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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. How does adult coarctation of the aorta present?
Chronic ischemic heart disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Concentric LV hypertophy
Infantile coarctation of the aorta PDA

2. What is endocardial fibroelastosis? In what population is it found?
Increased blood in right heart delays closure of P valve
Dense layer of elastic and fibrotic tissue in the endocardium - children
Louder - increased systemic resistence decreases LV emptying
Surgical closure small defects may close spontaneously

3. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Concentric LV hypertophy
NG or Ca channel blocker
20 min

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

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5. What are the laboratory findings of bacterial endocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Sudden cardiac death
Positive blood cultures anemia of chronic disease
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

6. What is cardiogenic shock?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Posterior wall of LV - posterior septum - papillary muscles
VSD
Inability to maintain systemic pressure w/lack of O2 to vital organs

7. When would arrhythmia occur after MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Fetal alcohol syndrome
4-24 hours
Within the first day

8. How does O2 tx MI?
Mitral regurg
Prinzmetal
Minimizes ischemia
Decreased forward perfusion pulmonary congestion

9. Sudden death in a young athlete.
Mid - systolic click followed by regurgitation murmur
Hypertrophic cardiomyopathy
Preductal - post aortic arch
Subendocardial

10. What causes acute endocarditis?
Group A beta - hemolytic streptococci
Aschoff bodies
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Large vegetations of S aureus

11. L- to - R shunt switching to R- to - L shunt.
Eisenmenger syndrome
Stretched muscle loses contractility
Dense layer of elastic and fibrotic tissue in the endocardium - children
CK- MB

12. With what endocarditis is S epidermidis associated?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Squatting - increased systemic resistence decreases LV emptying
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Endocarditis of prosthetic valves

13. What is the tx for VSD?
1%
Surgical closure small defects may close spontaneously
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Inability to fill ventricles

14. What drug relieves stable angina?
Breast and lung carcinoma - melanoma - lymphoma
Erythematous nontender lesions on palms and soles.
PDA
Nitroglycerin

15. What effect does mitral stenosis have on the heart chambers?
LA dilation
Infantile coarctation of the aorta
Membrane damage
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

16. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Fibrinous pericarditis
Endocardial fibroelastosis (rare)
Louder - increased systemic resistence decreases LV emptying
Heart transplant

17. What is the most common cause of mitral stenosis?
Atria and RV
Pancarditis
Chronic rheumatic heart disease
Intercostal arteries enlarged due to collateral circulation

18. What artery is the 2nd most often occluded in an MI?
Bacterial endocarditis
RCA
Fibrinous pericarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

19. What % stenosis causes stable angina?
Nonspecific - eg fever and elevated ESR
>70%
2-3 weeks
Reactive histiocyte with caterpillar nucleus

20. Holosystolic blowing murmur that increases w/expiration?
Posterior wall of LV - posterior septum - papillary muscles
Mitral regurg
Pericarditits
Mitral and tricuspid regurg - arrhythmia

21. How does aortic regurg affect the heart chambers?
Myocardium
Prinzmetal stable and unstable
Posterior wall of LV - posterior septum - papillary muscles
LV dilation and eccentric hypertrophy

22. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Gelatinous - abundant ground substance
Months out fibrosis
Rhabdomyoma

23. What causes microangiopathic hemolytic anemia in aortic stenosis?
Nitroglycerin
RBC damaged while crossing the calcified valve causing schistocytes
Restrictive cardiomyopathy
1-3 days

24. What causes notching of the ribs in adult coarctation of the aorta?
Friction rub and chest pain
Intercostal arteries enlarged due to collateral circulation
Slow HR - decreasing O2 demand and risk for arrhythmia
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

25. What conditions can cause nonbacterial thrombotic endocarditis?
ST- segment depression
Coexisting mitral stenosis and fusion of commisures exist
Hypercoagulable state or underlying adenocarcinoma
Endocardial fibroelastosis

26. What is the most common cause of myocarditis?
Nitroglycerin
Holosystolic blowing murmur
Coxsackie A or B
S aureus

27. What are the two effects of ATII?
Congestive heart failure
Opening snap followed by diastolic rumble
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Intercostal arteries enlarged due to collateral circulation

28. How does MI cause LHF?
Loss of LV fx
Valve replacement
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Stable angina

29. What does a biopsy of hypertrophic cardiomyopathy look like?
Coxsackie A or B
Contraction band necrosis
Myofiber hypertrophy with disarray
Small - nondestructive vegetations (subacute endocarditis)

30. How does asprin/heparin tx MI?
Limits thrombosis
Congenital rubella
Circumflex
Fibrosis and dystrophic calcification

31. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Autoimmune pericarditis 6-8 wks post MI
Valve replacement AFTER the onset of complications
Systolic dysfx leading to biventricular CHF

32. Infects predamaged valves after transient bacteremia?
S viridans
Valve scarring that arises as a consequence of rheumatic fever
Yellow pallor macrophages
Autoimmune pericarditis 6-8 wks post MI

33. What causes unstable angina?
Ventricles cannot pump
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
RHF
First 4 hours

34. What causes a mid - systolic click followed by a regurgitation murmur?
Prinzmetal stable and unstable
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Mitral valve prolapse
White scar fibrosis

35. What type of shunt does transposition of the great vessels cause?
Metastasis
R-->L
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ehlers - Danlow and Marfan syndrome

36. What shunt does tetralogy of fallot produce?
Right -->left
Tricuspid
Spontaneous
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

37. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Infectious endocarditis
ASD - R-->L
Myxoma - benign
Valve replacement once LV dysfx develops

38. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Streptococcus bovis/
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
>60 years - bicuspid aortic valve
PDA

39. What are the sx/complications of myocarditis?
1-3 days out
CK- MB
Pericarditits
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

40. Is injury due angina reversible or irreversible?
Reversible
Subendocardial
LV dilation and eccentric hypertrophy
Right to left

41. What genetic conditions predispose a pt to mitral valve prolapse?
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
Ehlers - Danlow and Marfan syndrome
Fibrinous pericarditis
Holosystolic machine like murmur

42. What murmur ccan be heard in PDA?
When a bacterial protein resembles a protein in human tissue
Holosystolic machine like murmur
Left -->right
Ostium primum

43. Pericarditis 6-8 wks post MI.
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
Mitral mitral+aortic
Dressler syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

44. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Type I
Systolic ejection click followed by crescendo - decrescendo murmur
Mitral insufficiency

45. What causes mitral valve prolapse?
Myxoid degeneration
Bacterial endocarditis
Dense layer of elastic and fibrotic tissue in the endocardium - children
LV dilation and eccentric hypertrophy

46. What is Loeffler syndrome?
Mitral mitral+aortic
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Positive blood cultures anemia of chronic disease
Bacterial endocarditis

47. In which chamber of the heart are cardiac myxomas found?
Large vegetations of S aureus
Squatting - increased systemic resistence decreases LV emptying
LA
Ostium primum

48. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
First 4 hours
4-7 days macrophage infiltration
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Inability to maintain systemic pressure w/lack of O2 to vital organs

49. What type of shunt dose PDA cause?
Elevated ASO anti - DNase B titers
4-24 hours
Left -->right
Prophylactic abx during dental procedures

50. How does restrictive cardiomyopathy cause LHF?

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