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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 are the causes of LHF?
Months out fibrosis
Systolic ejection click followed by crescendo - decrescendo murmur
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mid - systolic click followed by regurgitation murmur

2. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Osler nodes (ouch - ouch Osler)
MI
Rhadbomyoma - benign
Months out fibrosis

3. What causes the dependent pitting edema in RHF?
Cardiogenic shock - CHF - arrhythmia
Increased hydrostatic pressure
RBC damaged while crossing the calcified valve causing schistocytes
Elevated ASO anti - DNase B titers

4. In which chamber of the heart are rhabdomyomas found?
Aschoff bodies
Concentric LV hypertophy
Aortic regurg
Ventricle

5. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
S viridans
2-4 hours - 24 hours - 7-10 days
Shunt

6. What cardiac enzyme is useful for detecting reinfarction?
Congenital rubella
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 valve prolapse
CK- MB

7. What are the sx of pericardiits?
Osler nodes (ouch - ouch Osler)
Nonspecific - eg fever and elevated ESR
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Friction rub and chest pain

8. What is the tx for dilated cardiomyopathy?
Hemosiderin laden macrophages
Heart transplant
Harmartoma
Hypertophy of RV atrophy of LV

9. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
PDA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

10. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Mitral valve prolapse
Stretched muscle loses contractility
Fibrinous pericarditis

11. What disesase has Aschoff bodies?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Myocarditis in acute rheumatic heart fever
Infectious endocarditis - arrythmias - severe mitral regurg no
Sterile vegetations on mitral valve along lines of closure

12. What gross and microscopic changes occur 1-3 weeks after an MI?
Fetal alcohol syndrome
Split S2 on auscultation
Red border granulation tissue
Aortic regurg

13. How does reperfusion injury occur?
Right -->left
Hypertophy of RV atrophy of LV
Prinzmetal
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

14. What type of vegetations are associated with Libman - Sacks endocarditis?
Mitral mitral+aortic
1%
Sterile vegetations on surface and undersurface on mitral valve
Stable and unstable prinzmetal

15. What increases the volume of mitral regurg murmur?
Squatting - expiration
Mid - systolic click followed by regurgitation murmur
Mitral and tricuspid regurg - arrhythmia
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

16. Low voltage EKG w/diminished QRS amplitude.
Limits thrombosis
Troponin I
Restrictive cardiomyopathy
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

17. What is the main cause of MV regurg? What are other causes?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Red border granulation tissue
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Gelatinous - abundant ground substance

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

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19. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Cardiogenic shock - CHF - arrhythmia
Elevated ASO anti - DNase B titers
4-6 hours - 24 hours - 72 hours

20. Ostium primum ASD is associated with what congenital disorder?
Large vegetations of S aureus
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Posterior wall of LV - posterior septum - papillary muscles
Trisomy 21

21. What are heart failure cells?
Prophylactic abx during dental procedures
Hemosiderin laden macrophages
Slow HR - decreasing O2 demand and risk for arrhythmia
Day 1-7

22. What makes the MV prolapse murmur louder? Why?
Harmartoma
Contraction band necrosis
Squatting - increased systemic resistence decreases LV emptying
ST- segment depression

23. Dilated cardiomyopathy is a late complication of what illness?
IV drug users
Myocarditis
Friction rub and chest pain
Bacterial endocarditis

24. What side of the heart do carcinoid tumors affect? Why?
Granulation tissue
Right side - serotonin and other secretory products detoxified in the lung
LAD
Hypertophy of RV atrophy of LV

25. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Subendocardial
Endocardial fibroelastosis (rare)
Breast and lung carcinoma - melanoma - lymphoma

26. What compensatory mechanism do tetralogy of fallot pts learn?
Aortic stenosis
Squat in response to cyanotic spell
NG or Ca channel blocker
Cyanosis - RV hypertrophy - polycythemia - clubbing

27. What type of shunt dose PDA cause?
Left -->right
Subendocardial
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Colon cancer

28. Sudden death in a young athlete.
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Right -->left
Hypertrophic cardiomyopathy
R-->L

29. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Endocardial fibroelastosis
Transposition of the great vessels
Positive blood cultures anemia of chronic disease

30. What is the most common congenital heart defect?
Inability to maintain systemic pressure w/lack of O2 to vital organs
VSD
Subendocardial
Myofiber hypertrophy with disarray

31. What % of MIs involve the LAD?
Red border granulation tissue
45%
Ventricular arrhythmia
PDA

32. What gross and microscopic changes occur 4-24 hours after an MI?
Open blocked vessels
Circumflex
S aureus
Dark discoloration coagulative necrosis

33. What bug causes acute rheumatic fever?
Blood vessels coming in from normal tissue
Group A beta - hemolytic streptococci
VSD
Tricuspid

34. What type of collagen is involved in fibrosis?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Type I
Mitral regurg
Libman - Sacks endocarditis

35. How does restrictive cardiomyopathy present?
Congestive heart failure
Pulsating nail bed
Chest pain <20 min brought on by exertion or emotional stress
Months out fibrosis

36. Large vegetations on tricuspid valve?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Systemic venous congestion
S aureus
Fetal alcohol syndrome

37. What is the murmur of mitral valve prolapse?
Colon cancer
Tricuspid
Mid - systolic click followed by regurgitation murmur
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

38. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Prinzmetal angina
Fetal alcohol syndrome
Adult coarctation of the aorta
Slow HR - decreasing O2 demand and risk for arrhythmia

39. Turner syndrome is associated with which congenital heart defect?
RCA
Aortic regurg
PDA
Infantile coarctation of the aorta

40. What is the most common cause of myocarditis?
Coxsackie A or B
Janeway lesions
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
Prinzmetal

41. What are the laboratory findings of bacterial endocarditis?
Aortic stenosis
Split S2 on auscultation
1-3 days out
Positive blood cultures anemia of chronic disease

42. What is molecular mimicry?
RCA
Reperfusion injury
Low voltage EKG w/diminished QRS amplitude
When a bacterial protein resembles a protein in human tissue

43. What is a Quincke pulse?
Granulation tissue
Pulsating nail bed
Infectious endocarditis
Squatting - expiration

44. What is the murmur of mitral regurg?
PGE
Opening snap followed by diastolic rumble
Holosystolic blowing murmur
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

45. What causes microangiopathic hemolytic anemia in aortic stenosis?
ST- segment depression
RBC damaged while crossing the calcified valve causing schistocytes
Myofiber hypertrophy with disarray
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

46. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Inability to fill ventricles
4-7 days macrophage infiltration
Prinzmetal

47. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
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
Papillary muscle - free wall - IV septum
>60 years - bicuspid aortic valve
Contraction band necrosis

48. How does asprin/heparin tx MI?
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
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
S aureus
Limits thrombosis

49. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Granulation tissue
Opening snap followed by diastolic rumble
Louder - increased systemic resistence decreases LV emptying
When a bacterial protein resembles a protein in human tissue

50. What is cardiogenic shock?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
VSD
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mitral insufficiency