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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 eythema marginatum? What parts of the body does it commonly involve?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Infectious endocarditis - arrythmias - severe mitral regurg no
Large vegetations of S aureus

2. Large vegetations on tricuspid valve?
Inability to maintain systemic pressure w/lack of O2 to vital organs
S aureus
2-3 weeks
Cyanosis - RV hypertrophy - polycythemia - clubbing

3. What is the characteristic finding on CXR in tetralogy of fallot?
Limits thrombosis
Boot shaped heart
Thickening of chrodae tendinae and cusps - mitral stenosis
S aureus

4. What is the most common cause of death during the acute phase of rheumatic fever?
Asymptomatic
Myocarditis
Transposition of the great vessels
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

5. What is migratory polyarthritis?
Months out fibrosis
Circumflex
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Tender lesions on fingers or toes.

6. What are the complications of mitral stenosis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Backward LHF pulm htn and RHF - afib and associated mural thombis
Low voltage EKG w/diminished QRS amplitude

7. What is the JOneS mneumonic?
S viridans
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
>60 years - bicuspid aortic valve
Rhabdomyoma

8. What is the most common type of endocarditis?
Infectious
Louder - increased systemic resistence decreases LV emptying
Contraction band necrosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

9. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Transesophageal echo
Wear and tear
Reperfusion injury

10. Which artery is most often occluded in an MI?
>60 years - bicuspid aortic valve
Chest pain <20 min brought on by exertion or emotional stress
LAD
Concentric LV hypertophy

11. Poor myocardial fx due to chronic ischemic damage?
Paradoxical emboli
Right side - serotonin and other secretory products detoxified in the lung
Prinzmetal
Chronic ischemic heart disease

12. What two things cause coronary artery vasospasm?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Prinzmetal angina - cocaine
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pedunculated mass in the LA that causes syncope due to obstruction of MV

13. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Stable angina
S epidermidis
Heart transplant

14. When do troponin levels rise - peak - and return to normal?
S aureus
2-4 hours - 24 hours - 7-10 days
45%
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

15. When would arrhythmia occur after MI?
First 4 hours
Heart can't fill
Trisomy 21
Within the first day

16. What is dilated cardiomyopathy?
Mitral stenosis
Dilation of all four chambers of the heart
MI
Tuberous sclerosis

17. What is the most common type of ASD? What %?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Holosystolic blowing murmur
Ostium secundum (90%)
4-6 hours - 24 hours - 72 hours

18. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Left -->right
Rhabdomyoma
Infantile coarctation of the aorta
Loeffler syndrome

19. What increases the risk for chronic rheumatic heart disease?
Squatting - expiration
Prinzmetal angina - cocaine
Prophylactic abx during dental procedures
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

20. What is the gold standard blood marker for MI?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Troponin I
RCA
Red border granulation tissue

21. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Ventricular arrhythmia
Nitroglycerin
Bicuspid aortic valve

22. What are heart failure cells?
Loss of LV fx
Eisenmenger syndrome
Hemosiderin laden macrophages
Annular - non pruritic rash w/erythematous borders trunks and limbs

23. What endocarditis is commonly found in patients with colon cancer?
Sterile vegetations on surface and undersurface on mitral valve
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
Streptococcus bovis/
Loeffler syndrome

24. How does MI cause LHF?
L->R
Loss of LV fx
Transesophageal echo
IV drug users

25. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Dressler syndrome
Yellow pallor macrophages
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

26. What are other (not atherosclerotic) causes of MI?
SLE
Myofiber hypertrophy with disarray
Coronary artery vasospasm - emboli - vasculitis
Reperfusion injury

27. What are the sx of pericardiits?
Decreases LV dilation by decreasing volume
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Friction rub and chest pain
Nitroglycerin

28. What are the major criteria of the Jones criteria?
Chest pain <20 min brought on by exertion or emotional stress
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Heart can't fill
Pump failure

29. What % of MIs involve the LAD?
45%
Reperfusion injury
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
Systemic venous congestion

30. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral and tricuspid regurg - arrhythmia
Streptococcus bovis/
Trisomy 21

31. Vegetations on surface and undersurface of mitral valve.
Congested central veins
Libman - Sacks endocarditis
Ostium primum
Left -->right

32. What % stenosis causes stable angina?
Aortic stenosis
>70%
Pancarditis
Chest pain <20 min brought on by exertion or emotional stress

33. In what pt population does S aureus commonly cause valvular disease?
Coexisting mitral stenosis and fusion of commisures exist
Boot shaped heart
IV drug users
VSD

34. Dense layer of elastic and fibrotic tissue in the endocardium.
Subendocardial
Months out fibrosis
Endocardial fibroelastosis
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

35. What does chronic ischemic heart disease progress to?
Posterior wall of LV - posterior septum - papillary muscles
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
CHF
RCA

36. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Wear and tear
Left -->right
Prinzmetal angina
Mid - systolic click followed by regurgitation murmur

37. Infects predamaged valves after transient bacteremia?
Circumflex
S viridans
Metastasis
Tetralogy of fallot

38. Pericarditis 6-8 wks post MI.
Dressler syndrome
Yellow pallor neutrophils
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
1%

39. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Heart can't fill
Congestive heart failure
Systolic dysfx leading to biventricular CHF

40. What is the major cause of MI?
Dilation of all four chambers of the heart
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Posterior wall of LV - posterior septum - papillary muscles
45%

41. What complications occur within 4 hrs post MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Cardiogenic shock - CHF - arrhythmia
Chest pain <20 min brought on by exertion or emotional stress
RCA

42. What are the Jones criteria?
Months out fibrosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Slow HR - decreasing O2 demand and risk for arrhythmia
LAD

43. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Contraction band necrosis - reperfusion injury
Breast and lung carcinoma - melanoma - lymphoma
Dilation of all four chambers of the heart

44. What valves are most commonly involved in chronic rheumatic heart disease?
Sterile vegetations on surface and undersurface on mitral valve
Posterior wall of LV - posterior septum - papillary muscles
Mitral mitral+aortic
Right -->left

45. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Coexisting mitral stenosis and fusion of commisures exist
ST- segment depression
Louder - increased systemic resistence decreases LV emptying
2-4 hours - 24 hours - 7-10 days

46. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Hypercoagulable state or underlying adenocarcinoma
Libman - Sacks endocarditis
Valve replacement AFTER the onset of complications

47. What vavular defect results from acute rheumatic fever?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
CK- MB
Mitral regurgitation due to vegetations
Left -->right

48. What causes an early - blowing diastolic murmur?
4-7 days macrophage infiltration
Aortic regurg
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Pancarditis

49. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Type I
Inability to maintain systemic pressure w/lack of O2 to vital organs
Autoimmune pericarditis 6-8 wks post MI

50. What two things happen when a blocked vessel is opened after an MI?
CK- MB
Contraction band necrosis - reperfusion injury
Prophylactic abx during dental procedures
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR