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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 the effect of mitral regurg on the heart?
Volume overload and LHF
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
Surgical closure small defects may close spontaneously
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

2. What is migratory polyarthritis?
Valve scarring that arises as a consequence of rheumatic fever
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Infantile coarctation of the aorta PDA

3. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Coxsackie A or B
>60 years - bicuspid aortic valve
Posterior wall of LV - posterior septum - papillary muscles

4. What is the tx for LHF?
Prinzmetal
Janeway lesions
PDA
ACE inhibitor

5. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
LA
>60 years - bicuspid aortic valve
AD mutation in sarcomere proteins

6. How does O2 tx MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Friction rub and chest pain
Heart transplant
Minimizes ischemia

7. What are the laboratory findings of bacterial endocarditis?
Loeffler syndrome
Positive blood cultures anemia of chronic disease
Tricuspid
Hypertrophic cardiomyopathy

8. What side of the heart do carcinoid tumors affect? Why?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Ventricles cannot pump
Degree of pulmonary artery stenosis
Right side - serotonin and other secretory products detoxified in the lung

9. What is the most common tumor of the heart?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Bounding pulse
Metastasis
Inability to maintain systemic pressure w/lack of O2 to vital organs

10. What endocarditis is commonly found in patients with colon cancer?
Endocarditis of prosthetic valves
Cardiac tamponade
Streptococcus bovis/
Fibrosis and dystrophic calcification

11. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Limits thrombosis
Opening snap followed by diastolic rumble
PDA
Systolic ejection click followed by crescendo - decrescendo murmur

12. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
>60 years - bicuspid aortic valve
Ventricles cannot pump
Heart can't fill
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

13. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Shunt - PGE to maintain PDA until surgical repair can be performed
VSD
Systemic venous congestion

14. What effect does transposition of the great vessels have on the ventricles?
Small vegetations along the line of closure
Hypertophy of RV atrophy of LV
Myocarditis
Months out fibrosis

15. Low voltage EKG w/diminished QRS amplitude.
Dilated
PDA
Decreases LV dilation by decreasing volume
Restrictive cardiomyopathy

16. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Pump failure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

17. What is the most common type of ASD? What %?
Ostium secundum (90%)
Cardiogenic shock - CHF - arrhythmia
Restrictive cardiomyopathy
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

18. How do you tx prinzmetal angina?
Increased hydrostatic pressure
Yellow pallor neutrophils
Open blocked vessels
NG or Ca channel blocker

19. What drug relieves stable angina?
Rhadbomyoma - benign
Nitroglycerin
LV dilation and eccentric hypertrophy
Cardiac tamponade

20. What is the characteristic finding on CXR in tetralogy of fallot?
Erythematous nontender lesions on palms and soles.
Boot shaped heart
Bounding pulse
Mitral regurgitation due to vegetations

21. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Myocarditis
Heart transplant
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

22. What causes endocarditis of prosthetic valves?
Libman - Sacks endocarditis
Atherosclerosis of coronary arteries
Reperfusion injury
S epidermidis

23. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Months out fibrosis
RCA
Infectious endocarditis - arrythmias - severe mitral regurg no
Turner syndrome

24. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Stretched muscle loses contractility
Dilation of all four chambers of the heart
Nonbacterial thrombotic endocarditis (marantic endocarditis)

25. Are most congenital heart defects spontaneous or inherited?
Spontaneous
Fibrosis and dystrophic calcification
Thickening of chrodae tendinae and cusps - mitral stenosis
Transesophageal echo

26. What is the leading cause of death in the US?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Ischemic heart disease
Hypertophy of RV atrophy of LV
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

27. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Day 1-7
Myocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

28. What cardiac enzyme is useful for detecting reinfarction?
CHF
VSD
Heart transplant
CK- MB

29. What are the complications of mitral valve prolapse? Are they common?
2-3 weeks
Infectious endocarditis - arrythmias - severe mitral regurg no
Anitschow cell
RBC damaged while crossing the calcified valve causing schistocytes

30. What is the main cause of MV regurg? What are other causes?
Libman - Sacks endocarditis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Atherosclerosis of coronary arteries
Infantile coarctation of the aorta PDA

31. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Endocardial fibroelastosis (rare)
Small vegetations along the line of closure
Loss of fx

32. What are the clinical features of RHF due to?
45%
Systemic venous congestion
Myocarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

33. What are other (not atherosclerotic) causes of MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
PDA
Mitral regurg
Coronary artery vasospasm - emboli - vasculitis

34. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Coronary artery vasospasm
Prinzmetal stable and unstable
R-->L
Migratory polyarthritis

35. What is the classic EKG finding of restrictive cardiomyopathy?
Regurg vs stenosis
Low voltage EKG w/diminished QRS amplitude
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Streptococcus bovis/

36. How does ischemia cause LHF?
Reperfusion injury
Ehlers - Danlow and Marfan syndrome
Loss of fx
Hemosiderin laden macrophages

37. With what condition are rhabdomyomas associated?
Nonspecific - eg fever and elevated ESR
Tuberous sclerosis
1%
Mitral stenosis

38. What is a common complication of cardiac metastasis?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Aortic regurg
Pericardial effusion due to pericardial involvement
Prophylactic abx during dental procedures

39. What is an important complication of ASD?
Paradoxical emboli
Stable and unstable prinzmetal
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
R-->L

40. How does transmural MI/ischemia present on EKG?
Endocarditis of prosthetic valves
ST- segment elevation
Blood vessels coming in from normal tissue
Valve replacement

41. What are the clinical features of RHF?
Endocardial fibroelastosis
Metastasis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

42. What causes the dependent pitting edema in RHF?
Mitral mitral+aortic
Increased hydrostatic pressure
Myocarditis
PDA

43. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Valve scarring that arises as a consequence of rheumatic fever
Aortic stenosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

44. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Large vegetations of S aureus
Blood vessels coming in from normal tissue
Limits thrombosis

45. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Coronary artery vasospasm - emboli - vasculitis
Mitral valve prolapse
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

46. What is the basic principle of CHF?
Nitroglycerin
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
LHF
Pump failure

47. When does the heart have dark discoloration post MI?
Dressler syndrome
4-24 hours
Nonspecific - eg fever and elevated ESR
Pump failure

48. What is a complication of chronic rheumatic heart disease?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Infectious endocarditis
ST- segment elevation
Degree of pulmonary artery stenosis

49. What is systolic dysfx?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Ventricles cannot pump
Annular - non pruritic rash w/erythematous borders trunks and limbs
Bacterial endocarditis

50. With what developmental disorder is VSD associated?
Infantile coarctation of the aorta PDA
Fetal alcohol syndrome
When a bacterial protein resembles a protein in human tissue
Ischemic heart disease