant
Months out fibrosis

19. What complication occurs 1-3 days post MI?
Small - nondestructive vegetations (subacute endocarditis)
Fibrinous pericarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
When a bacterial protein resembles a protein in human tissue

20. What does rupture of the LV free wall cause?
Type I
Kawasaki disease
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Cardiac tamponade

21. Dilated cardiomyopathy is a late complication of what illness?
Preductal - post aortic arch
LA dilation
Sterile vegetations on surface and undersurface on mitral valve
Myocarditis

22. What are the complications of mitral valve prolapse? Are they common?
Coronary artery vasospasm - emboli - vasculitis
Posterior wall of LV - posterior septum - papillary muscles
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Infectious endocarditis - arrythmias - severe mitral regurg no

23. What are heart failure cells?
Acute inflammation
Hemosiderin laden macrophages
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
PDA

24. Opening snap followed by diastolic rumble.
RHF
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Mitral stenosis
Fetal alcohol syndrome

25. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Shunt
Yellow pallor macrophages
PDA
1-3 days

26. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Sudden cardiac death
1%
Chest pain <20 min brought on by exertion or emotional stress
Coexisting mitral stenosis and fusion of commisures exist

27. What causes acute endocarditis?
Aschoff bodies
Large vegetations of S aureus
Congested central veins
Sterile vegetations on mitral valve along lines of closure

28. What are the Jones criteria?
Circumflex
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
1%
Slow HR - decreasing O2 demand and risk for arrhythmia

29. What areas of the heart does the RCA supply?
Contraction band necrosis - reperfusion injury
Posterior wall of LV - posterior septum - papillary muscles
Nitroglycerin
Friction rub and chest pain

30. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Nitroglycerin
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Rupture of free wall - IV septum - or papillary muscle

31. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
4-24 hours
ASD - R-->L
Ventricles cannot pump
1-3 days

32. What effect does chronic rheumatic heart disease have the mitral valve?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Valve replacement
Thickening of chrodae tendinae and cusps - mitral stenosis
Myocarditis

33. In which chamber of the heart are rhabdomyomas found?
LAD
Ventricle
Aortic regurg
ST- segment depression

34. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Systolic ejection click followed by crescendo - decrescendo murmur
LHF
Rhabdomyoma
Increased hydrostatic pressure

35. What generally causes ischemic heart disease?
RCA
Atherosclerosis of coronary arteries
NG or Ca channel blocker
ST- segment depression

36. What are the forward and backward sx of LHF?
Mitral regurg
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
Cyanosis - RV hypertrophy - polycythemia - clubbing
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

37. What congenital heart defect often is present with infantile coarctation of the aorta?
Increased blood in right heart delays closure of P valve
PDA
Squatting - expiration
Janeway lesions

38. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
4-6 hours - 24 hours - 72 hours
Myofiber hypertrophy with disarray
Gelatinous - abundant ground substance

39. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Prinzmetal
Degree of pulmonary artery stenosis
Tender lesions on fingers or toes.
Dense layer of elastic and fibrotic tissue in the endocardium - children

40. What side of the heart do carcinoid tumors affect? Why?
Opening snap followed by diastolic rumble
S aureus
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Right side - serotonin and other secretory products detoxified in the lung

41. Infects predamaged valves after transient bacteremia?
Type I
4-6 hours - 24 hours - 72 hours
S viridans
Stable angina

42. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
L->R
Mitral valve prolapse
Squatting - expiration
Stable and unstable prinzmetal

43. What are the cancers that most commonly metastasize to the heart?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Breast and lung carcinoma - melanoma - lymphoma
Anitschow cell
1-3 days out

44. Erythematous nontender lesions on palms and soles.
Nitroglycerin
Anterior wall of LV and anterior septum
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Janeway lesions

45. What coronary arterysupplies the lateral wall of the LV?
Infectious endocarditis - arrythmias - severe mitral regurg no
Squat in response to cyanotic spell
Circumflex
S epidermidis

46. How does aortic regurg affect the heart chambers?
Nitroglycerin
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LV dilation and eccentric hypertrophy
Shunt - PGE to maintain PDA until surgical repair can be performed

47. Boot - shaped heart on x- ray?
Stretched muscle loses contractility
Tetralogy of fallot
Asymptomatic
RBC damaged while crossing the calcified valve causing schistocytes

48. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Surgical closure small defects may close spontaneously
CK- MB
Bicuspid aortic valve

49. When would arrhythmia occur after MI?
Within the first day
Annular - non pruritic rash w/erythematous borders trunks and limbs
SLE
Restrictive cardiomyopathy

50. What causes prinzmetal angina?
Slow HR - decreasing O2 demand and risk for arrhythmia
Contraction band necrosis
Dressler syndrome
Coronary artery vasospasm