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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 is the rate of mitral valve prolapse in the US?
Regurg vs stenosis
Mitral regurg
RHF
2-3%

2. What is a Quincke pulse?
Left -->right
Pulsating nail bed
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

3. How does subendocardial MI/ischemia present on EKG?
PDA
Streptococcus bovis/
ST- segment depression
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

4. What drugs can cause dilated cardiomyopathy?
S epidermidis
Regurg vs stenosis
Hypertophy of RV atrophy of LV
Doxorubicin - cocaine

5. In what pt population does S aureus commonly cause valvular disease?
IV drug users
4-7 days macrophage infiltration
Congested central veins
Concentric LV hypertophy

6. What are the HACEK organisms? With what condition are they associated?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Aortic regurg
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

7. How does ischemia cause LHF?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Loss of fx
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Aortic regurg

8. How long after pharyngitis does acute rheumatic fever occur?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
2-3 weeks
Transesophageal echo
Metastasis

9. What are the minor critera of the Jones criteria?
4-7 days macrophage infiltration
Nonspecific - eg fever and elevated ESR
Holosystolic machine like murmur
RCA

10. How does asprin/heparin tx MI?
Prinzmetal stable and unstable
Limits thrombosis
Coronary artery vasospasm
RCA

11. What causes acute endocarditis?
L->R
Large vegetations of S aureus
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
>60 years - bicuspid aortic valve

12. What structures are susceptible to rupture post MI?
Myofiber hypertrophy with disarray
Papillary muscle - free wall - IV septum
Tuberous sclerosis
LA

13. What bug causes acute rheumatic fever?
Prinzmetal
Group A beta - hemolytic streptococci
3-8 wks
Loss of fx

14. How does Eisenmeger syndrome occur?
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
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Inability to fill ventricles
Mitral regurg

15. Sudden death in a young athlete.
Fibrosis and dystrophic calcification
Prophylactic abx during dental procedures
Hypertrophic cardiomyopathy
Chronic ischemic heart disease

16. Tx for PDA?
1-3 days
Indomethacin - decreases PGE
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

17. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
1%
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Decreased forward perfusion pulmonary congestion

18. What are the sx of aortic regurg?
Valve scarring that arises as a consequence of rheumatic fever
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Volume overload and LHF

19. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
R-->L
Pump failure

20. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Fetal alcohol syndrome
Decrease in blood flow to an organ
Pump failure

21. What causes endocarditis of prosthetic valves?
S epidermidis
Pulsating nail bed
Indomethacin - decreases PGE
Within the first day

22. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Adult coarctation of the aorta
Degree of pulmonary artery stenosis
Nitroglycerin
Dressler syndrome

23. When do macrophagess infiltrate the myocardium post MI?
Hypertophy of RV atrophy of LV
Decreased forward perfusion pulmonary congestion
4-7 days
Libman - Sacks endocarditis

24. What causes notching of the ribs in adult coarctation of the aorta?
Aortic regurg
S aureus
Tender lesions on fingers or toes.
Intercostal arteries enlarged due to collateral circulation

25. At what point in development do congenital heart defects arise?
3-8 wks
Thickening of chrodae tendinae and cusps - mitral stenosis
Coronary artery vasospasm
Intercostal arteries enlarged due to collateral circulation

26. What is the most common type of endocarditis?
Large - destructive vegetations
Congestive heart failure
Chronic ischemic heart disease
Infectious

27. How does stable angina present?
Fetal alcohol syndrome
Left -->right
CK- MB
Chest pain <20 min brought on by exertion or emotional stress

28. How does hypertension cause LHF?

29. How does aortic regurg affect the heart chambers?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Stretched muscle loses contractility
LV dilation and eccentric hypertrophy

30. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
ST- segment elevation
Type I
Restrictive cardiomyopathy

31. With what endocarditis is S epidermidis associated?
Tuberous sclerosis
Annular - non pruritic rash w/erythematous borders trunks and limbs
4-6 hours - 24 hours - 72 hours
Endocarditis of prosthetic valves

32. What is chronic rheumatic heart disease?
Aschoff bodies
Valve scarring that arises as a consequence of rheumatic fever
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Streptococcus bovis/

33. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Type I
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Subendocardial

34. What is the effect of mitral regurg on the heart?
Congenital rubella
Volume overload and LHF
Paradoxical emboli
Decrease preload -->lowers myocardial stress

35. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Nitroglycerin
Increased hydrostatic pressure
4-7 days

36. What causes unstable angina?
Split S2 on auscultation
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Myocardium
Prinzmetal angina - cocaine

37. What is an important complication of ASD?
Preductal - post aortic arch
Paradoxical emboli
2-4 hours - 24 hours - 7-10 days
Libman - Sacks endocarditis

38. What typically causes hypertrophic cardiomyopathy?
Turner syndrome
Prinzmetal angina
Decreases LV dilation by decreasing volume
AD mutation in sarcomere proteins

39. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
RCA
Within the first day
Aortic regurg

40. 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
Trisomy 21
4-7 days
Pulsating nail bed

41. Large vegetations on tricuspid valve?
Congenital rubella
S aureus
Chest pain <20 min brought on by exertion or emotional stress
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

42. With what disease is transposition of the great vessels associated?
Increased hydrostatic pressure
S aureus
Bounding pulse
Maternal diabetes

43. How do ACE inhibitors tx MI?
Transposition of the great vessels
Dilated
Decreases LV dilation by decreasing volume
Months out fibrosis

44. What is the most common valve infected by S aureus?
Erythematous nontender lesions on palms and soles.
Hypercoagulable state or underlying adenocarcinoma
Tricuspid
Mitral regurg

45. What effect does chronic rheumatic heart disease have the mitral valve?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Thickening of chrodae tendinae and cusps - mitral stenosis
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
Chest pain <20 min brought on by exertion or emotional stress

46. What is the classic EKG finding of restrictive cardiomyopathy?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
RCA
Low voltage EKG w/diminished QRS amplitude

47. What are the complications that occur months after an MI?
S viridans
Aneurysm - mural thrombus - Dressler syndrome
Yellow pallor macrophages
Volume overload and LHF

48. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Gelatinous - abundant ground substance
Chronic rheumatic heart disease
Prophylactic abx during dental procedures

49. With what virus is PDA associated?
Mitral mitral+aortic
Aneurysm - mural thrombus - Dressler syndrome
Congenital rubella
RCA

50. What characterizes acute rheumatic fever endocarditiis?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Months out fibrosis
Slow HR - decreasing O2 demand and risk for arrhythmia
Small vegetations along the line of closure