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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. Poor myocardial fx due to chronic ischemic damage?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Myocarditis in acute rheumatic heart fever
Chronic ischemic heart disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

2. Which coronary artery supplies the anterior wall and anterior septum?
NG or Ca channel blocker
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Prinzmetal angina
LAD

3. What congenital heart defect does indomethacin tx?
Spontaneous
LAD
Mitral regurgitation due to vegetations
PDA

4. What is the etiology of S viridans endocarditis?
Osler nodes (ouch - ouch Osler)
Mitral and tricuspid regurg - arrhythmia
Nonspecific - eg fever and elevated ESR
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

5. At what point in development do congenital heart defects arise?
ASD - R-->L
3-8 wks
Aneurysm - mural thrombus - Dressler syndrome
Loeffler syndrome

6. What is the most common cause of infectious endocarditis?
Mid - systolic click followed by regurgitation murmur
Fibrosis and dystrophic calcification
Squatting - increased systemic resistence decreases LV emptying
Streptococcus viridans

7. Holosystolic blowing murmur that increases w/expiration?
Yellow pallor neutrophils
Coexisting mitral stenosis and fusion of commisures exist
Regurg vs stenosis
Mitral regurg

8. What are the clinical features of LHF due to?
Infantile coarctation of the aorta
Decreased forward perfusion pulmonary congestion
Infectious endocarditis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

9. What % of MIs involve the LAD?
45%
Myxoma - benign
Atria and RV
Sudden cardiac death

10. What does rupture of the IV septum cause?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Infantile coarctation of the aorta PDA
Boot shaped heart
Shunt

11. What does Libman - Sacks endocarditis cause?
Mitral stenosis
Mitral regurg
Endocardial fibroelastosis
Myocardium

12. With what disease is Libman - Sacks endocarditis associated?
Small vegetations along the line of closure
SLE
Chronic ischemic heart disease
S aureus

13. What drugs can cause dilated cardiomyopathy?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Dense layer of elastic and fibrotic tissue in the endocardium - children
Doxorubicin - cocaine
Contraction band necrosis - reperfusion injury

14. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
>60 years - bicuspid aortic valve
Circumflex
Janeway lesions

15. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aschoff bodies
Squatting - increased systemic resistence decreases LV emptying
PDA

16. 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.
Stable angina
AD mutation in sarcomere proteins
Atherosclerosis of coronary arteries
Mitral stenosis

17. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mitral mitral+aortic
Acute inflammation

18. What are the sx of right - to - left shunt?
Coronary artery vasospasm
Sterile vegetations on surface and undersurface on mitral valve
Cyanosis - RV hypertrophy - polycythemia - clubbing
R-->L

19. Which angina is relieved by Ca channel blockers?
Prinzmetal
Annular - non pruritic rash w/erythematous borders trunks and limbs
Atria and RV
Bacterial endocarditis

20. What is the most common cause of myocarditis?
Cardiogenic shock - CHF - arrhythmia
Ostium primum
1%
Coxsackie A or B

21. What are the complications of aortic stenosis?
Ventricle
Squatting - expiration
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

22. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Open blocked vessels
Tender lesions on fingers or toes.
Granulation tissue

23. What is the most common form of cardiomyopathy?
Reactive histiocyte with caterpillar nucleus
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Dilated
Aortic regurg

24. What iis the tx for aortic regurg?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Ventricle
2-4 hours - 24 hours - 7-10 days
Valve replacement once LV dysfx develops

25. What are the causes of restrictive cardiomyopathy in adults?
When a bacterial protein resembles a protein in human tissue
Reversible
Asymptomatic
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

26. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Fibrinous pericarditis
Subendocardial
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

27. What is the gold standard blood marker for MI?
ACE inhibitor
Colon cancer
Regurg vs stenosis
Troponin I

28. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Loeffler syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

29. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Stable and unstable prinzmetal
Fibrinous pericarditis
Infectious

30. What type of tumor is a rhabdomyoma?
Prinzmetal angina - cocaine
Harmartoma
Infectious endocarditis - arrythmias - severe mitral regurg no
Gelatinous - abundant ground substance

31. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Anterior wall of LV and anterior septum
Large - destructive vegetations
LV dilation and eccentric hypertrophy

32. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Tricuspid
MI
Indomethacin - decreases PGE
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

33. In transposition of the great vessels - What is required for survival? How is this achieved?
Pancarditis
Atria and RV
PGE
Shunt - PGE to maintain PDA until surgical repair can be performed

34. What effect does transposition of the great vessels have on the ventricles?
Left -->right
Hypertophy of RV atrophy of LV
Heart transplant
Limits thrombosis

35. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Mitral and tricuspid regurg - arrhythmia
VSD
PDA
Split S2 on auscultation

36. In which chamber of the heart are cardiac myxomas found?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
PDA
LA
Rhadbomyoma - benign

37. What type of shunt does a VSD cause?
L->R
Myocarditis
Limits thrombosis
Myofiber hypertrophy with disarray

38. What causes angina and syncope in aortic stenosis?

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39. What is eythema marginatum? What parts of the body does it commonly involve?
Acute inflammation
Annular - non pruritic rash w/erythematous borders trunks and limbs
Left -->right
NG or Ca channel blocker

40. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
R-->L
4-7 days macrophage infiltration
CHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

41. What are Osler nodes?
MI
Holosystolic machine like murmur
Harmartoma
Tender lesions on fingers or toes.

42. When do macrophagess infiltrate the myocardium post MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
4-7 days
Rhadbomyoma - benign
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

43. How does reperfusion injury occur?
Chronic ischemic heart disease
Pancarditis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
S epidermidis

44. How does restrictive cardiomyopathy cause LHF?

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45. What is typically the mechanims of sudden cardiac death?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ventricular arrhythmia
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mid - systolic click followed by regurgitation murmur

46. What type of shunt does transposition of the great vessels cause?
Holosystolic blowing murmur
R-->L
Aortic regurg
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

47. What are heart failure cells?
Hemosiderin laden macrophages
Inability to fill ventricles
Prophylactic abx during dental procedures
S viridans

48. What are the complications that occur months after an MI?
NG or Ca channel blocker
LAD
Aneurysm - mural thrombus - Dressler syndrome
Bicuspid aortic valve

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

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50. What is the leading cause of death in the US?
Ischemic heart disease
Valve replacement once LV dysfx develops
R-->L
Reperfusion injury