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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. Turner syndrome is associated with which congenital heart defect?
VSD
Loss of LV fx
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Infantile coarctation of the aorta

2. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Blood vessels coming in from normal tissue
Tricuspid

3. What are the clinical features of RHF?
ST- segment depression
Anitschow cell
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

4. Why would cardiac enzymes continue to increase after the initial MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Reperfusion injury
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased blood in right heart delays closure of P valve

5. Are most congenital heart defects spontaneous or inherited?
Group A beta - hemolytic streptococci
Spontaneous
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
VSD

6. What is the most common valve infected by S aureus?
4-7 days
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Streptococcus bovis/
Tricuspid

7. What is migratory polyarthritis?
Colon cancer
Yellow pallor macrophages
Rhabdomyoma
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

8. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Cardiogenic shock - CHF - arrhythmia
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

9. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
2-4 hours - 24 hours - 7-10 days
Chest pain <20 min brought on by exertion or emotional stress
Rhadbomyoma - benign

10. What does rupture of a papillary muscle cause?
Reperfusion injury
Mitral insufficiency
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Months out fibrosis

11. In which chamber of the heart are rhabdomyomas found?
Ventricle
Subendocardial
Holosystolic machine like murmur
Dressler syndrome

12. What side of the heart do carcinoid tumors affect? Why?
Contraction band necrosis - reperfusion injury
Ischemic heart disease
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Right side - serotonin and other secretory products detoxified in the lung

13. What is the tx for aortic stenosis?
Hypertophy of RV atrophy of LV
Stable angina
Myocarditis
Valve replacement AFTER the onset of complications

14. What are the sx of aortic regurg?
Hypertrophic cardiomyopathy
Rhabdomyoma
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aortic regurg

15. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Mitral regurg
White scar fibrosis
Reperfusion injury
Rhadbomyoma - benign

16. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Turner syndrome
Hypertrophic cardiomyopathy

17. What causes an early - blowing diastolic murmur?
RCA
Aortic regurg
LA
Acute inflammation

18. Infects predamaged valves after transient bacteremia?
S viridans
Stable and unstable prinzmetal
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

19. What is a complication of chronic rheumatic heart disease?
Infantile coarctation of the aorta
Ehlers - Danlow and Marfan syndrome
RCA
Infectious endocarditis

20. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
ASD - R-->L
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
Metastasis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

21. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Reperfusion injury
Loeffler syndrome
Sterile vegetations on mitral valve along lines of closure
Breast and lung carcinoma - melanoma - lymphoma

22. What is cardiogenic shock?
Turner syndrome
Inability to maintain systemic pressure w/lack of O2 to vital organs
Backward LHF pulm htn and RHF - afib and associated mural thombis
AD mutation in sarcomere proteins

23. When do macrophagess infiltrate the myocardium post MI?
Shunt
4-7 days
Boot shaped heart
Loeffler syndrome

24. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Rupture of free wall - IV septum - or papillary muscle
Cardiogenic shock - CHF - arrhythmia
Dressler syndrome

25. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Aneurysm - mural thrombus - Dressler syndrome
Tuberous sclerosis

26. What are the causes of LHF?
Small - nondestructive vegetations (subacute endocarditis)
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
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Yellow pallor neutrophils

27. At what point in development do congenital heart defects arise?
3-8 wks
Pts w/previously damaged valves
Infantile coarctation of the aorta PDA
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

28. What causes endocarditis of prosthetic valves?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Opening snap followed by diastolic rumble
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
S epidermidis

29. What is the effect of mitral regurg on the heart?
4-7 days
20 min
L->R
Volume overload and LHF

30. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Dense layer of elastic and fibrotic tissue in the endocardium - children
Pancarditis
Aortic regurg
Reperfusion injury

31. What type of shunt does ASD cause?
Split S2 on auscultation
Left -->right
MI
Mitral regurgitation due to vegetations

32. What complication occurs 1-3 days post MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Decreases LV dilation by decreasing volume
Fibrinous pericarditis
1-3 days out

33. What is the murmur of mitral regurg?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Spontaneous
Small - nondestructive vegetations (subacute endocarditis)
Holosystolic blowing murmur

34. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Reversible
Backward LHF pulm htn and RHF - afib and associated mural thombis

35. Systolic ejection click followed by crescendo - decrescendo murmur.
Squatting - increased systemic resistence decreases LV emptying
Fetal alcohol syndrome
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aortic stenosis

36. What heart sound manifest with an ASD?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Split S2 on auscultation
Infectious endocarditis - arrythmias - severe mitral regurg no
Myocardium

37. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Congested central veins
Nonspecific - eg fever and elevated ESR
Months out fibrosis
First 4 hours

38. What is the leading cause of death in the US?
Sudden cardiac death
Nitroglycerin
Ventricular arrhythmia
Ischemic heart disease

39. How does aortic regurg affect the heart chambers?
Streptococcus bovis/
LV dilation and eccentric hypertrophy
When a bacterial protein resembles a protein in human tissue
Ehlers - Danlow and Marfan syndrome

40. What are the complications of mitral valve prolapse? Are they common?
R-->L
Infectious endocarditis - arrythmias - severe mitral regurg no
Hemosiderin laden macrophages
Thickening of chrodae tendinae and cusps - mitral stenosis

41. What cardiac enzyme is useful for detecting reinfarction?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Type I
CK- MB
Asymptomatic

42. What type of vegetations form in nonbacterial thrombotic endocarditis?
Ventricle
Decrease in blood flow to an organ
Bacterial endocarditis
Sterile vegetations on mitral valve along lines of closure

43. Tender lesions on fingers or toes.
Holosystolic machine like murmur
Breast and lung carcinoma - melanoma - lymphoma
Group A beta - hemolytic streptococci
Osler nodes (ouch - ouch Osler)

44. What is the cause of restrictive cardiomyopathy in children?
Systemic venous congestion
Endocardial fibroelastosis (rare)
4-7 days
Autoimmune pericarditis 6-8 wks post MI

45. Pericarditis 6-8 wks post MI.
RCA
Coronary artery vasospasm - emboli - vasculitis
Dressler syndrome
Cardiogenic shock - CHF - arrhythmia

46. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Congenital rubella
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
>60 years - bicuspid aortic valve

47. Erythematous nontender lesions on palms and soles.
Spontaneous
Aortic regurg
Janeway lesions
Myocardium

48. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Chronic rheumatic heart disease
Valve replacement once LV dysfx develops
PDA

49. What tests show prior group A beta - hemolytic strep infection?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Large vegetations of S aureus
Elevated ASO anti - DNase B titers
Backward LHF pulm htn and RHF - afib and associated mural thombis

50. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Paradoxical emboli
RCA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
LHF