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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. Holosystolic blowing murmur that increases w/expiration?
SLE
Mitral regurg
Thickening of chrodae tendinae and cusps - mitral stenosis
Pump failure

2. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Wear and tear
Stable and unstable prinzmetal
Dark discoloration coagulative necrosis

3. What complications occur within 4 hrs post MI?
Reperfusion injury
Pericardial effusion due to pericardial involvement
NG or Ca channel blocker
Cardiogenic shock - CHF - arrhythmia

4. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Migratory polyarthritis
PDA
Sudden cardiac death
Infectious endocarditis - arrythmias - severe mitral regurg no

5. What are the sx of aortic regurg?
Endocardial fibroelastosis (rare)
Streptococcus viridans
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Libman - Sacks endocarditis

6. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
RCA
Acute inflammation
Shunt

7. What is the tx for VSD?
Mitral stenosis
Breast and lung carcinoma - melanoma - lymphoma
Surgical closure small defects may close spontaneously
Indomethacin - decreases PGE

8. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Shunt - PGE to maintain PDA until surgical repair can be performed
Positive blood cultures anemia of chronic disease
Prinzmetal angina

9. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
White scar fibrosis
Myofiber hypertrophy with disarray
Congestive heart failure

10. What are the laboratory findings of bacterial endocarditis?
First 4 hours
Prinzmetal stable and unstable
Loss of fx
Positive blood cultures anemia of chronic disease

11. What are heart failure cells?
Infantile coarctation of the aorta
Decreased forward perfusion pulmonary congestion
Hemosiderin laden macrophages
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

12. What tests show prior group A beta - hemolytic strep infection?
Holosystolic blowing murmur
Metastasis
Elevated ASO anti - DNase B titers
Reversible

13. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
PDA
4-7 days macrophage infiltration
S epidermidis
Mitral regurg

14. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Ostium secundum (90%)
2-3%
Aortic regurg

15. What congenital heart defect does indomethacin tx?
S aureus
PDA
Ostium secundum (90%)
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

16. What is eythema marginatum? What parts of the body does it commonly involve?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Ostium secundum (90%)
Annular - non pruritic rash w/erythematous borders trunks and limbs
Louder - increased systemic resistence decreases LV emptying

17. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
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
Turner syndrome

18. What are the major criteria of the Jones criteria?
Mitral insufficiency
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

19. Dilated cardiomyopathy is a late complication of what illness?
LA
Myocarditis
RCA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

20. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Pulsating nail bed
Doxorubicin - cocaine
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

21. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Increased blood in right heart delays closure of P valve
Degree of pulmonary artery stenosis
Colon cancer
Migratory polyarthritis

22. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
PDA
4-7 days
Mitral insufficiency

23. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
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
Systemic venous congestion
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

24. What is the characteristic murmurr of mitral stenosis?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Adult coarctation of the aorta
Opening snap followed by diastolic rumble

25. What are Osler nodes?
Tender lesions on fingers or toes.
First 4 hours
Adult coarctation of the aorta
Hypertrophic cardiomyopathy

26. Which angina(s) show ST elevation on EKG? ST depression?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Prinzmetal stable and unstable
Rhabdomyoma
Myocarditis

27. What is the characteristic finding on CXR in tetralogy of fallot?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Nonspecific - eg fever and elevated ESR
Hypercoagulable state or underlying adenocarcinoma
Boot shaped heart

28. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
SLE
Atria and RV
AD mutation in sarcomere proteins

29. What is the leading cause of death in the US?
Ischemic heart disease
Squatting - increased systemic resistence decreases LV emptying
Pancarditis
Valve replacement AFTER the onset of complications

30. What are the four defects in tetralogy of fallot?
LA
Coronary artery vasospasm
Aortic regurg
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

31. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
2-4 hours - 24 hours - 7-10 days
S aureus
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Bacterial endocarditis

32. What increases the risk for chronic rheumatic heart disease?
Pulsating nail bed
Aortic regurg
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Fibrinous pericarditis

33. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
>60 years - bicuspid aortic valve
Ehlers - Danlow and Marfan syndrome
Adult coarctation of the aorta
Reperfusion injury

34. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Valve replacement
Aschoff bodies
Anterior wall of LV and anterior septum

35. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Endocardial fibroelastosis
Pulsating nail bed
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

36. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
PDA
PDA
Chronic rheumatic heart disease

37. What gross and microscopic changes occur 4-7 days after an MI?
2-3 weeks
Systolic ejection click followed by crescendo - decrescendo murmur
Yellow pallor macrophages
Harmartoma

38. Systolic ejection click followed by crescendo - decrescendo murmur.
Papillary muscle - free wall - IV septum
Sterile vegetations on surface and undersurface on mitral valve
Transesophageal echo
Aortic stenosis

39. What heart sound manifest with an ASD?
Split S2 on auscultation
Breast and lung carcinoma - melanoma - lymphoma
Nitroglycerin
Ventricular arrhythmia

40. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infectious endocarditis
Squatting - increased systemic resistence decreases LV emptying
Increased hydrostatic pressure

41. When would arrhythmia occur after MI?
RHF
Within the first day
AD mutation in sarcomere proteins
PDA

42. What are the sx of cardiac myxoma?
Regurg vs stenosis
Coexisting mitral stenosis and fusion of commisures exist
Split S2 on auscultation
Pedunculated mass in the LA that causes syncope due to obstruction of MV

43. How do beta blockers tx MI?
PDA
Slow HR - decreasing O2 demand and risk for arrhythmia
4-7 days
Adult coarctation of the aorta

44. What causes endocarditis of prosthetic valves?
S epidermidis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
LAD
Cyanosis - RV hypertrophy - polycythemia - clubbing

45. What cardiac enzyme is useful for detecting reinfarction?
Bicuspid aortic valve
Thickening of chrodae tendinae and cusps - mitral stenosis
Endocarditis of prosthetic valves
CK- MB

46. How does ischemia cause LHF?
Day 1-7
Loss of fx
Infectious endocarditis
Degree of pulmonary artery stenosis

47. What increases the volume of mitral regurg murmur?
Squatting - expiration
Trisomy 21
Posterior wall of LV - posterior septum - papillary muscles
2-3%

48. What is the rate of mitral valve prolapse in the US?
4-7 days
Opening snap followed by diastolic rumble
2-3%
4-24 hours

49. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Subendocardial
Valve replacement AFTER the onset of complications
Bacterial endocarditis

50. What is the most common cause of dilated cardiomyopathy? What are other causes?
Sterile vegetations on mitral valve along lines of closure
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Prinzmetal angina