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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 a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Migratory polyarthritis
Friction rub and chest pain
Coexisting mitral stenosis and fusion of commisures exist

2. Which angina is relieved by Ca channel blockers?
Prinzmetal angina - cocaine
Gelatinous - abundant ground substance
Prinzmetal
Streptococcus viridans

3. What characterizes acute rheumatic fever endocarditiis?
Sterile vegetations on surface and undersurface on mitral valve
MI
Small vegetations along the line of closure
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

4. What are the complications of mitral stenosis?
Nitroglycerin
Backward LHF pulm htn and RHF - afib and associated mural thombis
Small vegetations along the line of closure
LA

5. What maintains patency of the PDA?
PGE
Restrictive cardiomyopathy
Infectious endocarditis - arrythmias - severe mitral regurg no
Pts w/previously damaged valves

6. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Troponin I
MI
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

7. What is the murmur of mitral regurg?
Harmartoma
Type I
Reversible
Holosystolic blowing murmur

8. What iis the tx for aortic regurg?
Eisenmenger syndrome
Valve replacement once LV dysfx develops
Left -->right
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

9. What is the basic principle of CHF?
Dilated
1-3 days out
Holosystolic machine like murmur
Pump failure

10. What type of ASD is associated w/Down syndrome?
Ostium primum
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Nonspecific - eg fever and elevated ESR
Nonbacterial thrombotic endocarditis (marantic endocarditis)

11. What effect does chronic rheumatic heart disease have the mitral valve?
ST- segment elevation
Myxoma - benign
Thickening of chrodae tendinae and cusps - mitral stenosis
Valve replacement

12. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Atherosclerosis of coronary arteries
Louder - increased systemic resistence decreases LV emptying
Circumflex
ACE inhibitor

13. How does hypertension cause LHF?

14. What causes the split S2 in ASD?
Migratory polyarthritis
Increased blood in right heart delays closure of P valve
Aortic regurg
Autoimmune pericarditis 6-8 wks post MI

15. What endocarditis is commonly found in patients with colon cancer?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ostium primum
Dressler syndrome
Streptococcus bovis/

16. Erythematous nontender lesions on palms and soles.
Troponin I
Janeway lesions
Heart transplant
Stable angina

17. What is the tx for dilated cardiomyopathy?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Ischemic heart disease
Harmartoma
Heart transplant

18. What is the 1day-1wk -1mo mneumonic for MI?
Infantile coarctation of the aorta
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
NG or Ca channel blocker
Mid - systolic click followed by regurgitation murmur

19. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
LA dilation
Coxsackie A or B
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

20. What tests show prior group A beta - hemolytic strep infection?
Mitral valve prolapse
LAD
4-7 days
Elevated ASO anti - DNase B titers

21. How do you prevent S viridans endocarditis?
Rupture of free wall - IV septum - or papillary muscle
Prophylactic abx during dental procedures
ST- segment depression
Cardiac tamponade

22. Which congenital heart defect is associated with congenital rubella?
Indomethacin - decreases PGE
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
PDA

23. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Infantile coarctation of the aorta
Congestive heart failure
Loss of LV fx

24. When does the heart have a yellow pallor post MI?
Mid - systolic click followed by regurgitation murmur
Day 1-7
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Tetralogy of fallot

25. How do nitrates tx MI?
IV drug users
Mid - systolic click followed by regurgitation murmur
PGE
Decrease preload -->lowers myocardial stress

26. What is the main cause of MV regurg? What are other causes?
Contraction band necrosis - reperfusion injury
Positive blood cultures anemia of chronic disease
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
R-->L

27. What are the causes of LHF?
Systemic venous congestion
Sterile vegetations on mitral valve along lines of closure
Months out fibrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

28. What is an Aschoff body?
Fetal alcohol syndrome
CHF
Squatting - increased systemic resistence decreases LV emptying
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

29. What causes mitral valve prolapse?
Myxoid degeneration
Fibrinous pericarditis
Systolic ejection click followed by crescendo - decrescendo murmur
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

30. What valves are most commonly involved in chronic rheumatic heart disease?
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
Surgical closure small defects may close spontaneously
Mitral mitral+aortic
Shunt

31. What causes prinzmetal angina?
Contraction band necrosis - reperfusion injury
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Regurg vs stenosis
Coronary artery vasospasm

32. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Aneurysm - mural thrombus - Dressler syndrome
Reversible
Wear and tear

33. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Holosystolic blowing murmur
Dilated
VSD

34. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Aortic regurg
ASD - R-->L
Rhabdomyoma
Endocardial fibroelastosis (rare)

35. What effect does aortic regurg have on the pulse pressure? Why?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Surgical closure small defects may close spontaneously

36. What is molecular mimicry?
Yellow pallor macrophages
S viridans
When a bacterial protein resembles a protein in human tissue
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

37. What are the clinical features of LHF due to?
Ostium primum
2-4 hours - 24 hours - 7-10 days
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Decreased forward perfusion pulmonary congestion

38. What causes acute endocarditis?
RCA
Valve replacement once LV dysfx develops
Large vegetations of S aureus
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

39. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Myxoid degeneration
Dressler syndrome
PDA

40. What is the most common cause of death during the acute phase of rheumatic fever?
RCA
ASD - R-->L
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myocarditis

41. What drug relieves stable angina?
Squatting - increased systemic resistence decreases LV emptying
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Nitroglycerin
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

42. How does restrictive cardiomyopathy present?
Papillary muscle - free wall - IV septum
Granulation tissue
Congestive heart failure
Plump fibroblasts - collagen - blood vessels

43. Which coronary artery supplies the anterior wall and anterior septum?
Coronary artery vasospasm
Nonspecific - eg fever and elevated ESR
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LAD

44. How does restrictive cardiomyopathy cause LHF?

45. With what virus is PDA associated?
LA dilation
Sudden cardiac death
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Congenital rubella

46. What is the rate of congenital heart defects?
1%
Fetal alcohol syndrome
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
LAD

47. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Ehlers - Danlow and Marfan syndrome
Low voltage EKG w/diminished QRS amplitude
Anitschow cell
Squatting - expiration

48. With what condition are rhabdomyomas associated?
Endocardial fibroelastosis (rare)
Annular - non pruritic rash w/erythematous borders trunks and limbs
LAD
Tuberous sclerosis

49. What is systolic dysfx?
Circumflex
Ventricles cannot pump
Coronary artery vasospasm - emboli - vasculitis
Nonspecific - eg fever and elevated ESR

50. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Dilation of all four chambers of the heart
IV drug users
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes