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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 are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
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
Nitroglycerin
Shunt

2. What type of shunt results in cyanosis at birth?
Hypertophy of RV atrophy of LV
4-24 hours
Prinzmetal
Right to left

3. Dilated cardiomyopathy is a late complication of what illness?
Right to left
Chronic rheumatic heart disease
Myocarditis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

4. What is a water - hammer pulse?
Decreases LV dilation by decreasing volume
Blood vessels coming in from normal tissue
Bounding pulse
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

5. What gross and microscopic changes occur 1-3 weeks after an MI?
Myocarditis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Red border granulation tissue
CHF

6. Low voltage EKG w/diminished QRS amplitude.
Reactive histiocyte with caterpillar nucleus
Bacterial endocarditis
Valve replacement
Restrictive cardiomyopathy

7. What is the tx for LHF?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myocarditis
ACE inhibitor
LV dilation and eccentric hypertrophy

8. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Myocardium
Pancarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Heart can't fill

9. What type of shunt dose PDA cause?
Friction rub and chest pain
Left -->right
>60 years - bicuspid aortic valve
Atria and RV

10. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
R-->L
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

11. What cardiac enzyme is useful for detecting reinfarction?
Endocarditis of prosthetic valves
PDA
CK- MB
Increased hydrostatic pressure

12. What type of vegetations form in nonbacterial thrombotic endocarditis?
Systolic dysfx leading to biventricular CHF
Left -->right
Sterile vegetations on mitral valve along lines of closure
Breast and lung carcinoma - melanoma - lymphoma

13. Which coronary artery supplies the anterior wall and anterior septum?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
LAD
Left -->right

14. What coronary arterysupplies the lateral wall of the LV?
Infantile coarctation of the aorta PDA
Circumflex
Papillary muscle - free wall - IV septum
Preductal - post aortic arch

15. What type of vegetations does Strep viridans cause?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Sterile vegetations on surface and undersurface on mitral valve
Small - nondestructive vegetations (subacute endocarditis)
Reperfusion injury

16. How does ischemia cause LHF?
Ischemic heart disease
Loss of fx
Rupture of free wall - IV septum - or papillary muscle
Transposition of the great vessels

17. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Posterior wall of LV - posterior septum - papillary muscles
Adult coarctation of the aorta
Months out fibrosis

18. What coronary artery supplies the mitral valve papillary muscles?
Congestive heart failure
Endocardial fibroelastosis
>70%
RCA

19. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Ostium secundum (90%)
Restrictive cardiomyopathy
Decreases LV dilation by decreasing volume

20. Which coronary artery supplies the posterior wall of the LV and posterior septum?
LV dilation and eccentric hypertrophy
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
RCA
Annular - non pruritic rash w/erythematous borders trunks and limbs

21. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Cardiac tamponade
Louder - increased systemic resistence decreases LV emptying
Valve replacement
Harmartoma

22. With what condition are rhabdomyomas associated?
Hypertrophic cardiomyopathy
Ostium secundum (90%)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Tuberous sclerosis

23. Which chambers of the heart are generally spared in an MI?
Atria and RV
Pericarditits
Plump fibroblasts - collagen - blood vessels
Valve replacement AFTER the onset of complications

24. What is migratory polyarthritis?
Aschoff bodies
Minimizes ischemia
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small - nondestructive vegetations (subacute endocarditis)

25. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Aortic regurg
SLE
Wear and tear

26. What is the basic principle of CHF?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Pump failure
Type I
Anitschow cell

27. What causes wear and tear aortic stenosis?
Slow HR - decreasing O2 demand and risk for arrhythmia
Loeffler syndrome
Fibrosis and dystrophic calcification
Granulation tissue

28. Which congenital heart defect is associated with congenital rubella?
Systemic venous congestion
PDA
Within the first day
Blood vessels coming in from normal tissue

29. What is molecular mimicry?
Shunt - PGE to maintain PDA until surgical repair can be performed
When a bacterial protein resembles a protein in human tissue
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
Metastasis

30. What causes a mid - systolic click followed by a regurgitation murmur?
Left -->right
Mitral valve prolapse
Loss of fx
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

31. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
RCA
LHF
Kawasaki disease
Libman - Sacks endocarditis

32. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Stable angina
Pulsating nail bed

33. What complications occur 4-7 days post MI?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
NG or Ca channel blocker
Rupture of free wall - IV septum - or papillary muscle
Troponin I

34. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Streptococcus viridans
Left -->right
IV drug users

35. When do neutrophils infiltrate the myocardium post MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1-3 days
Reversible
Systolic ejection click followed by crescendo - decrescendo murmur

36. How does stable angina present?
ST- segment depression
Valve replacement
Ehlers - Danlow and Marfan syndrome
Chest pain <20 min brought on by exertion or emotional stress

37. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
MI
Holosystolic machine like murmur
Concentric LV hypertophy

38. What is the definition of ischemia?
Reversible
Rhabdomyoma
Slow HR - decreasing O2 demand and risk for arrhythmia
Decrease in blood flow to an organ

39. What disesase has Aschoff bodies?
Nonspecific - eg fever and elevated ESR
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Myocarditis in acute rheumatic heart fever
R-->L

40. What is a Quincke pulse?
Pulsating nail bed
1%
Asymptomatic
Harmartoma

41. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Valve replacement AFTER the onset of complications
Holosystolic blowing murmur
AD mutation in sarcomere proteins
Migratory polyarthritis

42. What side of the heart do carcinoid tumors affect? Why?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Squatting - expiration
Right side - serotonin and other secretory products detoxified in the lung
Gelatinous - abundant ground substance

43. What type of shunt does ASD cause?
Decrease in blood flow to an organ
Left -->right
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
RBC damaged while crossing the calcified valve causing schistocytes

44. Why are cardiac enzymes elevated after an MI?
Ventricles cannot pump
Transposition of the great vessels
Kawasaki disease
Membrane damage

45. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
S epidermidis
Valve replacement AFTER the onset of complications
Hemosiderin laden macrophages

46. With what disease is Libman - Sacks endocarditis associated?
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
Libman - Sacks endocarditis
SLE
Sterile vegetations on surface and undersurface on mitral valve

47. What are Janeway lesions?
Mitral and tricuspid regurg - arrhythmia
Mitral insufficiency
Erythematous nontender lesions on palms and soles.
Streptococcus viridans

48. What are the sx of aortic regurg?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Aortic regurg
VSD
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

49. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Stable and unstable prinzmetal
Ostium primum
Pericarditits

50. What does chronic ischemic heart disease progress to?
Mitral mitral+aortic
CHF
Mitral regurgitation due to vegetations
Chronic rheumatic heart disease