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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 Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
VSD
Shunt - PGE to maintain PDA until surgical repair can be performed
Paradoxical emboli

2. What type of shunt results in cyanosis at birth?
Right to left
Erythematous nontender lesions on palms and soles.
Congested central veins
Heart transplant

3. What effect does aortic stenosis have on the chambers of the heart?
Myocardium
Ehlers - Danlow and Marfan syndrome
Pericardial effusion due to pericardial involvement
Concentric LV hypertophy

4. What maintains patency of the PDA?
PGE
Small vegetations along the line of closure
PDA
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

5. How does Eisenmeger syndrome occur?
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
Increased hydrostatic pressure
Chest pain <20 min brought on by exertion or emotional stress
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

6. What is diastolic dysfx?
Yellow pallor neutrophils
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
Inability to fill ventricles
LA dilation

7. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Ehlers - Danlow and Marfan syndrome
Aortic regurg
Coronary artery vasospasm
Dark discoloration coagulative necrosis

8. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Transposition of the great vessels
Infectious endocarditis - arrythmias - severe mitral regurg no
Valve replacement once LV dysfx develops
Bacterial endocarditis

9. What is the most common cause of mitral stenosis?
Elevated ASO anti - DNase B titers
Chronic rheumatic heart disease
Endocardial fibroelastosis (rare)
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

10. What are the major criteria of the Jones criteria?
Myxoid degeneration
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
4-7 days macrophage infiltration
Tetralogy of fallot

11. Which angina(s) show ST elevation on EKG? ST depression?
Large vegetations of S aureus
Prinzmetal stable and unstable
Sterile vegetations on surface and undersurface on mitral valve
LA dilation

12. What are the complications that occur months after an MI?
Surgical closure small defects may close spontaneously
Paradoxical emboli
Mitral and tricuspid regurg - arrhythmia
Aneurysm - mural thrombus - Dressler syndrome

13. What is the murmur of mitral valve prolapse?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mid - systolic click followed by regurgitation murmur
Erythematous nontender lesions on palms and soles.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

14. Why are cardiac enzymes elevated after an MI?
Tetralogy of fallot
Pump failure
Membrane damage
45%

15. What is the most common tumor of the heart?
Papillary muscle - free wall - IV septum
Metastasis
2-3 weeks
Mitral regurg

16. What causes notching of the ribs in adult coarctation of the aorta?
Hypertrophic cardiomyopathy
Intercostal arteries enlarged due to collateral circulation
4-24 hours
Right side - serotonin and other secretory products detoxified in the lung

17. What artery is the 2nd most often occluded in an MI?
Ventricle
ASD - R-->L
RCA
Myofiber hypertrophy with disarray

18. In transposition of the great vessels - What is required for survival? How is this achieved?
Positive blood cultures anemia of chronic disease
Shunt - PGE to maintain PDA until surgical repair can be performed
Prinzmetal stable and unstable
PDA

19. Boot - shaped heart on x- ray?
Yellow pallor neutrophils
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Tetralogy of fallot
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

20. What is a Quincke pulse?
Acute inflammation
Pulsating nail bed
Membrane damage
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

21. What is the characteristic murmur of aortic stenosis?
2-3 weeks
AD mutation in sarcomere proteins
Surgical closure small defects may close spontaneously
Systolic ejection click followed by crescendo - decrescendo murmur

22. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Autoimmune pericarditis 6-8 wks post MI
Myofiber hypertrophy with disarray

23. In what pt population does S aureus commonly cause valvular disease?
Decrease preload -->lowers myocardial stress
Open blocked vessels
Endocardial fibroelastosis (rare)
IV drug users

24. What valves are involved in rhuematic endocarditis?
Opening snap followed by diastolic rumble
Mitral mitral+aortic
Myocarditis
Hypertophy of RV atrophy of LV

25. What is the most common cause of myocarditis?
Coxsackie A or B
Janeway lesions
S viridans
Large - destructive vegetations

26. Which vasculitis can cause MI?
Tuberous sclerosis
Kawasaki disease
Streptococcus bovis/
Harmartoma

27. Pericarditis 6-8 wks post MI.
Dressler syndrome
Ventricular arrhythmia
Prinzmetal stable and unstable
Transposition of the great vessels

28. What is the most common cause of endocarditis in IV drug users?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Fetal alcohol syndrome
S aureus
Reactive histiocyte with caterpillar nucleus

29. What are the minor critera of the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Nonspecific - eg fever and elevated ESR
Plump fibroblasts - collagen - blood vessels
Hypertophy of RV atrophy of LV

30. What are other (not atherosclerotic) causes of MI?
Myocarditis in acute rheumatic heart fever
RHF
Fibrosis and dystrophic calcification
Coronary artery vasospasm - emboli - vasculitis

31. What are the sx of right - to - left shunt?
Mitral mitral+aortic
Cyanosis - RV hypertrophy - polycythemia - clubbing
Asymptomatic
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

32. What are the clinical features of RHF?
Squat in response to cyanotic spell
Low voltage EKG w/diminished QRS amplitude
Mitral valve prolapse
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

33. Lower extremity cyanosis in infants? In adults?
Left -->right
LA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Infantile coarctation of the aorta PDA

34. What are the complications of aortic stenosis?
Membrane damage
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Inability to maintain systemic pressure w/lack of O2 to vital organs
Left -->right

35. What is the most common congenital heart defect?
Prinzmetal angina
VSD
Myocardium
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

36. What increases the risk for chronic rheumatic heart disease?
Plump fibroblasts - collagen - blood vessels
Infectious endocarditis - arrythmias - severe mitral regurg no
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
AD mutation in sarcomere proteins

37. In which chamber of the heart are cardiac myxomas found?
LA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Cardiogenic shock - CHF - arrhythmia
Metastasis

38. Turner syndrome is associated with which congenital heart defect?
CK- MB
Chronic ischemic heart disease
Infantile coarctation of the aorta
Anterior wall of LV and anterior septum

39. What type of ASD is associated w/Down syndrome?
Valve replacement once LV dysfx develops
Ostium primum
Cyanosis - RV hypertrophy - polycythemia - clubbing
Holosystolic blowing murmur

40. What is the most common cause of infectious endocarditis?
Bounding pulse
Mitral regurgitation due to vegetations
Months out fibrosis
Streptococcus viridans

41. What causes endocarditis of prosthetic valves?
Decrease in blood flow to an organ
Reperfusion injury
Low voltage EKG w/diminished QRS amplitude
S epidermidis

42. What does chronic ischemic heart disease progress to?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Bicuspid aortic valve
CHF
Intercostal arteries enlarged due to collateral circulation

43. What congenital heart defect is associated with fetal alcohol syndrome?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Myocarditis
VSD
Granulation tissue

44. What is dilated cardiomyopathy?
NG or Ca channel blocker
Mitral insufficiency
Dilation of all four chambers of the heart
ACE inhibitor

45. What is the leading cause of death in the US?
Mid - systolic click followed by regurgitation murmur
1%
Ischemic heart disease
Months out fibrosis

46. What are the laboratory findings of bacterial endocarditis?
LV dilation and eccentric hypertrophy
Nonbacterial thrombotic endocarditis (marantic endocarditis)
IV drug users
Positive blood cultures anemia of chronic disease

47. What coronary arterysupplies the lateral wall of the LV?
Janeway lesions
Myofiber hypertrophy with disarray
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Circumflex

48. What type of shunt does transposition of the great vessels cause?
Small - nondestructive vegetations (subacute endocarditis)
Stretched muscle loses contractility
Systemic venous congestion
R-->L

49. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Fibrinous pericarditis
RCA
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Myocardium

50. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Increased blood in right heart delays closure of P valve
Mitral stenosis
Louder - increased systemic resistence decreases LV emptying
Loss of LV fx