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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. When does the heart have a yellow pallor post MI?
Day 1-7
Left -->right
Preductal - post aortic arch
RBC damaged while crossing the calcified valve causing schistocytes

2. What does rupture of a papillary muscle cause?
Mitral insufficiency
Mid - systolic click followed by regurgitation murmur
Infectious
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

3. What coronary arterysupplies the lateral wall of the LV?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Circumflex
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
Decrease in blood flow to an organ

4. What are the two effects of ATII?
Bicuspid aortic valve
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
LA dilation

5. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Breast and lung carcinoma - melanoma - lymphoma
Group A beta - hemolytic streptococci
Cardiogenic shock - CHF - arrhythmia

6. At what point in development do congenital heart defects arise?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Granulation tissue
3-8 wks
Increased blood in right heart delays closure of P valve

7. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
Mitral regurg
Mitral regurgitation due to vegetations
Holosystolic blowing murmur

8. What is the most common valve infected by S aureus?
Sterile vegetations on mitral valve along lines of closure
Pulsating nail bed
Stable and unstable prinzmetal
Tricuspid

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

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10. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Decreased forward perfusion pulmonary congestion
Mid - systolic click followed by regurgitation murmur
4-6 hours - 24 hours - 72 hours

11. What side of the heart do carcinoid tumors affect? Why?
Prinzmetal
Nitroglycerin
Right side - serotonin and other secretory products detoxified in the lung
PDA

12. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Stable and unstable prinzmetal
Backward LHF pulm htn and RHF - afib and associated mural thombis
Fetal alcohol syndrome

13. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Aschoff bodies
Blood vessels coming in from normal tissue
RCA
Valve replacement AFTER the onset of complications

14. What always follows necrosis?
Streptococcus bovis/
4-24 hours
LA
Acute inflammation

15. How does asprin/heparin tx MI?
Hypertrophic cardiomyopathy
Systemic venous congestion
Limits thrombosis
Right -->left

16. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Decreases LV dilation by decreasing volume
>60 years - bicuspid aortic valve
Bounding pulse
Circumflex

17. What does nonbacterial thrombotic endocarditis cause?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
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 regurg
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

18. What is the most common type of ASD? What %?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Hemosiderin laden macrophages
Ostium secundum (90%)
LHF

19. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Hypertrophic cardiomyopathy
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Split S2 on auscultation

20. What is the tx for LHF?
Congenital rubella
Membrane damage
ACE inhibitor
Posterior wall of LV - posterior septum - papillary muscles

21. What is typically the mechanims of sudden cardiac death?
Trisomy 21
Cardiogenic shock - CHF - arrhythmia
Ventricular arrhythmia
S aureus

22. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Congestive heart failure
1%
4-24 hours

23. What genetic conditions predispose a pt to mitral valve prolapse?
Within the first day
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Ehlers - Danlow and Marfan syndrome
Streptococcus viridans

24. What structures are susceptible to rupture post MI?
Mid - systolic click followed by regurgitation murmur
ASD - R-->L
Prinzmetal stable and unstable
Papillary muscle - free wall - IV septum

25. What is the most comon cause of aortic regurg? What are the other causes?
Congenital rubella
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
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
Group A beta - hemolytic streptococci

26. What does rupture of the IV septum cause?
Valve replacement
Shunt
Prinzmetal angina
Myocarditis

27. What congenital heart defect does indomethacin tx?
Aortic stenosis
Right -->left
PDA
Paradoxical emboli

28. Where is the coarctation in infantile coarctation of the aorta?
LA
Myxoma - benign
CHF
Preductal - post aortic arch

29. What are the sx of hypertrophic cardiomyopathy?
Small - nondestructive vegetations (subacute endocarditis)
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Friction rub and chest pain
Cardiogenic shock - CHF - arrhythmia

30. What is a common complication of cardiac metastasis?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Nitroglycerin
Pericardial effusion due to pericardial involvement
Degree of pulmonary artery stenosis

31. What artery is the 2nd most often occluded in an MI?
PDA
Maternal diabetes
RCA
Mid - systolic click followed by regurgitation murmur

32. With what virus is PDA associated?
Congenital rubella
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
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Contraction band necrosis - reperfusion injury

33. What increases the risk for chronic rheumatic heart disease?
MI
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Plump fibroblasts - collagen - blood vessels

34. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Mitral mitral+aortic
Type I
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

35. What areas of the heart does the RCA supply?
LV dilation and eccentric hypertrophy
Months out fibrosis
Trisomy 21
Posterior wall of LV - posterior septum - papillary muscles

36. What is the leading cause of death in the US?
Small vegetations along the line of closure
Aortic regurg
Valve replacement
Ischemic heart disease

37. What is the most common cause of endocarditis in IV drug users?
S aureus
Months out fibrosis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Friction rub and chest pain

38. What is the effect of mitral regurg on the heart?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
2-3%
Volume overload and LHF
Contraction band necrosis - reperfusion injury

39. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Contraction band necrosis
LA
Aortic regurg

40. What increases the volume of mitral regurg murmur?
Squatting - expiration
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Valve replacement AFTER the onset of complications
Colon cancer

41. What characterizes acute rheumatic fever endocarditiis?
Spontaneous
L->R
Atherosclerosis of coronary arteries
Small vegetations along the line of closure

42. What conditions can cause nonbacterial thrombotic endocarditis?
Preductal - post aortic arch
Sterile vegetations on surface and undersurface on mitral valve
Large - destructive vegetations
Hypercoagulable state or underlying adenocarcinoma

43. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
RCA
Small - nondestructive vegetations (subacute endocarditis)
Squatting - expiration

44. Lower extremity cyanosis in infants? In adults?
Congestive heart failure
Infantile coarctation of the aorta PDA
Split S2 on auscultation
Yellow pallor neutrophils

45. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Mitral regurg
PDA
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

46. What is the most common cause of dilated cardiomyopathy? What are other causes?
Ischemic heart disease
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Mitral regurg

47. What are the forward and backward sx of LHF?
1%
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
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

48. What valves are involved in rhuematic endocarditis?
Systolic dysfx leading to biventricular CHF
Nitroglycerin
Mitral mitral+aortic
Ventricles cannot pump

49. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LAD
Ventricular arrhythmia
Rhadbomyoma - benign

50. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Dressler syndrome
Hypertrophic cardiomyopathy
Mitral and tricuspid regurg - arrhythmia