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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 effect does chronic rheumatic heart disease have on the aortic valve?

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2. What are the laboratory findings of bacterial endocarditis?
Shunt - PGE to maintain PDA until surgical repair can be performed
Positive blood cultures anemia of chronic disease
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ehlers - Danlow and Marfan syndrome

3. In which chamber of the heart are cardiac myxomas found?
LA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Congenital rubella
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

4. What causes a mid - systolic click followed by a regurgitation murmur?
Contraction band necrosis
Rupture of free wall - IV septum - or papillary muscle
Loeffler syndrome
Mitral valve prolapse

5. What is the most common cause of dilated cardiomyopathy? What are other causes?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Myocardium
Squatting - increased systemic resistence decreases LV emptying

6. What is the classic EKG finding of restrictive cardiomyopathy?
Positive blood cultures anemia of chronic disease
Low voltage EKG w/diminished QRS amplitude
Libman - Sacks endocarditis
Cardiac tamponade

7. How does adult coarctation of the aorta present?
Increased blood in right heart delays closure of P valve
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Low voltage EKG w/diminished QRS amplitude

8. What causes notching of the ribs in adult coarctation of the aorta?
Right side - serotonin and other secretory products detoxified in the lung
Bounding pulse
Intercostal arteries enlarged due to collateral circulation
Louder - increased systemic resistence decreases LV emptying

9. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Mitral mitral+aortic
Granulation tissue
Hypertophy of RV atrophy of LV

10. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Hypertrophic cardiomyopathy
Fetal alcohol syndrome
RBC damaged while crossing the calcified valve causing schistocytes

11. How do you tx prinzmetal angina?
RCA
NG or Ca channel blocker
Spontaneous
Right side - serotonin and other secretory products detoxified in the lung

12. What does nonbacterial thrombotic endocarditis cause?
4-7 days
Open blocked vessels
Mitral regurg
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

13. What gross and microscopic changes occur 1-3 weeks after an MI?
SLE
Tender lesions on fingers or toes.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Red border granulation tissue

14. What type of valvular vegetations does S aureus cause?
>60 years - bicuspid aortic valve
Large - destructive vegetations
Prinzmetal angina
Nonbacterial thrombotic endocarditis (marantic endocarditis)

15. What causes endocarditis of prosthetic valves?
Type I
S epidermidis
Streptococcus bovis/
Low voltage EKG w/diminished QRS amplitude

16. Boot - shaped heart on x- ray?
Tetralogy of fallot
Right to left
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Maternal diabetes

17. With what virus is PDA associated?
Dilated
Congenital rubella
>70%
Concentric LV hypertophy

18. What is the most common cause of RHF? What are others?
Systemic venous congestion
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Rupture of free wall - IV septum - or papillary muscle
Dark discoloration coagulative necrosis

19. What type of shunt does truncus arteriosus cause?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
S aureus
Endocarditis of prosthetic valves
R-->L

20. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Myofiber hypertrophy with disarray
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Congested central veins
Endocarditis of prosthetic valves

21. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Holosystolic machine like murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
45%

22. What is the most common cause of endocarditis in IV drug users?
Turner syndrome
Congestive heart failure
Aneurysm - mural thrombus - Dressler syndrome
S aureus

23. What is the tx for dilated cardiomyopathy?
Valve replacement
Myxoid degeneration
Heart transplant
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

24. What does rupture of the LV free wall cause?
Cardiac tamponade
Infantile coarctation of the aorta
Maternal diabetes
45%

25. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Pericarditits
Coxsackie A or B
Concentric LV hypertophy

26. EKG for stable angina?
ST- segment depression
Chronic ischemic heart disease
Rhadbomyoma - benign
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

27. What effect does squatting have on the murmur of mitral valve prolapse? Why?
CK- MB
Louder - increased systemic resistence decreases LV emptying
L->R
Sterile vegetations on mitral valve along lines of closure

28. What complications occur within 4 hrs post MI?
Atherosclerosis of coronary arteries
LA dilation
Cardiogenic shock - CHF - arrhythmia
Subendocardial

29. How do ACE inhibitors tx MI?
CHF
RBC damaged while crossing the calcified valve causing schistocytes
Decreases LV dilation by decreasing volume
Stable and unstable prinzmetal

30. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Congenital rubella
Shunt
S aureus

31. What is an Aschoff body?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

32. Opening snap followed by diastolic rumble.
Dense layer of elastic and fibrotic tissue in the endocardium - children
Increased blood in right heart delays closure of P valve
Mitral stenosis
Fibrosis and dystrophic calcification

33. How does dilated cardiomyopathy cause LHF?
Congenital rubella
Fetal alcohol syndrome
Large vegetations of S aureus
Stretched muscle loses contractility

34. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Breast and lung carcinoma - melanoma - lymphoma
2-3 weeks
Circumflex

35. How does ischemia cause LHF?
Fibrinous pericarditis
Loss of fx
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
White scar fibrosis

36. With what disease is transposition of the great vessels associated?
Coronary artery vasospasm
Sterile vegetations on surface and undersurface on mitral valve
Maternal diabetes
Anterior wall of LV and anterior septum

37. What is the tx for aortic stenosis?
Endocarditis of prosthetic valves
Valve replacement AFTER the onset of complications
Friction rub and chest pain
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

38. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Large vegetations of S aureus
Congested central veins

39. Friction rub and chest pain.
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Aortic regurg
Small - nondestructive vegetations (subacute endocarditis)
Pericarditits

40. How does squating decrease hypoxemia in tetralogy of fallot?
Prinzmetal angina
Harmartoma
Months out fibrosis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

41. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Systolic ejection click followed by crescendo - decrescendo murmur
Within the first day
Prophylactic abx during dental procedures
Degree of pulmonary artery stenosis

42. What causes the dependent pitting edema in RHF?
PDA
Increased hydrostatic pressure
Rhadbomyoma - benign
Left -->right

43. What coronary artery supplies the mitral valve papillary muscles?
S epidermidis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
RCA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

44. With what disease is Libman - Sacks endocarditis associated?
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
Papillary muscle - free wall - IV septum
SLE
Aortic regurg

45. Why are cardiac enzymes elevated after an MI?
>60 years - bicuspid aortic valve
Systolic dysfx leading to biventricular CHF
Mitral stenosis
Membrane damage

46. What are the two effects of ATII?
Fibrinous pericarditis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Increased hydrostatic pressure
Sterile vegetations on mitral valve along lines of closure

47. What are the complications of mitral stenosis?
Contraction band necrosis - reperfusion injury
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Backward LHF pulm htn and RHF - afib and associated mural thombis
Restrictive cardiomyopathy

48. How does aortic regurg affect the heart chambers?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
LV dilation and eccentric hypertrophy
Libman - Sacks endocarditis
Group A beta - hemolytic streptococci

49. When would arrhythmia occur after MI?
Within the first day
Tender lesions on fingers or toes.
PDA
Valve scarring that arises as a consequence of rheumatic fever

50. What causes angina and syncope in aortic stenosis?

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