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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. L- to - R shunt switching to R- to - L shunt.
Congested central veins
Eisenmenger syndrome
Thickening of chrodae tendinae and cusps - mitral stenosis
4-7 days macrophage infiltration

2. What areas of the heart does the LAD supply?
Infantile coarctation of the aorta
Low voltage EKG w/diminished QRS amplitude
Anterior wall of LV and anterior septum
Sterile vegetations on surface and undersurface on mitral valve

3. What is the most common type of ASD? What %?
Degree of pulmonary artery stenosis
Within the first day
Mitral regurgitation due to vegetations
Ostium secundum (90%)

4. What is the most common type of endocarditis?
Limits thrombosis
Bounding pulse
LHF
Infectious

5. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Nitroglycerin
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

6. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Open blocked vessels
Limits thrombosis
Nitroglycerin
Spontaneous

7. Vegetations on surface and undersurface of mitral valve.
When a bacterial protein resembles a protein in human tissue
Blood vessels coming in from normal tissue
Libman - Sacks endocarditis
Ventricle

8. What typically causes hypertrophic cardiomyopathy?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
AD mutation in sarcomere proteins
Left -->right
Infectious endocarditis

9. What does rupture of a papillary muscle cause?
Ostium primum
LV dilation and eccentric hypertrophy
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Mitral insufficiency

10. When is an MI patent at highest risk for fibrionous pericarditis?
Aortic stenosis
1-3 days out
Prinzmetal stable and unstable
ST- segment depression

11. How does squating decrease hypoxemia in tetralogy of fallot?
Increased blood in right heart delays closure of P valve
RCA
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Mitral mitral+aortic

12. What causes wear and tear aortic stenosis?
Large - destructive vegetations
Fibrosis and dystrophic calcification
Right to left
Restrictive cardiomyopathy

13. What are other (not atherosclerotic) causes of MI?
Squatting - expiration
Coronary artery vasospasm - emboli - vasculitis
Volume overload and LHF
Mitral stenosis

14. What is the JOneS mneumonic?
2-4 hours - 24 hours - 7-10 days
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
Large vegetations of S aureus
Right -->left

15. What is Dressler syndrome? When does it occur?
When a bacterial protein resembles a protein in human tissue
Minimizes ischemia
Stretched muscle loses contractility
Autoimmune pericarditis 6-8 wks post MI

16. What vavular defect results from acute rheumatic fever?
Nitroglycerin
ST- segment elevation
Hypertrophic cardiomyopathy
Mitral regurgitation due to vegetations

17. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Myofiber hypertrophy with disarray
Hypercoagulable state or underlying adenocarcinoma
ST- segment depression

18. What structures are susceptible to rupture post MI?
Erythematous nontender lesions on palms and soles.
Paradoxical emboli
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Papillary muscle - free wall - IV septum

19. What congenital heart defect is associated with fetal alcohol syndrome?
Reperfusion injury
Months out fibrosis
VSD
Ischemic heart disease

20. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Infantile coarctation of the aorta PDA
Increased hydrostatic pressure
Streptococcus bovis/

21. How does adult coarctation of the aorta present?
Right to left
Elevated ASO anti - DNase B titers
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
R-->L

22. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
3-8 wks
Infectious endocarditis
2-3%

23. What are the two effects of ATII?
Myofiber hypertrophy with disarray
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Paradoxical emboli
Decrease in blood flow to an organ

24. What is dilated cardiomyopathy?
Doxorubicin - cocaine
S aureus
Dilation of all four chambers of the heart
Stretched muscle loses contractility

25. What is the tx for VSD?
PDA
Surgical closure small defects may close spontaneously
Sterile vegetations on mitral valve along lines of closure
Type I

26. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Intercostal arteries enlarged due to collateral circulation
Maternal diabetes
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

27. How do nitrates tx MI?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Decrease preload -->lowers myocardial stress
Regurg vs stenosis

28. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Autoimmune pericarditis 6-8 wks post MI
Aschoff bodies
Anitschow cell
Myocarditis

29. Which congenital heart defect is associated with congenital rubella?
Cyanosis - RV hypertrophy - polycythemia - clubbing
RBC damaged while crossing the calcified valve causing schistocytes
Backward LHF pulm htn and RHF - afib and associated mural thombis
PDA

30. How does Eisenmeger syndrome occur?
Nitroglycerin
Shunt
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
Mitral mitral+aortic

31. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Tricuspid
S aureus
PDA
Months out fibrosis

32. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Mitral valve prolapse
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Degree of pulmonary artery stenosis

33. Ostium primum ASD is associated with what congenital disorder?
Mitral regurg
RHF
Trisomy 21
Mitral regurg

34. What two things cause coronary artery vasospasm?
Ostium secundum (90%)
RCA
Prinzmetal angina - cocaine
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

35. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Tender lesions on fingers or toes.
Chronic rheumatic heart disease
Mitral stenosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

36. What are the clinical features of RHF?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

37. What is the most common cause of RHF? What are others?
S viridans
Eisenmenger syndrome
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
NG or Ca channel blocker

38. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
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
Chronic ischemic heart disease

39. In transposition of the great vessels - What is required for survival? How is this achieved?
Ventricular arrhythmia
Tender lesions on fingers or toes.
Mitral regurgitation due to vegetations
Shunt - PGE to maintain PDA until surgical repair can be performed

40. Tender lesions on fingers or toes.
Increased hydrostatic pressure
Chronic ischemic heart disease
RBC damaged while crossing the calcified valve causing schistocytes
Osler nodes (ouch - ouch Osler)

41. Which coronary artery supplies the anterior wall and anterior septum?
Prinzmetal stable and unstable
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LAD
Thickening of chrodae tendinae and cusps - mitral stenosis

42. What is an Anitschow cell?
Pancarditis
Reactive histiocyte with caterpillar nucleus
Spontaneous
Backward LHF pulm htn and RHF - afib and associated mural thombis

43. With what virus is PDA associated?
Day 1-7
L->R
Congenital rubella
Rupture of free wall - IV septum - or papillary muscle

44. What heart sound manifest with an ASD?
Large - destructive vegetations
VSD
Split S2 on auscultation
Streptococcus bovis/

45. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Contraction band necrosis
4-7 days macrophage infiltration
S aureus

46. In which chamber of the heart are rhabdomyomas found?
Infantile coarctation of the aorta PDA
Membrane damage
Ventricle
CK- MB

47. Which congenital heart defect is associated with maternal diabetes?
1-3 days out
Transposition of the great vessels
Heart transplant
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

48. When do macrophagess infiltrate the myocardium post MI?
Sterile vegetations on mitral valve along lines of closure
RCA
Troponin I
4-7 days

49. What is the basic principle of CHF?
Pump failure
4-7 days
Mitral regurg
Decrease preload -->lowers myocardial stress

50. In which chamber of the heart are cardiac myxomas found?
LA
Endocarditis of prosthetic valves
AD mutation in sarcomere proteins
Positive blood cultures anemia of chronic disease