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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. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Pancarditis
LHF
Chest pain <20 min brought on by exertion or emotional stress
Anitschow cell

2. Which artery is most often occluded in an MI?
PDA
Myocarditis
LAD
Myxoid degeneration

3. What is the most common valve infected by S aureus?
Tricuspid
Streptococcus bovis/
Transesophageal echo
Plump fibroblasts - collagen - blood vessels

4. What is the major cause of MI?
>60 years - bicuspid aortic valve
Boot shaped heart
Loss of LV fx
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

5. What is the characteristic finding on CXR in tetralogy of fallot?
IV drug users
LAD
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
Boot shaped heart

6. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
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
Pulsating nail bed
Stable angina
Fibrosis and dystrophic calcification

7. What causes angina and syncope in aortic stenosis?

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8. What is the foundation of a scar?
Squatting - increased systemic resistence decreases LV emptying
Granulation tissue
Cardiac tamponade
Valve replacement once LV dysfx develops

9. What type of shunt does transposition of the great vessels cause?
Rupture of free wall - IV septum - or papillary muscle
R-->L
Transposition of the great vessels
Bacterial endocarditis

10. What are the causes of restrictive cardiomyopathy in adults?
Mitral regurg
S epidermidis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

11. What does granulation tissue contain?
Streptococcus bovis/
Ostium secundum (90%)
Contraction band necrosis
Plump fibroblasts - collagen - blood vessels

12. What causes the split S2 in ASD?
45%
Chest pain <20 min brought on by exertion or emotional stress
Increased blood in right heart delays closure of P valve
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

13. Which vasculitis can cause MI?
Hypertrophic cardiomyopathy
Kawasaki disease
Infantile coarctation of the aorta
Thickening of chrodae tendinae and cusps - mitral stenosis

14. When does the heart have dark discoloration post MI?
45%
Pts w/previously damaged valves
4-24 hours
Osler nodes (ouch - ouch Osler)

15. What is the tx for aortic stenosis?
When a bacterial protein resembles a protein in human tissue
Slow HR - decreasing O2 demand and risk for arrhythmia
Contraction band necrosis
Valve replacement AFTER the onset of complications

16. What does rupture of a papillary muscle cause?
Systolic dysfx leading to biventricular CHF
Mitral insufficiency
Anterior wall of LV and anterior septum
Aortic stenosis

17. What is the most common form of cardiomyopathy?
Reperfusion injury
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Dilated
CHF

18. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
AD mutation in sarcomere proteins
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Aschoff bodies
Pericarditits

19. What is the gross and microscopic appearance of cardiac myxomas?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Gelatinous - abundant ground substance
Hypertrophic cardiomyopathy

20. What creates the immune reaction in acute rhuematic fever?

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21. In which chamber of the heart are cardiac myxomas found?
Restrictive cardiomyopathy
Gelatinous - abundant ground substance
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
LA

22. What is the characteristic murmurr of mitral stenosis?
Dark discoloration coagulative necrosis
Acute inflammation
Opening snap followed by diastolic rumble
Endocardial fibroelastosis (rare)

23. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
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
Low voltage EKG w/diminished QRS amplitude
Valve scarring that arises as a consequence of rheumatic fever

24. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Mitral insufficiency
Inability to maintain systemic pressure w/lack of O2 to vital organs
Rhadbomyoma - benign
LAD

25. What effect does aortic stenosis have on the chambers of the heart?
Intercostal arteries enlarged due to collateral circulation
Valve replacement AFTER the onset of complications
RCA
Concentric LV hypertophy

26. What is the most common cause of myocarditis?
Ventricular arrhythmia
Adult coarctation of the aorta
Congenital rubella
Coxsackie A or B

27. How does transmural MI/ischemia present on EKG?
4-24 hours
ST- segment elevation
Prophylactic abx during dental procedures
Coxsackie A or B

28. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Hemosiderin laden macrophages
>60 years - bicuspid aortic valve
Prinzmetal stable and unstable

29. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Tricuspid
LAD
Sterile vegetations on mitral valve along lines of closure

30. Which coronary artery supplies the anterior wall and anterior septum?
Sterile vegetations on surface and undersurface on mitral valve
LAD
PDA
Hypertrophic cardiomyopathy

31. What is a water - hammer pulse?
SLE
LA dilation
Bounding pulse
Cyanosis - RV hypertrophy - polycythemia - clubbing

32. What are the sx of cardiac myxoma?
Colon cancer
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Pedunculated mass in the LA that causes syncope due to obstruction of MV

33. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
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
Pedunculated mass in the LA that causes syncope due to obstruction of MV
2-4 hours - 24 hours - 7-10 days

34. What are the clinical features of LHF due to?
Nitroglycerin
Reversible
Decreased forward perfusion pulmonary congestion
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

35. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Breast and lung carcinoma - melanoma - lymphoma
Restrictive cardiomyopathy
Dressler syndrome

36. What coronary artery supplies the mitral valve papillary muscles?
Reperfusion injury
Increased blood in right heart delays closure of P valve
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
RCA

37. What type of shunt results in cyanosis at birth?
Ostium primum
Large vegetations of S aureus
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Right to left

38. What is the most common cause of endocarditis in IV drug users?
Infantile coarctation of the aorta
Dense layer of elastic and fibrotic tissue in the endocardium - children
LA
S aureus

39. Sudden death in a young athlete.
20 min
Hypertrophic cardiomyopathy
Streptococcus viridans
White scar fibrosis

40. What causes endocarditis of prosthetic valves?
Prinzmetal stable and unstable
S epidermidis
Bounding pulse
Elevated ASO anti - DNase B titers

41. With what condition are rhabdomyomas associated?
Bicuspid aortic valve
Squatting - increased systemic resistence decreases LV emptying
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Tuberous sclerosis

42. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Wear and tear
Minimizes ischemia
Rupture of free wall - IV septum - or papillary muscle

43. Lower extremity cyanosis in infants? In adults?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Squatting - expiration
Infantile coarctation of the aorta PDA

44. How do you tx prinzmetal angina?
NG or Ca channel blocker
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Myofiber hypertrophy with disarray
Janeway lesions

45. What heart sound manifest with an ASD?
Chronic rheumatic heart disease
Within the first day
Split S2 on auscultation
Harmartoma

46. What causes heart failure cells?
Myxoid degeneration
Reperfusion injury
Reversible
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

47. What congenital heart defect presents later in life with lower extremity cyanosis?
Libman - Sacks endocarditis
PDA
Endocarditis of prosthetic valves
Increased hydrostatic pressure

48. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

49. Lower extremity cyanosis later in life - holostystolic machine like murmur.
RBC damaged while crossing the calcified valve causing schistocytes
First 4 hours
Volume overload and LHF
PDA

50. What is the cause of restrictive cardiomyopathy in children?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Endocardial fibroelastosis (rare)
Ischemic heart disease
>60 years - bicuspid aortic valve