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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 does chronic ischemic heart disease progress to?
Congested central veins
Colon cancer
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
CHF

2. What iis the tx for aortic regurg?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Breast and lung carcinoma - melanoma - lymphoma
Valve replacement once LV dysfx develops
Valve replacement

3. What is the most common cause of death during the acute phase of rheumatic fever?
Mitral mitral+aortic
Endocardial fibroelastosis (rare)
Myocarditis
Troponin I

4. What are other (not atherosclerotic) causes of MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Regurg vs stenosis
Prinzmetal angina
Coronary artery vasospasm - emboli - vasculitis

5. What causes acute endocarditis?
Tetralogy of fallot
Large vegetations of S aureus
Ventricle
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

6. What is cardiogenic shock?
Left -->right
Inability to maintain systemic pressure w/lack of O2 to vital organs
Erythematous nontender lesions on palms and soles.
Coexisting mitral stenosis and fusion of commisures exist

7. What areas of the heart does the RCA supply?
PDA
PGE
Turner syndrome
Posterior wall of LV - posterior septum - papillary muscles

8. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
Pericardial effusion due to pericardial involvement
Streptococcus bovis/
Hypertrophic cardiomyopathy

9. What is the murmur of mitral valve prolapse?
Holosystolic machine like murmur
Heart transplant
Mid - systolic click followed by regurgitation murmur
Coronary artery vasospasm

10. What are the forward and backward sx of LHF?
Hypertrophic cardiomyopathy
Concentric LV hypertophy
Libman - Sacks endocarditis
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA

11. What are the complications of mitral valve prolapse? Are they common?
Infantile coarctation of the aorta
Sterile vegetations on mitral valve along lines of closure
Cardiac tamponade
Infectious endocarditis - arrythmias - severe mitral regurg no

12. What effect does chronic rheumatic heart disease have on the aortic valve?

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13. What causes heart failure cells?
Atherosclerosis of coronary arteries
Fibrosis and dystrophic calcification
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Systolic dysfx leading to biventricular CHF

14. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Spontaneous
Transposition of the great vessels
PDA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

15. What drug relieves stable angina?
Nitroglycerin
1-3 days out
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Heart transplant

16. What % of MIs involve the LAD?
Stretched muscle loses contractility
CK- MB
45%
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

17. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Red border granulation tissue
Osler nodes (ouch - ouch Osler)
Ostium secundum (90%)

18. What structures are susceptible to rupture post MI?
Mitral stenosis
Papillary muscle - free wall - IV septum
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Months out fibrosis

19. What makes the MV prolapse murmur louder? Why?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Squatting - increased systemic resistence decreases LV emptying
CK- MB
Friction rub and chest pain

20. What causes the nutmeg color in nutmeg liver?
Congested central veins
Chronic rheumatic heart disease
Pericardial effusion due to pericardial involvement
Chest pain <20 min brought on by exertion or emotional stress

21. What are the complications of mitral stenosis?
Congestive heart failure
Backward LHF pulm htn and RHF - afib and associated mural thombis
Systolic ejection click followed by crescendo - decrescendo murmur
VSD

22. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Chronic ischemic heart disease
Right side - serotonin and other secretory products detoxified in the lung
Hypertophy of RV atrophy of LV

23. What type of shunt does truncus arteriosus cause?
R-->L
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Opening snap followed by diastolic rumble
White scar fibrosis

24. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Aschoff bodies
Ventricular arrhythmia
Reversible

25. Holosystolic blowing murmur that increases w/expiration?
Myocardium
Type I
Mitral regurg
Congenital rubella

26. L- to - R shunt switching to R- to - L shunt.
Left -->right
ST- segment depression
Eisenmenger syndrome
Indomethacin - decreases PGE

27. What areas of the heart does the LAD supply?
Preductal - post aortic arch
Increased hydrostatic pressure
Anterior wall of LV and anterior septum
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

28. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Squatting - expiration
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
RHF
PDA

29. What is the rate of congenital heart defects?
Sterile vegetations on surface and undersurface on mitral valve
Squatting - expiration
Heart transplant
1%

30. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Dense layer of elastic and fibrotic tissue in the endocardium - children
Papillary muscle - free wall - IV septum
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

31. What is the cause of the red border around granulation tissue?
Libman - Sacks endocarditis
>70%
Granulation tissue
Blood vessels coming in from normal tissue

32. What are the two effects of ATII?
Concentric LV hypertophy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral mitral+aortic
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

33. Dense layer of elastic and fibrotic tissue in the endocardium.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Endocardial fibroelastosis
Streptococcus viridans
Restrictive cardiomyopathy

34. What is the most common cause of endocarditis in IV drug users?
S aureus
Hemosiderin laden macrophages
4-24 hours
Yellow pallor neutrophils

35. Which coronary artery supplies the anterior wall and anterior septum?
Myxoma - benign
ST- segment depression
LHF
LAD

36. What is the most common congenital heart defect?
Osler nodes (ouch - ouch Osler)
Shunt - PGE to maintain PDA until surgical repair can be performed
VSD
Mitral stenosis

37. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Paradoxical emboli
Limits thrombosis
Blood vessels coming in from normal tissue

38. What is the main cause of MV regurg? What are other causes?
Months out fibrosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Low voltage EKG w/diminished QRS amplitude
Tricuspid

39. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Contraction band necrosis - reperfusion injury

40. What imaging test is useful for detecting lesions on valves?
Large vegetations of S aureus
Infantile coarctation of the aorta
Ostium secundum (90%)
Transesophageal echo

41. What are the sx of aortic regurg?
Myocarditis
Squat in response to cyanotic spell
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Blood vessels coming in from normal tissue

42. What is a complication of chronic rheumatic heart disease?
LAD
Infectious endocarditis
Coexisting mitral stenosis and fusion of commisures exist
Small - nondestructive vegetations (subacute endocarditis)

43. What is the definition of ischemia?
2-3 weeks
Posterior wall of LV - posterior septum - papillary muscles
Decrease in blood flow to an organ
PDA

44. Why are cardiac enzymes elevated after an MI?
Membrane damage
2-3 weeks
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Anterior wall of LV and anterior septum

45. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Ostium secundum (90%)
Atherosclerosis of coronary arteries
Myxoma - benign

46. How does hypertension cause LHF?

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47. What are complications of dilated cardiomyopathy?
Holosystolic machine like murmur
Mitral and tricuspid regurg - arrhythmia
Thickening of chrodae tendinae and cusps - mitral stenosis
Mitral regurg

48. When does the heart have a yellow pallor post MI?
LAD
Within the first day
Ehlers - Danlow and Marfan syndrome
Day 1-7

49. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Chest pain <20 min brought on by exertion or emotional stress
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
Rhadbomyoma - benign
Contraction band necrosis

50. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Pancarditis
Streptococcus bovis/
Nitroglycerin