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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 O2 tx MI?
Chest pain <20 min brought on by exertion or emotional stress
Loss of LV fx
Minimizes ischemia
Bounding pulse

2. How do you prevent S viridans endocarditis?
Louder - increased systemic resistence decreases LV emptying
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Prophylactic abx during dental procedures
Within the first day

3. What is the most common cause of infectious endocarditis?
Anterior wall of LV and anterior septum
Right -->left
Streptococcus viridans
Fibrosis and dystrophic calcification

4. With what developmental disorder is VSD associated?
RCA
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA
Fetal alcohol syndrome

5. How does MI cause LHF?
Spontaneous
Infantile coarctation of the aorta
Loss of LV fx
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

6. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Decrease preload -->lowers myocardial stress
Fibrosis and dystrophic calcification
Colon cancer

7. With what endocarditis is S epidermidis associated?
Atria and RV
Reactive histiocyte with caterpillar nucleus
Endocarditis of prosthetic valves
Pump failure

8. What congenital heart defect often is present with infantile coarctation of the aorta?
Doxorubicin - cocaine
Sterile vegetations on mitral valve along lines of closure
R-->L
PDA

9. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
First 4 hours
Hypertrophic cardiomyopathy
Anitschow cell

10. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Systemic venous congestion
When a bacterial protein resembles a protein in human tissue
RCA

11. How does ischemia cause LHF?
Loss of fx
Ehlers - Danlow and Marfan syndrome
ST- segment depression
Cardiac tamponade

12. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Congested central veins
Louder - increased systemic resistence decreases LV emptying
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

13. What does granulation tissue contain?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Hypertophy of RV atrophy of LV
Plump fibroblasts - collagen - blood vessels
S aureus

14. What is the tx for aortic stenosis?
Aortic regurg
Valve replacement AFTER the onset of complications
Ehlers - Danlow and Marfan syndrome
Myxoid degeneration

15. What type of shunt does ASD cause?
Prinzmetal stable and unstable
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Left -->right
Infectious

16. When would arrhythmia occur after MI?
LV dilation and eccentric hypertrophy
Fetal alcohol syndrome
Within the first day
Valve replacement

17. What effect does dilated cardiomyopathy have on the heart?
Adult coarctation of the aorta
Type I
Systolic dysfx leading to biventricular CHF
Shunt - PGE to maintain PDA until surgical repair can be performed

18. What effect does aortic stenosis have on the chambers of the heart?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Concentric LV hypertophy
R-->L
Eisenmenger syndrome

19. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Libman - Sacks endocarditis
Prinzmetal
>60 years - bicuspid aortic valve

20. What gross and microscopic changes occur 4-24 hours after an MI?
Hypertophy of RV atrophy of LV
LV dilation and eccentric hypertrophy
Dark discoloration coagulative necrosis
PDA

21. What is the most common valve infected by S aureus?
Tricuspid
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Mitral regurg
Troponin I

22. Where is the coarctation in infantile coarctation of the aorta?
Infectious
Preductal - post aortic arch
Valve scarring that arises as a consequence of rheumatic fever
Months out fibrosis

23. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Squat in response to cyanotic spell
Restrictive cardiomyopathy
Mid - systolic click followed by regurgitation murmur

24. What does rupture of the IV septum cause?
S viridans
Shunt
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
4-7 days macrophage infiltration

25. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
1-3 days
Rhabdomyoma
Troponin I

26. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Decrease in blood flow to an organ
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Stable and unstable prinzmetal
First 4 hours

27. Dense layer of elastic and fibrotic tissue in the endocardium.
CK- MB
Endocardial fibroelastosis
Ostium primum
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

28. What are the sx of pericardiits?
1-3 days out
Infectious
Friction rub and chest pain
Inability to maintain systemic pressure w/lack of O2 to vital organs

29. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Plump fibroblasts - collagen - blood vessels
Prinzmetal
Mitral regurgitation due to vegetations

30. How do nitrates tx MI?
VSD
Decrease preload -->lowers myocardial stress
Slow HR - decreasing O2 demand and risk for arrhythmia
AD mutation in sarcomere proteins

31. How does reperfusion injury occur?
L->R
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Low voltage EKG w/diminished QRS amplitude
Louder - increased systemic resistence decreases LV emptying

32. What is the tx for mitral valve prolapse?
Left -->right
RBC damaged while crossing the calcified valve causing schistocytes
ASD - R-->L
Valve replacement

33. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Pulsating nail bed
Increased hydrostatic pressure
Mitral regurg

34. In which chamber of the heart are cardiac myxomas found?
Wear and tear
Hypertophy of RV atrophy of LV
1%
LA

35. What type of ASD is associated w/Down syndrome?
Chest pain <20 min brought on by exertion or emotional stress
Paradoxical emboli
Ostium primum
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

36. What is the tx for LHF?
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
Coexisting mitral stenosis and fusion of commisures exist
Nitroglycerin
ACE inhibitor

37. What congenital heart defect does indomethacin tx?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
S aureus
PDA
20 min

38. What does nonbacterial thrombotic endocarditis cause?
Valve scarring that arises as a consequence of rheumatic fever
Libman - Sacks endocarditis
Mitral regurg
1-3 days

39. What drug relieves stable angina?
Nitroglycerin
Osler nodes (ouch - ouch Osler)
Maternal diabetes
Coronary artery vasospasm - emboli - vasculitis

40. When do troponin levels rise - peak - and return to normal?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Open blocked vessels
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
2-4 hours - 24 hours - 7-10 days

41. What vavular defect results from acute rheumatic fever?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Doxorubicin - cocaine
Mitral regurgitation due to vegetations
Anitschow cell

42. Why would cardiac enzymes continue to increase after the initial MI?
Myocardium
Reperfusion injury
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
Increased blood in right heart delays closure of P valve

43. What is the most common cause of dilated cardiomyopathy? What are other causes?
Mitral and tricuspid regurg - arrhythmia
Nitroglycerin
Ostium primum
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

44. What are the complications of mitral valve prolapse? Are they common?
Paradoxical emboli
Infectious endocarditis - arrythmias - severe mitral regurg no
Volume overload and LHF
Yellow pallor macrophages

45. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
R-->L
Ostium primum
Sudden cardiac death

46. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
4-6 hours - 24 hours - 72 hours

47. Which congenital heart defect is associated with maternal diabetes?
Louder - increased systemic resistence decreases LV emptying
Transposition of the great vessels
Turner syndrome
Red border granulation tissue

48. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
2-4 hours - 24 hours - 7-10 days
Breast and lung carcinoma - melanoma - lymphoma
Loeffler syndrome

49. What is the JOneS mneumonic?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Group A beta - hemolytic streptococci
PDA
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

50. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Louder - increased systemic resistence decreases LV emptying
Valve replacement AFTER the onset of complications
4-7 days macrophage infiltration