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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 classic EKG finding of restrictive cardiomyopathy?
PDA
Pancarditis
Low voltage EKG w/diminished QRS amplitude
Chest pain <20 min brought on by exertion or emotional stress

2. What is systolic dysfx?
Endocardial fibroelastosis (rare)
Ventricles cannot pump
S epidermidis
Mitral regurg

3. What is endocardial fibroelastosis? In what population is it found?
Asymptomatic
Reversible
Sterile vegetations on mitral valve along lines of closure
Dense layer of elastic and fibrotic tissue in the endocardium - children

4. What does chronic ischemic heart disease progress to?
CHF
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Circumflex
Sudden cardiac death

5. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Aneurysm - mural thrombus - Dressler syndrome
Day 1-7
RHF
Stretched muscle loses contractility

6. What are the sx of PDA at birth?
Dressler syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Asymptomatic
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

7. How does asprin/heparin tx MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Aortic regurg
Limits thrombosis
Granulation tissue

8. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Transposition of the great vessels
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
Breast and lung carcinoma - melanoma - lymphoma

9. Is scar tissue or myocardium stronger?
Metastasis
Hypertrophic cardiomyopathy
Myocardium
LA

10. How do you prevent S viridans endocarditis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Dilated
Mitral stenosis
Prophylactic abx during dental procedures

11. What is the tx for VSD?
R-->L
Surgical closure small defects may close spontaneously
Asymptomatic
Valve replacement

12. What are Osler nodes?
PDA
Coronary artery vasospasm - emboli - vasculitis
Tender lesions on fingers or toes.
Stretched muscle loses contractility

13. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Coxsackie A or B
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
ST- segment depression
Regurg vs stenosis

14. How does restrictive cardiomyopathy present?
Stretched muscle loses contractility
Squat in response to cyanotic spell
Congestive heart failure
ACE inhibitor

15. What areas of the heart does the RCA supply?
Breast and lung carcinoma - melanoma - lymphoma
White scar fibrosis
Posterior wall of LV - posterior septum - papillary muscles
Reversible

16. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Dark discoloration coagulative necrosis
Infectious endocarditis
Cardiogenic shock - CHF - arrhythmia

17. What maintains patency of the PDA?
S viridans
PGE
Cardiac tamponade
Red border granulation tissue

18. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Heart transplant
Contraction band necrosis
Pancarditis

19. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Months out fibrosis
Harmartoma
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. What is migratory polyarthritis?
Left -->right
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Infectious endocarditis
Infectious

21. What is the gross and microscopic appearance of cardiac myxomas?
Acute inflammation
Louder - increased systemic resistence decreases LV emptying
Gelatinous - abundant ground substance
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

22. What type of vegetations are associated with Libman - Sacks endocarditis?
Squatting - expiration
Sterile vegetations on surface and undersurface on mitral valve
Restrictive cardiomyopathy
Squat in response to cyanotic spell

23. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Libman - Sacks endocarditis
LA
Anterior wall of LV and anterior septum
LHF

24. What causes heart failure cells?
Infectious endocarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Chronic rheumatic heart disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

25. What is the most common form of cardiomyopathy?
Mitral regurg
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Dilated
Pericardial effusion due to pericardial involvement

26. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Yellow pallor macrophages
Bicuspid aortic valve
R-->L
Degree of pulmonary artery stenosis

27. When is an MI pt at greatest risk for cardiogenic shock?
Reperfusion injury
Large vegetations of S aureus
First 4 hours
Erythematous nontender lesions on palms and soles.

28. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Cardiogenic shock - CHF - arrhythmia
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Plump fibroblasts - collagen - blood vessels

29. What are the causes of restrictive cardiomyopathy in adults?
Dressler syndrome
Intercostal arteries enlarged due to collateral circulation
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

30. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Pancarditis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Large vegetations of S aureus
Mitral valve prolapse

31. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
>60 years - bicuspid aortic valve
Limits thrombosis
Left -->right

32. What are the cancers that most commonly metastasize to the heart?
Red border granulation tissue
Inability to maintain systemic pressure w/lack of O2 to vital organs
Breast and lung carcinoma - melanoma - lymphoma
Prinzmetal

33. What is the most common valve infected by S aureus?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Doxorubicin - cocaine
Tricuspid
AD mutation in sarcomere proteins

34. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
LAD
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Nonspecific - eg fever and elevated ESR

35. When does the heart have a yellow pallor post MI?
PDA
Intercostal arteries enlarged due to collateral circulation
Day 1-7
Backward LHF pulm htn and RHF - afib and associated mural thombis

36. What are the Jones criteria?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Membrane damage
Erythematous nontender lesions on palms and soles.

37. Which artery is most often occluded in an MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LAD
Months out fibrosis
Libman - Sacks endocarditis

38. What does rupture of the LV free wall cause?
Intercostal arteries enlarged due to collateral circulation
Loss of fx
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Cardiac tamponade

39. What causes mitral valve prolapse?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myxoid degeneration
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
LAD

40. What is dilated cardiomyopathy?
Streptococcus bovis/
Dilation of all four chambers of the heart
Aneurysm - mural thrombus - Dressler syndrome
Left -->right

41. What type of valvular vegetations does S aureus cause?
Surgical closure small defects may close spontaneously
Large - destructive vegetations
Left -->right
Reperfusion injury

42. How does MI cause LHF?
Myocarditis
Mitral valve prolapse
Turner syndrome
Loss of LV fx

43. What are the forward and backward sx of LHF?
Hypertrophic cardiomyopathy
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
Turner syndrome
Libman - Sacks endocarditis

44. What is the rate of mitral valve prolapse in the US?
20 min
Mid - systolic click followed by regurgitation murmur
S epidermidis
2-3%

45. What type of collagen is involved in fibrosis?
LAD
Bounding pulse
Type I
Dilated

46. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Left -->right
R-->L
Mitral mitral+aortic

47. What causes endocarditis of prosthetic valves?
S epidermidis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Friction rub and chest pain
Boot shaped heart

48. What type of ASD is associated w/Down syndrome?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Mitral mitral+aortic
Ostium primum
Right side - serotonin and other secretory products detoxified in the lung

49. What is the most common cause of myocarditis?
Coxsackie A or B
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Bicuspid aortic valve
Opening snap followed by diastolic rumble

50. What is the 1day-1wk -1mo mneumonic for MI?
Open blocked vessels
Intercostal arteries enlarged due to collateral circulation
Adult coarctation of the aorta
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar