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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 the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dressler syndrome
Cardiac tamponade
Left -->right

2. L- to - R shunt switching to R- to - L shunt.
Migratory polyarthritis
Loss of LV fx
Mitral insufficiency
Eisenmenger syndrome

3. Friction rub and chest pain.
ST- segment depression
Janeway lesions
Pericarditits
Reperfusion injury

4. What are the complications of mitral valve prolapse? Are they common?
Osler nodes (ouch - ouch Osler)
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Infectious endocarditis - arrythmias - severe mitral regurg no
Fibrosis and dystrophic calcification

5. What is the most common cause of endocarditis in IV drug users?
Ostium primum
S aureus
Fibrinous pericarditis
Friction rub and chest pain

6. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
RCA
Prinzmetal angina
Prinzmetal angina - cocaine

7. What is the most common valve infected by S aureus?
Tricuspid
ACE inhibitor
Valve scarring that arises as a consequence of rheumatic fever
Holosystolic machine like murmur

8. What is the most common cause of RHF? What are others?
Stable angina
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Heart transplant
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

9. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Atherosclerosis of coronary arteries
Mitral regurg
PDA

10. What is a water - hammer pulse?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Mitral valve prolapse
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Bounding pulse

11. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
CHF
Reactive histiocyte with caterpillar nucleus
Rhabdomyoma

12. What coronary artery supplies the mitral valve papillary muscles?
Loeffler syndrome
Streptococcus viridans
RCA
R-->L

13. What is endocardial fibroelastosis? In what population is it found?
Pancarditis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Dense layer of elastic and fibrotic tissue in the endocardium - children

14. What is Loeffler syndrome?
Nitroglycerin
Day 1-7
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Surgical closure small defects may close spontaneously

15. What is the most common congenital heart defect?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
VSD
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
RCA

16. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Restrictive cardiomyopathy
Hypercoagulable state or underlying adenocarcinoma
CHF

17. What causes prinzmetal angina?
Breast and lung carcinoma - melanoma - lymphoma
Shunt
Concentric LV hypertophy
Coronary artery vasospasm

18. What is diastolic dysfx?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Inability to fill ventricles
CK- MB

19. How does asprin/heparin tx MI?
Limits thrombosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Reversible
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

20. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Congested central veins
Heart transplant
L->R

21. What are the HACEK organisms? With what condition are they associated?
2-4 hours - 24 hours - 7-10 days
PDA
Bounding pulse
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

22. What are the sx of pericardiits?
Friction rub and chest pain
Small - nondestructive vegetations (subacute endocarditis)
Endocardial fibroelastosis
Pulsating nail bed

23. What two things cause coronary artery vasospasm?
Turner syndrome
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Prinzmetal angina - cocaine
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

24. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
3-8 wks
Mitral mitral+aortic
Regurg vs stenosis
Prinzmetal angina

25. What are the clinical features of endocarditis? What causes each feature?
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
Ventricular arrhythmia
Hypertrophic cardiomyopathy
Large - destructive vegetations

26. What does rupture of the IV septum cause?
Decreases LV dilation by decreasing volume
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Dilated
Shunt

27. What are the clinical features of LHF due to?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LA
Prophylactic abx during dental procedures
Decreased forward perfusion pulmonary congestion

28. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
4-6 hours - 24 hours - 72 hours
Loeffler syndrome
Erythematous nontender lesions on palms and soles.
Nitroglycerin

29. What type of valvular vegetations does S aureus cause?
PDA
Large - destructive vegetations
Mitral mitral+aortic
Open blocked vessels

30. Pericarditis 6-8 wks post MI.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
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
Pericarditits
Dressler syndrome

31. What congenital heart defect presents later in life with lower extremity cyanosis?
First 4 hours
PDA
Mid - systolic click followed by regurgitation murmur
Gelatinous - abundant ground substance

32. What are Osler nodes?
S aureus
45%
Tender lesions on fingers or toes.
Small - nondestructive vegetations (subacute endocarditis)

33. What structures are susceptible to rupture post MI?
Mitral regurgitation due to vegetations
PDA
Papillary muscle - free wall - IV septum
>70%

34. What type of tumor is a rhabdomyoma?
Louder - increased systemic resistence decreases LV emptying
Harmartoma
Mitral regurgitation due to vegetations
Asymptomatic

35. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
White scar fibrosis
4-6 hours - 24 hours - 72 hours
Bacterial endocarditis

36. What are the minor critera of the Jones criteria?
When a bacterial protein resembles a protein in human tissue
SLE
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nonspecific - eg fever and elevated ESR

37. What two things happen when a blocked vessel is opened after an MI?
ACE inhibitor
Contraction band necrosis - reperfusion injury
ST- segment depression
Thickening of chrodae tendinae and cusps - mitral stenosis

38. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Hypertrophic cardiomyopathy
Sterile vegetations on surface and undersurface on mitral valve
Troponin I

39. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Endocardial fibroelastosis (rare)
Tetralogy of fallot
Months out fibrosis

40. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Restrictive cardiomyopathy
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Myocardium

41. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Loeffler syndrome
Months out fibrosis

42. What is eythema marginatum? What parts of the body does it commonly involve?
Anterior wall of LV and anterior septum
Myocarditis
Ehlers - Danlow and Marfan syndrome
Annular - non pruritic rash w/erythematous borders trunks and limbs

43. What increases the volume of mitral regurg murmur?
Squatting - expiration
Loss of fx
Hemosiderin laden macrophages
Systolic dysfx leading to biventricular CHF

44. What % of MIs involve the LAD?
4-6 hours - 24 hours - 72 hours
Tender lesions on fingers or toes.
45%
Small - nondestructive vegetations (subacute endocarditis)

45. What creates the immune reaction in acute rhuematic fever?

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46. What does chronic ischemic heart disease progress to?
Heart can't fill
CHF
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Congestive heart failure

47. When do macrophagess infiltrate the myocardium post MI?
Minimizes ischemia
4-7 days
Osler nodes (ouch - ouch Osler)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

48. What type of shunt does ASD cause?
PDA
RBC damaged while crossing the calcified valve causing schistocytes
Left -->right
Loss of LV fx

49. What type of collagen is involved in fibrosis?
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
VSD
Chronic rheumatic heart disease
Type I

50. What type of shunt does a VSD cause?
Infectious endocarditis
L->R
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Fibrinous pericarditis