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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. 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.
Small vegetations along the line of closure
Stable angina
Mitral and tricuspid regurg - arrhythmia
Cyanosis - RV hypertrophy - polycythemia - clubbing

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

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3. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
RCA
Regurg vs stenosis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Months out fibrosis

4. Which coronary artery supplies the posterior wall of the LV and posterior septum?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
RCA
Mitral valve prolapse
Blood vessels coming in from normal tissue

5. How does asprin/heparin tx MI?
Squat in response to cyanotic spell
Transesophageal echo
Limits thrombosis
Opening snap followed by diastolic rumble

6. What is the most comon cause of aortic regurg? What are the other causes?
Atria and RV
Small - nondestructive vegetations (subacute endocarditis)
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Tricuspid

7. Which coronary artery supplies the anterior wall and anterior septum?
Holosystolic blowing murmur
LAD
RBC damaged while crossing the calcified valve causing schistocytes
Yellow pallor macrophages

8. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
When a bacterial protein resembles a protein in human tissue
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Prinzmetal stable and unstable

9. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Concentric LV hypertophy
Maternal diabetes
Granulation tissue

10. What is the most common cause of infectious endocarditis?
>60 years - bicuspid aortic valve
Streptococcus viridans
Congestive heart failure
Small - nondestructive vegetations (subacute endocarditis)

11. Why are cardiac enzymes elevated after an MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Yellow pallor neutrophils
Membrane damage
Low voltage EKG w/diminished QRS amplitude

12. What coronary arterysupplies the lateral wall of the LV?
Myocardium
Mitral valve prolapse
Red border granulation tissue
Circumflex

13. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
ACE inhibitor
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
LAD

14. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Nitroglycerin
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Contraction band necrosis - reperfusion injury

15. With what disease is Libman - Sacks endocarditis associated?
Libman - Sacks endocarditis
SLE
Autoimmune pericarditis 6-8 wks post MI
Mitral insufficiency

16. What coronary artery supplies the mitral valve papillary muscles?
RCA
Fibrosis and dystrophic calcification
Heart can't fill
Chronic rheumatic heart disease

17. Turner syndrome is associated with which congenital heart defect?
Mitral regurg
Wear and tear
Infantile coarctation of the aorta
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

18. What type of vegetations form in nonbacterial thrombotic endocarditis?
Kawasaki disease
Metastasis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Sterile vegetations on mitral valve along lines of closure

19. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Subendocardial
Contraction band necrosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

20. What is the murmur of mitral regurg?
Split S2 on auscultation
Holosystolic blowing murmur
Systolic dysfx leading to biventricular CHF
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

21. Which artery is most often occluded in an MI?
LAD
Stable angina
Bacterial endocarditis
Infectious

22. How does ischemia cause LHF?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Large vegetations of S aureus
Loss of fx
Type I

23. What cardiac disease is associated with tuberous sclerosis?
NG or Ca channel blocker
Rhabdomyoma
Backward LHF pulm htn and RHF - afib and associated mural thombis
Pericarditits

24. What is the most common cause of endocarditis in IV drug users?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
S viridans
Subendocardial
S aureus

25. What is the gold standard blood marker for MI?
First 4 hours
Eisenmenger syndrome
Troponin I
Mitral regurg

26. What endocarditis is commonly found in patients with colon cancer?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
ST- segment depression
Tuberous sclerosis
Streptococcus bovis/

27. What is the leading cause of death in the US?
Transesophageal echo
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ischemic heart disease
Type I

28. What is the rate of congenital heart defects?
Atherosclerosis of coronary arteries
1%
Membrane damage
Valve scarring that arises as a consequence of rheumatic fever

29. What causes the split S2 in ASD?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Increased blood in right heart delays closure of P valve
IV drug users
Ostium secundum (90%)

30. What is the tx for LHF?
ACE inhibitor
Nonspecific - eg fever and elevated ESR
Within the first day
Friction rub and chest pain

31. What are the minor critera of the Jones criteria?
3-8 wks
Nonspecific - eg fever and elevated ESR
Mid - systolic click followed by regurgitation murmur
4-24 hours

32. What is the most common congenital heart defect?
Valve replacement
VSD
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
Loss of fx

33. In which pts does S viridans cause endocarditits?
4-24 hours
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Pts w/previously damaged valves
PGE

34. What does granulation tissue contain?
Transposition of the great vessels
Nonspecific - eg fever and elevated ESR
Minimizes ischemia
Plump fibroblasts - collagen - blood vessels

35. What is the cause of restrictive cardiomyopathy in children?
NG or Ca channel blocker
Endocardial fibroelastosis (rare)
Squatting - increased systemic resistence decreases LV emptying
Tender lesions on fingers or toes.

36. What is the most common cause of mitral stenosis?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Chronic rheumatic heart disease
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Systemic venous congestion

37. What effect does aortic stenosis have on the chambers of the heart?
Day 1-7
PDA
Concentric LV hypertophy
Congenital rubella

38. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Limits thrombosis
Hypercoagulable state or underlying adenocarcinoma
Coxsackie A or B

39. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Cardiogenic shock - CHF - arrhythmia
Myxoma - benign
Backward LHF pulm htn and RHF - afib and associated mural thombis
>70%

40. What murmur ccan be heard in PDA?
Pulsating nail bed
Right -->left
Streptococcus bovis/
Holosystolic machine like murmur

41. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Left -->right
Fibrinous pericarditis
Opening snap followed by diastolic rumble

42. What are the clinical features of LHF due to?
Libman - Sacks endocarditis
Nonspecific - eg fever and elevated ESR
NG or Ca channel blocker
Decreased forward perfusion pulmonary congestion

43. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Endocardial fibroelastosis (rare)
Right side - serotonin and other secretory products detoxified in the lung
Nitroglycerin

44. What is the characteristic murmur of aortic stenosis?
PDA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Reversible
Systolic ejection click followed by crescendo - decrescendo murmur

45. Is injury due angina reversible or irreversible?
Reversible
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Mid - systolic click followed by regurgitation murmur
Infantile coarctation of the aorta

46. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Hypertrophic cardiomyopathy
Mitral regurg
Months out fibrosis

47. What drug relieves stable angina?
Heart transplant
Decreases LV dilation by decreasing volume
Nitroglycerin
CK- MB

48. When does the heart have a yellow pallor post MI?
Dilation of all four chambers of the heart
Day 1-7
Loeffler syndrome
Months out fibrosis

49. What compensatory mechanism do tetralogy of fallot pts learn?
Inability to fill ventricles
Membrane damage
ST- segment depression
Squat in response to cyanotic spell

50. Which vasculitis can cause MI?
Turner syndrome
Kawasaki disease
Coxsackie A or B
Opening snap followed by diastolic rumble