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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 is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Cyanosis - RV hypertrophy - polycythemia - clubbing
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Infectious

2. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Decrease preload -->lowers myocardial stress
2-3 weeks
Hypertrophic cardiomyopathy
Adult coarctation of the aorta

3. What is the tx for dilated cardiomyopathy?
4-7 days
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
Heart transplant
1-3 days out

4. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Split S2 on auscultation
Endocarditis of prosthetic valves
Mitral insufficiency

5. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rhadbomyoma - benign
Loeffler syndrome
>60 years - bicuspid aortic valve

6. What are the sx of cardiac myxoma?
Loeffler syndrome
Valve replacement
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Pedunculated mass in the LA that causes syncope due to obstruction of MV

7. What shunt does tetralogy of fallot produce?
Volume overload and LHF
Large vegetations of S aureus
Right -->left
PDA

8. What maintains patency of the PDA?
Chronic ischemic heart disease
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Rhabdomyoma
PGE

9. What is the major cause of MI?
Day 1-7
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Pulsating nail bed
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

10. What effect does mitral stenosis have on the heart chambers?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Osler nodes (ouch - ouch Osler)
>60 years - bicuspid aortic valve
LA dilation

11. How does reperfusion injury occur?
Aortic regurg
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
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

12. What type of valvular vegetations does S aureus cause?
Loeffler syndrome
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Ehlers - Danlow and Marfan syndrome
Large - destructive vegetations

13. What are the minor critera of the Jones criteria?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Colon cancer
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Nonspecific - eg fever and elevated ESR

14. What always follows necrosis?
Myocarditis in acute rheumatic heart fever
Hypertrophic cardiomyopathy
Acute inflammation
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

15. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
S aureus
Fibrosis and dystrophic calcification

16. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Ventricular arrhythmia
Right -->left
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

17. What type of vegetations are associated with Libman - Sacks endocarditis?
Mitral insufficiency
Sterile vegetations on surface and undersurface on mitral valve
VSD
Cardiogenic shock - CHF - arrhythmia

18. EKG for stable angina?
Coronary artery vasospasm - emboli - vasculitis
ST- segment depression
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

19. Erythematous nontender lesions on palms and soles.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Janeway lesions
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

20. Tx for PDA?
Holosystolic machine like murmur
Endocarditis of prosthetic valves
Volume overload and LHF
Indomethacin - decreases PGE

21. What is the rate of congenital heart defects?
Anitschow cell
1%
Sudden cardiac death
Hypercoagulable state or underlying adenocarcinoma

22. At what point in development do congenital heart defects arise?
3-8 wks
Atria and RV
Dense layer of elastic and fibrotic tissue in the endocardium - children
Reactive histiocyte with caterpillar nucleus

23. Opening snap followed by diastolic rumble.
Endocardial fibroelastosis
>60 years - bicuspid aortic valve
Mitral stenosis
Atria and RV

24. What is Dressler syndrome? When does it occur?
Trisomy 21
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Autoimmune pericarditis 6-8 wks post MI
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

25. What does Libman - Sacks endocarditis cause?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Mitral regurg
PDA
Mitral and tricuspid regurg - arrhythmia

26. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Nonspecific - eg fever and elevated ESR
Migratory polyarthritis
Right side - serotonin and other secretory products detoxified in the lung
Maternal diabetes

27. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Atria and RV
Ventricles cannot pump
Degree of pulmonary artery stenosis
Type I

28. What drugs can cause dilated cardiomyopathy?
SLE
Valve replacement
Doxorubicin - cocaine
>60 years - bicuspid aortic valve

29. What is the gold standard blood marker for MI?
Troponin I
Coronary artery vasospasm
Circumflex
Hypercoagulable state or underlying adenocarcinoma

30. Which artery is most often occluded in an MI?
L->R
LAD
Ventricle
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

31. What areas of the heart does the LAD supply?
Migratory polyarthritis
Anterior wall of LV and anterior septum
Colon cancer
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

32. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Aschoff bodies
Cardiac tamponade
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Pericarditits

33. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Hypercoagulable state or underlying adenocarcinoma
Ventricles cannot pump
Dilation of all four chambers of the heart

34. What areas of the heart does the RCA supply?
Systolic dysfx leading to biventricular CHF
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Valve scarring that arises as a consequence of rheumatic fever
Posterior wall of LV - posterior septum - papillary muscles

35. What coronary artery supplies the mitral valve papillary muscles?
Transesophageal echo
R-->L
RCA
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

36. With what condition are rhabdomyomas associated?
LA dilation
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Tuberous sclerosis
Coexisting mitral stenosis and fusion of commisures exist

37. How does O2 tx MI?
Reversible
Reperfusion injury
Coxsackie A or B
Minimizes ischemia

38. What congenital heart defect does indomethacin tx?
4-7 days
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Preductal - post aortic arch
PDA

39. What cardiac enzyme is useful for detecting reinfarction?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Myocarditis in acute rheumatic heart fever
RHF
CK- MB

40. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Contraction band necrosis
Intercostal arteries enlarged due to collateral circulation
Prinzmetal angina
RHF

41. What is the most common primary cardiac tumor in children? Is it malignant or benign?
4-6 hours - 24 hours - 72 hours
Fibrinous pericarditis
Rhadbomyoma - benign
Ventricle

42. What is eythema marginatum? What parts of the body does it commonly involve?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Doxorubicin - cocaine
4-7 days macrophage infiltration
Annular - non pruritic rash w/erythematous borders trunks and limbs

43. How does asprin/heparin tx MI?
Aneurysm - mural thrombus - Dressler syndrome
Limits thrombosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Subendocardial

44. In which chamber of the heart are cardiac myxomas found?
Mitral and tricuspid regurg - arrhythmia
Reversible
Erythematous nontender lesions on palms and soles.
LA

45. 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.
Nitroglycerin
Migratory polyarthritis
Stable angina
PGE

46. When does the heart have dark discoloration post MI?
4-24 hours
Tender lesions on fingers or toes.
Paradoxical emboli
Group A beta - hemolytic streptococci

47. How do nitrates tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Decrease preload -->lowers myocardial stress
LV dilation and eccentric hypertrophy
Eisenmenger syndrome

48. What are other (not atherosclerotic) causes of MI?
Systolic dysfx leading to biventricular CHF
Open blocked vessels
Kawasaki disease
Coronary artery vasospasm - emboli - vasculitis

49. What does rupture of a papillary muscle cause?
LA dilation
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Aneurysm - mural thrombus - Dressler syndrome
Mitral insufficiency

50. When does the heart have a yellow pallor post MI?
Day 1-7
Coexisting mitral stenosis and fusion of commisures exist
ST- segment depression
ST- segment depression

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Cardiac

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