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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 are the causes of LHF?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Janeway lesions
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Nonbacterial thrombotic endocarditis (marantic endocarditis)

2. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Tricuspid
PDA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

3. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Systolic ejection click followed by crescendo - decrescendo murmur
Pericardial effusion due to pericardial involvement
Holosystolic machine like murmur

4. What is the main cause of MV regurg? What are other causes?
Infectious endocarditis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Restrictive cardiomyopathy
2-4 hours - 24 hours - 7-10 days

5. When is an MI patent at highest risk for fibrionous pericarditis?
Open blocked vessels
IV drug users
2-4 hours - 24 hours - 7-10 days
1-3 days out

6. What type of shunt does transposition of the great vessels cause?
R-->L
Ventricular arrhythmia
S viridans
Louder - increased systemic resistence decreases LV emptying

7. What causes a mid - systolic click followed by a regurgitation murmur?
Heart can't fill
Within the first day
Intercostal arteries enlarged due to collateral circulation
Mitral valve prolapse

8. What type of shunt does a VSD cause?
L->R
Left -->right
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

9. What causes the split S2 in ASD?
Metastasis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Infectious endocarditis - arrythmias - severe mitral regurg no
Increased blood in right heart delays closure of P valve

10. What bug causes acute rheumatic fever?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dressler syndrome
Group A beta - hemolytic streptococci

11. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Squatting - increased systemic resistence decreases LV emptying
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Systolic dysfx leading to biventricular CHF

12. What is the classic EKG finding of restrictive cardiomyopathy?
Fibrosis and dystrophic calcification
Prinzmetal angina - cocaine
Low voltage EKG w/diminished QRS amplitude
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

13. What are the sx of pericardiits?
Libman - Sacks endocarditis
Friction rub and chest pain
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Asymptomatic

14. Erythematous nontender lesions on palms and soles.
Janeway lesions
Asymptomatic
Anitschow cell
Atherosclerosis of coronary arteries

15. What is endocardial fibroelastosis? In what population is it found?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Sterile vegetations on mitral valve along lines of closure
Nitroglycerin
Dense layer of elastic and fibrotic tissue in the endocardium - children

16. What is the tx for VSD?
Thickening of chrodae tendinae and cusps - mitral stenosis
45%
Surgical closure small defects may close spontaneously
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

17. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
Atria and RV
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Left -->right

18. What gross and microscopic changes occur months after an MI?
When a bacterial protein resembles a protein in human tissue
White scar fibrosis
Valve replacement AFTER the onset of complications
S epidermidis

19. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Infantile coarctation of the aorta
Kawasaki disease
Restrictive cardiomyopathy

20. What is Dressler syndrome? When does it occur?
Infantile coarctation of the aorta
Cyanosis - RV hypertrophy - polycythemia - clubbing
Autoimmune pericarditis 6-8 wks post MI
Small vegetations along the line of closure

21. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Holosystolic machine like murmur
Ventricular arrhythmia
Shunt

22. What are the complications of mitral stenosis?
Valve replacement once LV dysfx develops
Type I
2-3%
Backward LHF pulm htn and RHF - afib and associated mural thombis

23. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Acute inflammation
Streptococcus viridans

24. What are the complications that occur months after an MI?
Paradoxical emboli
Aneurysm - mural thrombus - Dressler syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia
Acute inflammation

25. Large vegetations on tricuspid valve?
CK- MB
2-3%
Red border granulation tissue
S aureus

26. What is the most common cause of myocarditis?
Coxsackie A or B
Dark discoloration coagulative necrosis
Ventricles cannot pump
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

27. Poor myocardial fx due to chronic ischemic damage?
Mitral mitral+aortic
Circumflex
Chronic ischemic heart disease
Decreases LV dilation by decreasing volume

28. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Prinzmetal angina
PDA
Bacterial endocarditis
4-24 hours

29. What is the most common cause of dilated cardiomyopathy? What are other causes?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Left -->right
Coronary artery vasospasm
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

30. How does subendocardial MI/ischemia present on EKG?
Prinzmetal stable and unstable
ST- segment depression
Hypertrophic cardiomyopathy
Left -->right

31. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Infectious
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Breast and lung carcinoma - melanoma - lymphoma
Nonbacterial thrombotic endocarditis (marantic endocarditis)

32. With what disease is Libman - Sacks endocarditis associated?
R-->L
Coronary artery vasospasm
SLE
1-3 days out

33. What is the most common cause of aortic stenosis?
Intercostal arteries enlarged due to collateral circulation
Colon cancer
Wear and tear
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

34. What is the murmur of mitral regurg?
Increased hydrostatic pressure
Holosystolic blowing murmur
Ventricle
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

35. How do beta blockers tx MI?
S aureus
Slow HR - decreasing O2 demand and risk for arrhythmia
Squatting - increased systemic resistence decreases LV emptying
Tetralogy of fallot

36. How do you prevent S viridans endocarditis?
Rhabdomyoma
Acute inflammation
Prophylactic abx during dental procedures
Degree of pulmonary artery stenosis

37. How does dilated cardiomyopathy cause LHF?
Yellow pallor macrophages
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
RCA
Stretched muscle loses contractility

38. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
LV dilation and eccentric hypertrophy
Increased blood in right heart delays closure of P valve
Pedunculated mass in the LA that causes syncope due to obstruction of MV

39. What effect does chronic rheumatic heart disease have the mitral valve?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Thickening of chrodae tendinae and cusps - mitral stenosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
4-7 days

40. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Blood vessels coming in from normal tissue
1%
Autoimmune pericarditis 6-8 wks post MI

41. What is the cause of restrictive cardiomyopathy in children?
Pancarditis
NG or Ca channel blocker
Endocardial fibroelastosis (rare)
LA

42. How does restrictive cardiomyopathy present?
Maternal diabetes
Congestive heart failure
Endocardial fibroelastosis (rare)
Mitral mitral+aortic

43. When is an MI pt at greatest risk for cardiogenic shock?
Turner syndrome
Aortic stenosis
First 4 hours
Prinzmetal angina

44. What does rupture of a papillary muscle cause?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Chronic ischemic heart disease
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral insufficiency

45. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Reactive histiocyte with caterpillar nucleus
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

46. What type of collagen is involved in fibrosis?
Type I
Prinzmetal angina - cocaine
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
Transposition of the great vessels

47. What is a water - hammer pulse?
Eisenmenger syndrome
Bounding pulse
Chronic rheumatic heart disease
Erythematous nontender lesions on palms and soles.

48. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
LHF
RCA
ACE inhibitor

49. How does hypertension cause LHF?

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50. What causes wear and tear aortic stenosis?
Systemic venous congestion
Fibrosis and dystrophic calcification
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
PDA