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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. How does dilated cardiomyopathy cause LHF?
AD mutation in sarcomere proteins
Within the first day
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Stretched muscle loses contractility

2. When does the heart have a yellow pallor post MI?
Valve replacement once LV dysfx develops
CHF
Day 1-7
Right side - serotonin and other secretory products detoxified in the lung

3. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Squatting - increased systemic resistence decreases LV emptying
>60 years - bicuspid aortic valve
RCA

4. What is the tx for VSD?
Nonspecific - eg fever and elevated ESR
Cardiac tamponade
Surgical closure small defects may close spontaneously
Day 1-7

5. When does the heart have dark discoloration post MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Metastasis
4-6 hours - 24 hours - 72 hours
4-24 hours

6. What is the characteristic murmurr of mitral stenosis?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
45%
Opening snap followed by diastolic rumble
S viridans

7. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Spontaneous
Large vegetations of S aureus
Increased blood in right heart delays closure of P valve

8. What is the most common type of ASD? What %?
Ostium secundum (90%)
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Infectious
Contraction band necrosis - reperfusion injury

9. What % of MIs involve the LAD?
Ischemic heart disease
Chronic rheumatic heart disease
When a bacterial protein resembles a protein in human tissue
45%

10. What endocarditis is commonly found in patients with colon cancer?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Left -->right
Infectious
Streptococcus bovis/

11. What drugs can cause dilated cardiomyopathy?
Atherosclerosis of coronary arteries
Doxorubicin - cocaine
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
20 min

12. What is the cause of restrictive cardiomyopathy in children?
Large - destructive vegetations
Transposition of the great vessels
Endocardial fibroelastosis (rare)
Cardiac tamponade

13. What effect does chronic rheumatic heart disease have the mitral valve?
When a bacterial protein resembles a protein in human tissue
Shunt - PGE to maintain PDA until surgical repair can be performed
Myxoid degeneration
Thickening of chrodae tendinae and cusps - mitral stenosis

14. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Yellow pallor macrophages
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Backward LHF pulm htn and RHF - afib and associated mural thombis
Breast and lung carcinoma - melanoma - lymphoma

15. Why would cardiac enzymes continue to increase after the initial MI?
Mitral and tricuspid regurg - arrhythmia
Dilated
Reperfusion injury
Positive blood cultures anemia of chronic disease

16. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
When a bacterial protein resembles a protein in human tissue
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
Prophylactic abx during dental procedures

17. At what point in development do congenital heart defects arise?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Indomethacin - decreases PGE
3-8 wks
Infantile coarctation of the aorta

18. With what endocarditis is S epidermidis associated?
Colon cancer
Endocarditis of prosthetic valves
Hypertophy of RV atrophy of LV
Sterile vegetations on mitral valve along lines of closure

19. With what disease is infantile coarctation of the aorta associated?
Fibrinous pericarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Turner syndrome

20. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
First 4 hours
Dilation of all four chambers of the heart
Sudden cardiac death
Within the first day

21. What maintains patency of the PDA?
Bounding pulse
PGE
Left -->right
RBC damaged while crossing the calcified valve causing schistocytes

22. What causes the split S2 in ASD?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Right to left
Coronary artery vasospasm
Increased blood in right heart delays closure of P valve

23. With what disease is Libman - Sacks endocarditis associated?
Ventricles cannot pump
Streptococcus viridans
LAD
SLE

24. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Right -->left
Mitral regurgitation due to vegetations
PDA
Sterile vegetations on surface and undersurface on mitral valve

25. How does hypertension cause LHF?

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26. What is the tx for LHF?
ACE inhibitor
Harmartoma
S aureus
Volume overload and LHF

27. How does O2 tx MI?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Months out fibrosis
Concentric LV hypertophy
Minimizes ischemia

28. How does restrictive cardiomyopathy cause LHF?

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29. What is the 1day-1wk -1mo mneumonic for MI?
Opening snap followed by diastolic rumble
Bicuspid aortic valve
Stable and unstable prinzmetal
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

30. Which vasculitis can cause MI?
Heart transplant
Prinzmetal
Libman - Sacks endocarditis
Kawasaki disease

31. When is an MI patent at highest risk for fibrionous pericarditis?
Congested central veins
1-3 days out
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

32. What iis the tx for aortic regurg?
Fetal alcohol syndrome
Valve replacement once LV dysfx develops
Granulation tissue
Slow HR - decreasing O2 demand and risk for arrhythmia

33. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Valve replacement AFTER the onset of complications
Slow HR - decreasing O2 demand and risk for arrhythmia
Holosystolic blowing murmur

34. What type of vegetations does Strep viridans cause?
LAD
Valve replacement AFTER the onset of complications
1%
Small - nondestructive vegetations (subacute endocarditis)

35. What type of vegetations form in nonbacterial thrombotic endocarditis?
Libman - Sacks endocarditis
Sterile vegetations on mitral valve along lines of closure
Hypertrophic cardiomyopathy
Cardiogenic shock - CHF - arrhythmia

36. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Asymptomatic
Fibrinous pericarditis
Ostium secundum (90%)

37. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Prinzmetal
Infantile coarctation of the aorta
PDA
Months out fibrosis

38. What causes endocarditis of prosthetic valves?
4-24 hours
S epidermidis
Bounding pulse
L->R

39. What effect does transposition of the great vessels have on the ventricles?
Mid - systolic click followed by regurgitation murmur
Stable angina
Hypertophy of RV atrophy of LV
PDA

40. What is the rate of mitral valve prolapse in the US?
Reversible
Aneurysm - mural thrombus - Dressler syndrome
1%
2-3%

41. Opening snap followed by diastolic rumble.
Ventricular arrhythmia
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral stenosis
Indomethacin - decreases PGE

42. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Regurg vs stenosis
Prinzmetal angina
Posterior wall of LV - posterior septum - papillary muscles

43. In which pts does S viridans cause endocarditits?
Surgical closure small defects may close spontaneously
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Osler nodes (ouch - ouch Osler)
Pts w/previously damaged valves

44. What does a biopsy of hypertrophic cardiomyopathy look like?
Congestive heart failure
Bounding pulse
Coronary artery vasospasm
Myofiber hypertrophy with disarray

45. What are heart failure cells?
Myocardium
Decreases LV dilation by decreasing volume
Erythematous nontender lesions on palms and soles.
Hemosiderin laden macrophages

46. What is the most common cause of infectious endocarditis?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Streptococcus viridans
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Low voltage EKG w/diminished QRS amplitude

47. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Infantile coarctation of the aorta PDA
RCA
2-4 hours - 24 hours - 7-10 days
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

48. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Myocarditis in acute rheumatic heart fever
Myxoma - benign
Fibrinous pericarditis

49. What is the gold standard blood marker for MI?
Gelatinous - abundant ground substance
Contraction band necrosis
Troponin I
Slow HR - decreasing O2 demand and risk for arrhythmia

50. Pericarditis 6-8 wks post MI.
Hypertrophic cardiomyopathy
Kawasaki disease
Dressler syndrome
45%