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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 only Jones criteria that doesn't resolve with time?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Pancarditis
Hypercoagulable state or underlying adenocarcinoma
1-3 days out

2. What typically causes hypertrophic cardiomyopathy?
Coxsackie A or B
Systemic venous congestion
Mitral mitral+aortic
AD mutation in sarcomere proteins

3. What is endocardial fibroelastosis? In what population is it found?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Minimizes ischemia
ACE inhibitor
Dense layer of elastic and fibrotic tissue in the endocardium - children

4. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Decrease in blood flow to an organ
RCA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
AD mutation in sarcomere proteins

5. What is diastolic dysfx?
Dressler syndrome
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Large - destructive vegetations
Inability to fill ventricles

6. What type of collagen is involved in fibrosis?
Type I
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Transesophageal echo

7. What causes an early - blowing diastolic murmur?
Chest pain <20 min brought on by exertion or emotional stress
Congenital rubella
Aortic regurg
Dressler syndrome

8. What drugs can cause dilated cardiomyopathy?
Infantile coarctation of the aorta
Valve scarring that arises as a consequence of rheumatic fever
1-3 days
Doxorubicin - cocaine

9. What is the classic EKG finding of restrictive cardiomyopathy?
Months out fibrosis
Tetralogy of fallot
Valve replacement AFTER the onset of complications
Low voltage EKG w/diminished QRS amplitude

10. What type of shunt does ASD cause?
Left -->right
First 4 hours
Chronic rheumatic heart disease
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

11. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Tricuspid
45%
Degree of pulmonary artery stenosis
Myofiber hypertrophy with disarray

12. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
2-3 weeks
Infectious endocarditis
RCA

13. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Valve scarring that arises as a consequence of rheumatic fever
Sudden cardiac death
Prophylactic abx during dental procedures

14. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Mitral regurgitation due to vegetations
Colon cancer
Transposition of the great vessels

15. What valves are most commonly involved in chronic rheumatic heart disease?
Decreases LV dilation by decreasing volume
Myxoma - benign
Mitral mitral+aortic
Squat in response to cyanotic spell

16. Why are cardiac enzymes elevated after an MI?
Membrane damage
Circumflex
Congenital rubella
Streptococcus viridans

17. What type of tumor is a rhabdomyoma?
Harmartoma
Inability to fill ventricles
Degree of pulmonary artery stenosis
Prinzmetal angina

18. What is the most common cause of myocarditis?
Endocardial fibroelastosis
Coxsackie A or B
Squatting - expiration
Open blocked vessels

19. What gross and microscopic changes occur 4-7 days after an MI?
Chest pain <20 min brought on by exertion or emotional stress
Endocarditis of prosthetic valves
Yellow pallor macrophages
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

20. With what disease is transposition of the great vessels associated?
Maternal diabetes
Squat in response to cyanotic spell
Mid - systolic click followed by regurgitation murmur
Yellow pallor macrophages

21. How does asprin/heparin tx MI?
Contraction band necrosis - reperfusion injury
Limits thrombosis
Bounding pulse
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

22. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Shunt - PGE to maintain PDA until surgical repair can be performed
Friction rub and chest pain
4-7 days macrophage infiltration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

23. What type of vegetations does Strep viridans cause?
Harmartoma
LV dilation and eccentric hypertrophy
Dark discoloration coagulative necrosis
Small - nondestructive vegetations (subacute endocarditis)

24. What causes heart failure cells?
Ostium secundum (90%)
Prophylactic abx during dental procedures
Within the first day
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

25. What is an important complication of ASD?
Paradoxical emboli
Subendocardial
S viridans
When a bacterial protein resembles a protein in human tissue

26. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
S aureus
Endocarditis of prosthetic valves
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

27. What bug causes acute rheumatic fever?
Rupture of free wall - IV septum - or papillary muscle
Group A beta - hemolytic streptococci
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
LA

28. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Inability to maintain systemic pressure w/lack of O2 to vital organs
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Cardiogenic shock - CHF - arrhythmia

29. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
LHF
Myofiber hypertrophy with disarray
Turner syndrome

30. What are the forward and backward sx of LHF?
ACE inhibitor
Ventricles cannot pump
Valve scarring that arises as a consequence of rheumatic fever
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

31. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
LA dilation
Heart can't fill
Indomethacin - decreases PGE

32. How does MI cause LHF?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Shunt
Aortic regurg
Loss of LV fx

33. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Myxoid degeneration
Atria and RV
2-3 weeks

34. What is the rate of congenital heart defects?
Inability to fill ventricles
1%
Increased hydrostatic pressure
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

35. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Limits thrombosis
Dilated

36. What congenital heart defect does indomethacin tx?
4-24 hours
PDA
NG or Ca channel blocker
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

37. How does ischemia cause LHF?
Endocardial fibroelastosis (rare)
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Loss of fx
Pericardial effusion due to pericardial involvement

38. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
SLE
LV dilation and eccentric hypertrophy
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

39. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Rupture of free wall - IV septum - or papillary muscle
Mitral and tricuspid regurg - arrhythmia
LA dilation

40. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Elevated ASO anti - DNase B titers
Mitral insufficiency
When a bacterial protein resembles a protein in human tissue

41. What is the definition of ischemia?
Prinzmetal angina
Large vegetations of S aureus
1-3 days out
Decrease in blood flow to an organ

42. What are the complications that occur months after an MI?
Left -->right
4-6 hours - 24 hours - 72 hours
Bounding pulse
Aneurysm - mural thrombus - Dressler syndrome

43. Which chambers of the heart are generally spared in an MI?
Troponin I
Pericardial effusion due to pericardial involvement
Atria and RV
Ventricles cannot pump

44. Erythematous nontender lesions on palms and soles.
Janeway lesions
NG or Ca channel blocker
Pancarditis
LV dilation and eccentric hypertrophy

45. What always follows necrosis?
Congestive heart failure
Ehlers - Danlow and Marfan syndrome
Atria and RV
Acute inflammation

46. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Congested central veins
Hemosiderin laden macrophages
Anitschow cell
Loss of LV fx

47. What type of shunt dose PDA cause?
20 min
Left -->right
PDA
Ventricle

48. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Holosystolic machine like murmur
MI
Transesophageal echo
Contraction band necrosis

49. What is an Aschoff body?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
VSD
Acute inflammation
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

50. What is the characteristic finding on CXR in tetralogy of fallot?
LHF
Mitral regurg
Boot shaped heart
4-6 hours - 24 hours - 72 hours