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Cardiac

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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 creates the immune reaction in acute rhuematic fever?

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2. In which pts does S viridans cause endocarditits?
Infantile coarctation of the aorta
White scar fibrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pts w/previously damaged valves

3. What does nonbacterial thrombotic endocarditis cause?
PDA
Transposition of the great vessels
Mitral regurg
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

4. What is the JOneS mneumonic?
Inability to maintain systemic pressure w/lack of O2 to vital organs
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
Dilated
Ventricle

5. What is the most common cause of mitral stenosis?
Doxorubicin - cocaine
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Streptococcus bovis/
Chronic rheumatic heart disease

6. What are the sx of right - to - left shunt?
Pts w/previously damaged valves
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Cyanosis - RV hypertrophy - polycythemia - clubbing
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

7. How does restrictive cardiomyopathy present?
Congestive heart failure
Opening snap followed by diastolic rumble
Regurg vs stenosis
RBC damaged while crossing the calcified valve causing schistocytes

8. What is the cause of restrictive cardiomyopathy in children?
NG or Ca channel blocker
Stable angina
Valve replacement
Endocardial fibroelastosis (rare)

9. What is the most common cause of infectious endocarditis?
Infantile coarctation of the aorta
Reversible
Valve scarring that arises as a consequence of rheumatic fever
Streptococcus viridans

10. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Systolic ejection click followed by crescendo - decrescendo murmur
Within the first day
Group A beta - hemolytic streptococci

11. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Aschoff bodies
Slow HR - decreasing O2 demand and risk for arrhythmia

12. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Shunt - PGE to maintain PDA until surgical repair can be performed
Nitroglycerin
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

13. EKG for stable angina?
Aschoff bodies
Thickening of chrodae tendinae and cusps - mitral stenosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
ST- segment depression

14. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Sterile vegetations on surface and undersurface on mitral valve
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
MI
Inability to maintain systemic pressure w/lack of O2 to vital organs

15. What are Janeway lesions?
Valve replacement AFTER the onset of complications
Dilation of all four chambers of the heart
Erythematous nontender lesions on palms and soles.
Papillary muscle - free wall - IV septum

16. What drug relieves stable angina?
Ostium primum
Nitroglycerin
Loeffler syndrome
Prinzmetal angina - cocaine

17. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Chronic rheumatic heart disease
Valve replacement
Aortic regurg

18. What is the major cause of MI?
Mitral stenosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Concentric LV hypertophy
Anterior wall of LV and anterior septum

19. What does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
Bacterial endocarditis
Months out fibrosis
Ostium primum

20. What are Osler nodes?
Tender lesions on fingers or toes.
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Blood vessels coming in from normal tissue
Chronic rheumatic heart disease

21. When do troponin levels rise - peak - and return to normal?
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
2-4 hours - 24 hours - 7-10 days
PDA

22. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Stable and unstable prinzmetal
AD mutation in sarcomere proteins
Small - nondestructive vegetations (subacute endocarditis)

23. Which chambers of the heart are generally spared in an MI?
Heart transplant
Atria and RV
PGE
Pericardial effusion due to pericardial involvement

24. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Coronary artery vasospasm - emboli - vasculitis
Months out fibrosis
Pericardial effusion due to pericardial involvement

25. What are the clinical features of LHF due to?
Blood vessels coming in from normal tissue
Decreased forward perfusion pulmonary congestion
Shunt
Limits thrombosis

26. What causes microangiopathic hemolytic anemia in aortic stenosis?
Transesophageal echo
RBC damaged while crossing the calcified valve causing schistocytes
>60 years - bicuspid aortic valve
Chronic rheumatic heart disease

27. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
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
Months out fibrosis
Holosystolic blowing murmur
Tricuspid

28. In transposition of the great vessels - What is required for survival? How is this achieved?
Decreased forward perfusion pulmonary congestion
Aortic regurg
Tricuspid
Shunt - PGE to maintain PDA until surgical repair can be performed

29. What is a common complication of cardiac metastasis?
Boot shaped heart
Pericardial effusion due to pericardial involvement
Contraction band necrosis
Within the first day

30. Pericarditis 6-8 wks post MI.
Increased blood in right heart delays closure of P valve
Dressler syndrome
Ehlers - Danlow and Marfan syndrome
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

31. How does adult coarctation of the aorta present?
Positive blood cultures anemia of chronic disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Mitral regurgitation due to vegetations
Congestive heart failure

32. What is the most common cause of endocarditis in IV drug users?
S aureus
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Aortic regurg
Contraction band necrosis

33. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Rhabdomyoma
Dressler syndrome
Migratory polyarthritis

34. Which congenital heart defect is associated with congenital rubella?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
RCA
PDA
Pump failure

35. What gross and microscopic changes occur months after an MI?
Maternal diabetes
Day 1-7
Inability to maintain systemic pressure w/lack of O2 to vital organs
White scar fibrosis

36. What are the two effects of ATII?
Mitral and tricuspid regurg - arrhythmia
Reperfusion injury
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Maternal diabetes

37. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral regurgitation due to vegetations
LAD
Tuberous sclerosis

38. What is a Quincke pulse?
Pulsating nail bed
Troponin I
Yellow pallor neutrophils
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

39. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Red border granulation tissue
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Small vegetations along the line of closure

40. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
VSD
4-24 hours
Endocardial fibroelastosis (rare)

41. What causes wear and tear aortic stenosis?
Decrease preload -->lowers myocardial stress
Fibrosis and dystrophic calcification
Transposition of the great vessels
4-24 hours

42. Infects predamaged valves after transient bacteremia?
Prinzmetal angina - cocaine
Right -->left
S viridans
Chronic rheumatic heart disease

43. What are the major criteria of the Jones criteria?
Large - destructive vegetations
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Systemic venous congestion
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

44. What does rupture of a papillary muscle cause?
Mid - systolic click followed by regurgitation murmur
Mitral insufficiency
Months out fibrosis
Maternal diabetes

45. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Contraction band necrosis - reperfusion injury
Breast and lung carcinoma - melanoma - lymphoma
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

46. How do you tx prinzmetal angina?
Tetralogy of fallot
NG or Ca channel blocker
Bacterial endocarditis
Mitral regurg

47. Which coronary artery supplies the anterior wall and anterior septum?
LAD
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
Spontaneous
Stretched muscle loses contractility

48. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Increased hydrostatic pressure
Granulation tissue
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

49. What type of shunt dose PDA cause?
Left -->right
Infantile coarctation of the aorta PDA
S viridans
Janeway lesions

50. What % of MIs involve the LAD?
Janeway lesions
Ventricle
45%
Maternal diabetes