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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 determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Turner syndrome
Myofiber hypertrophy with disarray
Infantile coarctation of the aorta PDA

2. What are the sx of aortic regurg?
Dilated
Reactive histiocyte with caterpillar nucleus
Left -->right
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

3. What valves are involved in rhuematic endocarditis?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Congested central veins
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Mitral mitral+aortic

4. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Tetralogy of fallot
NG or Ca channel blocker
Dense layer of elastic and fibrotic tissue in the endocardium - children

5. What is the most common type of endocarditis?
Infectious
NG or Ca channel blocker
Janeway lesions
Valve replacement

6. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Sterile vegetations on mitral valve along lines of closure
Colon cancer
Tricuspid
Aschoff bodies

7. What is the characteristic murmur of aortic stenosis?
Intercostal arteries enlarged due to collateral circulation
Nitroglycerin
Hypertrophic cardiomyopathy
Systolic ejection click followed by crescendo - decrescendo murmur

8. What artery is the 2nd most often occluded in an MI?
RCA
Hypertrophic cardiomyopathy
LV dilation and eccentric hypertrophy
Surgical closure small defects may close spontaneously

9. How does adult coarctation of the aorta present?
RCA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Valve scarring that arises as a consequence of rheumatic fever
ACE inhibitor

10. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
LHF
Nitroglycerin
Valve scarring that arises as a consequence of rheumatic fever

11. What is diastolic dysfx?
Inability to fill ventricles
R-->L
Left -->right
Fibrinous pericarditis

12. What causes notching of the ribs in adult coarctation of the aorta?
S aureus
Intercostal arteries enlarged due to collateral circulation
Low voltage EKG w/diminished QRS amplitude
Adult coarctation of the aorta

13. What are the tx for MI?
NG or Ca channel blocker
Rhabdomyoma
Pericarditits
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

14. What areas of the heart does the LAD supply?
Decreases LV dilation by decreasing volume
Anterior wall of LV and anterior septum
Tender lesions on fingers or toes.
Bounding pulse

15. What is migratory polyarthritis?
Ischemic heart disease
Blood vessels coming in from normal tissue
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Cardiac tamponade

16. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Within the first day
Coexisting mitral stenosis and fusion of commisures exist
CHF

17. How does asprin/heparin tx MI?
LV dilation and eccentric hypertrophy
PDA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Limits thrombosis

18. What coronary arterysupplies the lateral wall of the LV?
Circumflex
LV dilation and eccentric hypertrophy
Positive blood cultures anemia of chronic disease
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

19. What are the sx of hypertrophic cardiomyopathy?
Metastasis
Libman - Sacks endocarditis
Loss of LV fx
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

20. What causes the nutmeg color in nutmeg liver?
Congested central veins
Plump fibroblasts - collagen - blood vessels
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

21. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Holosystolic machine like murmur
VSD
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

22. Are most congenital heart defects spontaneous or inherited?
Decreases LV dilation by decreasing volume
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Spontaneous
Ventricles cannot pump

23. What is the most common cause of myocarditis?
Janeway lesions
Coxsackie A or B
Mitral regurg
Dense layer of elastic and fibrotic tissue in the endocardium - children

24. What are the causes of LHF?
2-3 weeks
R-->L
Cardiac tamponade
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

25. What typically causes hypertrophic cardiomyopathy?
Endocardial fibroelastosis (rare)
AD mutation in sarcomere proteins
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Acute inflammation

26. In which chamber of the heart are cardiac myxomas found?
R-->L
Boot shaped heart
LA
Infectious endocarditis - arrythmias - severe mitral regurg no

27. How does stable angina present?
Mitral stenosis
Increased blood in right heart delays closure of P valve
Chest pain <20 min brought on by exertion or emotional stress
Pericardial effusion due to pericardial involvement

28. What are the sx of PDA at birth?
Mitral mitral+aortic
Asymptomatic
Bicuspid aortic valve
Hypercoagulable state or underlying adenocarcinoma

29. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
L->R
Libman - Sacks endocarditis
Rupture of free wall - IV septum - or papillary muscle

30. Low voltage EKG w/diminished QRS amplitude.
Right -->left
LA dilation
2-3 weeks
Restrictive cardiomyopathy

31. What is the most common type of ASD? What %?
Dilation of all four chambers of the heart
1%
Ostium secundum (90%)
Shunt - PGE to maintain PDA until surgical repair can be performed

32. What is the murmur of mitral regurg?
Mitral insufficiency
1%
LAD
Holosystolic blowing murmur

33. What effect does dilated cardiomyopathy have on the heart?
ASD - R-->L
RCA
Systolic dysfx leading to biventricular CHF
Aortic regurg

34. What are the complications that occur months after an MI?
Contraction band necrosis - reperfusion injury
PDA
Aneurysm - mural thrombus - Dressler syndrome
Autoimmune pericarditis 6-8 wks post MI

35. What are the clinical features of endocarditis? What causes each feature?
Dilation of all four chambers of the heart
L->R
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
Large vegetations of S aureus

36. How does O2 tx MI?
Minimizes ischemia
Plump fibroblasts - collagen - blood vessels
Inability to fill ventricles
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

37. What causes angina and syncope in aortic stenosis?

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38. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Within the first day
Congested central veins
Louder - increased systemic resistence decreases LV emptying
Tuberous sclerosis

39. What gross and microscopic changes occur 4-7 days after an MI?
Type I
Months out fibrosis
Aneurysm - mural thrombus - Dressler syndrome
Yellow pallor macrophages

40. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Decrease in blood flow to an organ
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infectious endocarditis - arrythmias - severe mitral regurg no

41. What is the effect of mitral regurg on the heart?
Positive blood cultures anemia of chronic disease
4-24 hours
Mitral regurgitation due to vegetations
Volume overload and LHF

42. Vegetations on surface and undersurface of mitral valve.
Pump failure
Type I
3-8 wks
Libman - Sacks endocarditis

43. What are complications of dilated cardiomyopathy?
Doxorubicin - cocaine
Mitral and tricuspid regurg - arrhythmia
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

44. Erythematous nontender lesions on palms and soles.
2-3 weeks
Rhabdomyoma
Janeway lesions
Osler nodes (ouch - ouch Osler)

45. What is the gold standard blood marker for MI?
Aortic regurg
Small - nondestructive vegetations (subacute endocarditis)
Troponin I
When a bacterial protein resembles a protein in human tissue

46. What is the etiology of S viridans endocarditis?
Thickening of chrodae tendinae and cusps - mitral stenosis
Tetralogy of fallot
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Endocardial fibroelastosis (rare)

47. What always follows necrosis?
Small - nondestructive vegetations (subacute endocarditis)
Troponin I
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Acute inflammation

48. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Myxoma - benign
Months out fibrosis
Coexisting mitral stenosis and fusion of commisures exist

49. Which congenital heart defect is associated with congenital rubella?
Infantile coarctation of the aorta PDA
Friction rub and chest pain
Decreases LV dilation by decreasing volume
PDA

50. What cardiac enzyme is useful for detecting reinfarction?
Group A beta - hemolytic streptococci
Turner syndrome
CK- MB
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations