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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. Where is the coarctation in infantile coarctation of the aorta?
Chronic ischemic heart disease
Preductal - post aortic arch
Systolic ejection click followed by crescendo - decrescendo murmur
Dressler syndrome

2. What is the characteristic murmur of aortic stenosis?
Plump fibroblasts - collagen - blood vessels
Squatting - increased systemic resistence decreases LV emptying
Systolic ejection click followed by crescendo - decrescendo murmur
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

3. What are the cancers that most commonly metastasize to the heart?
1-3 days
Breast and lung carcinoma - melanoma - lymphoma
LA dilation
Inability to fill ventricles

4. How does restrictive cardiomyopathy cause LHF?

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5. How do beta blockers tx MI?
PDA
Slow HR - decreasing O2 demand and risk for arrhythmia
Infantile coarctation of the aorta PDA
Cardiogenic shock - CHF - arrhythmia

6. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Prophylactic abx during dental procedures
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

7. What is dilated cardiomyopathy?
Ostium secundum (90%)
Prinzmetal stable and unstable
Dilation of all four chambers of the heart
Aortic regurg

8. What congenital heart defect does indomethacin tx?
Dilation of all four chambers of the heart
Congested central veins
PDA
Backward LHF pulm htn and RHF - afib and associated mural thombis

9. Infects predamaged valves after transient bacteremia?
S viridans
Congestive heart failure
Nonspecific - eg fever and elevated ESR
Months out fibrosis

10. What gross and microscopic changes occur 1-3 weeks after an MI?
Doxorubicin - cocaine
Red border granulation tissue
RCA
Reperfusion injury

11. How does contraction band necrosis occur?
Cardiogenic shock - CHF - arrhythmia
Coexisting mitral stenosis and fusion of commisures exist
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

12. What gross and microscopic changes occur 1-3 days after an MI?
Type I
Yellow pallor neutrophils
Ostium secundum (90%)
Left -->right

13. What is molecular mimicry?
Heart can't fill
LAD
Libman - Sacks endocarditis
When a bacterial protein resembles a protein in human tissue

14. What is the most common tumor of the heart?
Metastasis
Increased hydrostatic pressure
Type I
Fibrosis and dystrophic calcification

15. What are the complications of mitral stenosis?
4-6 hours - 24 hours - 72 hours
Adult coarctation of the aorta
Backward LHF pulm htn and RHF - afib and associated mural thombis
Decrease preload -->lowers myocardial stress

16. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Myocarditis in acute rheumatic heart fever
Bounding pulse
PDA

17. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Prinzmetal
Osler nodes (ouch - ouch Osler)

18. What complication occurs 1-3 days post MI?
Eisenmenger syndrome
Infantile coarctation of the aorta
Fibrinous pericarditis
Left -->right

19. What vavular defect results from acute rheumatic fever?
Prinzmetal angina
Spontaneous
Mitral regurgitation due to vegetations
Infantile coarctation of the aorta

20. What drug relieves stable angina?
ST- segment elevation
MI
Paradoxical emboli
Nitroglycerin

21. Dense layer of elastic and fibrotic tissue in the endocardium.
Systemic venous congestion
Opening snap followed by diastolic rumble
Loeffler syndrome
Endocardial fibroelastosis

22. Which angina(s) show ST elevation on EKG? ST depression?
Fibrinous pericarditis
Myocarditis in acute rheumatic heart fever
Prinzmetal angina
Prinzmetal stable and unstable

23. With what condition are rhabdomyomas associated?
Tuberous sclerosis
PDA
Mitral regurg
White scar fibrosis

24. In which chamber of the heart are cardiac myxomas found?
LA
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Gelatinous - abundant ground substance
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

25. What coronary artery supplies the mitral valve papillary muscles?
RCA
LAD
Hypertrophic cardiomyopathy
ACE inhibitor

26. How does fibrinolysis/angioplasty tx MI?
Wear and tear
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Yellow pallor macrophages
Open blocked vessels

27. What is the most common cause of RHF? What are others?
Janeway lesions
Breast and lung carcinoma - melanoma - lymphoma
Intercostal arteries enlarged due to collateral circulation
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

28. What is the JOneS mneumonic?
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
Dilation of all four chambers of the heart
NG or Ca channel blocker
ST- segment depression

29. What is a complication of chronic rheumatic heart disease?
Harmartoma
Cyanosis - RV hypertrophy - polycythemia - clubbing
Opening snap followed by diastolic rumble
Infectious endocarditis

30. With what developmental disorder is VSD associated?
Intercostal arteries enlarged due to collateral circulation
Heart transplant
Systemic venous congestion
Fetal alcohol syndrome

31. What complications occur within 4 hrs post MI?
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
Tender lesions on fingers or toes.
Tricuspid
Cardiogenic shock - CHF - arrhythmia

32. What two things cause coronary artery vasospasm?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Low voltage EKG w/diminished QRS amplitude
Prinzmetal angina - cocaine
Increased hydrostatic pressure

33. What is the most common type of ASD? What %?
White scar fibrosis
Ostium secundum (90%)
When a bacterial protein resembles a protein in human tissue
Opening snap followed by diastolic rumble

34. In which chamber of the heart are rhabdomyomas found?
Split S2 on auscultation
Prinzmetal angina - cocaine
Ventricle
Ischemic heart disease

35. What is the effect of mitral regurg on the heart?
Within the first day
Volume overload and LHF
Aschoff bodies
NG or Ca channel blocker

36. What are the HACEK organisms? With what condition are they associated?
4-7 days
Mitral stenosis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Dilated

37. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Myocarditis
Migratory polyarthritis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
MI

38. What are the clinical features of LHF due to?
Heart can't fill
L->R
Squat in response to cyanotic spell
Decreased forward perfusion pulmonary congestion

39. What is a Quincke pulse?
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
Mitral and tricuspid regurg - arrhythmia
Heart can't fill
Pulsating nail bed

40. What determines the extent of shunting and cyanosis in tetralogy of fallot?
VSD
Degree of pulmonary artery stenosis
Mitral regurg
Aortic regurg

41. What is the definition of ischemia?
Nitroglycerin
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
Restrictive cardiomyopathy
Decrease in blood flow to an organ

42. With what virus is PDA associated?
Friction rub and chest pain
Inability to fill ventricles
Left -->right
Congenital rubella

43. When would arrhythmia occur after MI?
Dilation of all four chambers of the heart
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Inability to maintain systemic pressure w/lack of O2 to vital organs
Within the first day

44. Dilated cardiomyopathy is a late complication of what illness?
Rhabdomyoma
Heart can't fill
Myocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

45. How does transmural MI/ischemia present on EKG?
Infectious endocarditis
Pulsating nail bed
ST- segment elevation
Minimizes ischemia

46. L- to - R shunt switching to R- to - L shunt.
Dilation of all four chambers of the heart
Fetal alcohol syndrome
Mitral regurg
Eisenmenger syndrome

47. Friction rub and chest pain.
ST- segment depression
Loss of fx
Friction rub and chest pain
Pericarditits

48. What effect does transposition of the great vessels have on the ventricles?
ST- segment depression
S aureus
Hypertophy of RV atrophy of LV
Prinzmetal

49. Holosystolic blowing murmur that increases w/expiration?
Ventricular arrhythmia
Chest pain <20 min brought on by exertion or emotional stress
Mitral regurg
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

50. What does rupture of the IV septum cause?
Boot shaped heart
Shunt
Ischemic heart disease
Yellow pallor neutrophils