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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 most common cause of myocarditis?
Transesophageal echo
SLE
Stable angina
Coxsackie A or B

2. What does nonbacterial thrombotic endocarditis cause?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Limits thrombosis
Months out fibrosis
Mitral regurg

3. What effect does squatting have on the murmur of mitral valve prolapse? Why?
4-7 days macrophage infiltration
Louder - increased systemic resistence decreases LV emptying
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Aneurysm - mural thrombus - Dressler syndrome

4. Tx for PDA?
Indomethacin - decreases PGE
Open blocked vessels
Ventricle
Mitral regurgitation due to vegetations

5. What type of vegetations does Strep viridans cause?
Adult coarctation of the aorta
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Small - nondestructive vegetations (subacute endocarditis)
Ventricle

6. Poor myocardial fx due to chronic ischemic damage?
Cardiac tamponade
Coronary artery vasospasm - emboli - vasculitis
Hypertrophic cardiomyopathy
Chronic ischemic heart disease

7. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Heart can't fill
Prinzmetal stable and unstable
Nonbacterial thrombotic endocarditis (marantic endocarditis)

8. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Chronic rheumatic heart disease
ASD - R-->L
Adult coarctation of the aorta
Nonspecific - eg fever and elevated ESR

9. What does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
Decrease preload -->lowers myocardial stress
NG or Ca channel blocker
45%

10. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Minimizes ischemia
Systolic ejection click followed by crescendo - decrescendo murmur
Metastasis

11. What are the HACEK organisms? With what condition are they associated?
Janeway lesions
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Mitral insufficiency
Prinzmetal stable and unstable

12. What is the most common cause of aortic stenosis?
Wear and tear
PDA
Myocarditis
White scar fibrosis

13. What is the 1day-1wk -1mo mneumonic for MI?
Erythematous nontender lesions on palms and soles.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Decrease preload -->lowers myocardial stress
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

14. What compensatory mechanism do tetralogy of fallot pts learn?
Cardiac tamponade
Metastasis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Squat in response to cyanotic spell

15. What are the tx for MI?
Spontaneous
AD mutation in sarcomere proteins
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

16. When is an MI patent at highest risk for fibrionous pericarditis?
LA
1-3 days out
Pts w/previously damaged valves
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

17. Which congenital heart defect is associated with maternal diabetes?
Tricuspid
Transposition of the great vessels
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ventricle

18. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Eisenmenger syndrome
Cardiac tamponade
Dressler syndrome

19. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
First 4 hours
Hemosiderin laden macrophages
Nitroglycerin
Papillary muscle - free wall - IV septum

20. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Janeway lesions
Aortic stenosis
Rhabdomyoma

21. Infects predamaged valves after transient bacteremia?
S viridans
4-6 hours - 24 hours - 72 hours
White scar fibrosis
Hypercoagulable state or underlying adenocarcinoma

22. What is the most common type of endocarditis?
Anterior wall of LV and anterior septum
Infectious
Dark discoloration coagulative necrosis
Intercostal arteries enlarged due to collateral circulation

23. What are the cancers that most commonly metastasize to the heart?
Loss of LV fx
Mitral regurg
Coronary artery vasospasm
Breast and lung carcinoma - melanoma - lymphoma

24. Lower extremity cyanosis in infants? In adults?
R-->L
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Mitral regurg
Infantile coarctation of the aorta PDA

25. What shunt does tetralogy of fallot produce?
Fetal alcohol syndrome
VSD
Right -->left
CK- MB

26. 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.
Membrane damage
Stable angina
Contraction band necrosis - reperfusion injury
Gelatinous - abundant ground substance

27. What bug causes acute rheumatic fever?
Fibrinous pericarditis
Elevated ASO anti - DNase B titers
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Group A beta - hemolytic streptococci

28. Which angina(s) show ST elevation on EKG? ST depression?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Prinzmetal stable and unstable
Low voltage EKG w/diminished QRS amplitude

29. What are Osler nodes?
Low voltage EKG w/diminished QRS amplitude
Tender lesions on fingers or toes.
Streptococcus bovis/
Ventricles cannot pump

30. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Limits thrombosis
Intercostal arteries enlarged due to collateral circulation
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

31. What is the tx for mitral valve prolapse?
ST- segment elevation
Right side - serotonin and other secretory products detoxified in the lung
Valve replacement
Anitschow cell

32. What maintains patency of the PDA?
PGE
SLE
1-3 days out
Coexisting mitral stenosis and fusion of commisures exist

33. What endocarditis is commonly found in patients with colon cancer?
Sudden cardiac death
Streptococcus bovis/
Day 1-7
Regurg vs stenosis

34. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Myxoma - benign
Within the first day
Holosystolic machine like murmur

35. What type of tumor is a rhabdomyoma?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Dense layer of elastic and fibrotic tissue in the endocardium - children
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Harmartoma

36. What is the gold standard blood marker for MI?
Maternal diabetes
Troponin I
Heart transplant
Mitral stenosis

37. How does restrictive cardiomyopathy present?
Congestive heart failure
Nitroglycerin
Hypertrophic cardiomyopathy
Rhabdomyoma

38. What are the major criteria of the Jones criteria?
Holosystolic machine like murmur
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Mitral valve prolapse
Eisenmenger syndrome

39. What typically causes hypertrophic cardiomyopathy?
VSD
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
Red border granulation tissue
AD mutation in sarcomere proteins

40. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Ischemic heart disease
Sudden cardiac death
Infantile coarctation of the aorta
Stable and unstable prinzmetal

41. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Bacterial endocarditis
Ventricular arrhythmia

42. What is the most common cause of dilated cardiomyopathy? What are other causes?
Ischemic heart disease
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
4-7 days macrophage infiltration
Membrane damage

43. What complications occur within 4 hrs post MI?
Tuberous sclerosis
Rupture of free wall - IV septum - or papillary muscle
Cardiogenic shock - CHF - arrhythmia
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

44. What is the effect of mitral regurg on the heart?
Migratory polyarthritis
Volume overload and LHF
Sudden cardiac death
Mitral insufficiency

45. What vavular defect results from acute rheumatic fever?
Pulsating nail bed
Mitral regurgitation due to vegetations
Cardiac tamponade
Dressler syndrome

46. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
LHF
S aureus
SLE

47. What % of MIs involve the LAD?
45%
Coronary artery vasospasm - emboli - vasculitis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
2-3%

48. What is an Aschoff body?
Left -->right
Pericarditits
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Type I

49. What effect does dilated cardiomyopathy have on the heart?
Right -->left
Split S2 on auscultation
Systolic dysfx leading to biventricular CHF
Boot shaped heart

50. What type of collagen is involved in fibrosis?
Type I
Transesophageal echo
White scar fibrosis
L->R