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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. Opening snap followed by diastolic rumble.
Osler nodes (ouch - ouch Osler)
Anterior wall of LV and anterior septum
AD mutation in sarcomere proteins
Mitral stenosis

2. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
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
CK- MB
>70%

3. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
PGE
Metastasis
Coexisting mitral stenosis and fusion of commisures exist

4. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Small vegetations along the line of closure
Rhadbomyoma - benign
Holosystolic machine like murmur
VSD

5. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Right -->left
2-3 weeks
Myxoma - benign

6. What is molecular mimicry?
LAD
Coronary artery vasospasm
IV drug users
When a bacterial protein resembles a protein in human tissue

7. What congenital heart defect presents later in life with lower extremity cyanosis?
Turner syndrome
R-->L
3-8 wks
PDA

8. What drugs can cause dilated cardiomyopathy?
Aortic stenosis
Systolic dysfx leading to biventricular CHF
Increased blood in right heart delays closure of P valve
Doxorubicin - cocaine

9. What is the basic principle of CHF?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Pump failure
Spontaneous
Indomethacin - decreases PGE

10. What is migratory polyarthritis?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Coexisting mitral stenosis and fusion of commisures exist
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Plump fibroblasts - collagen - blood vessels

11. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
L->R
Myocarditis in acute rheumatic heart fever
RBC damaged while crossing the calcified valve causing schistocytes

12. What are the major criteria of the Jones criteria?
Heart can't fill
S aureus
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

13. What is the rate of mitral valve prolapse in the US?
Squatting - expiration
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
LAD
2-3%

14. What is the gold standard blood marker for MI?
Troponin I
Split S2 on auscultation
Mitral regurg
Coexisting mitral stenosis and fusion of commisures exist

15. L- to - R shunt switching to R- to - L shunt.
Right to left
Eisenmenger syndrome
Pericardial effusion due to pericardial involvement
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

16. What is the tx for VSD?
Contraction band necrosis
Aortic regurg
Surgical closure small defects may close spontaneously
Tender lesions on fingers or toes.

17. What is diastolic dysfx?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Inability to fill ventricles
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
4-6 hours - 24 hours - 72 hours

18. With what developmental disorder is VSD associated?
Anterior wall of LV and anterior septum
Endocardial fibroelastosis (rare)
Fetal alcohol syndrome
Circumflex

19. What increases the volume of mitral regurg murmur?
Blood vessels coming in from normal tissue
Squatting - expiration
Friction rub and chest pain
Migratory polyarthritis

20. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Congenital rubella
Endocarditis of prosthetic valves
Pulsating nail bed

21. What does chronic ischemic heart disease progress to?
Hypertrophic cardiomyopathy
CHF
>60 years - bicuspid aortic valve
Nitroglycerin

22. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
VSD
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Infectious endocarditis

23. What causes unstable angina?
Mitral regurg
Dense layer of elastic and fibrotic tissue in the endocardium - children
RCA
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

24. What conditions can cause nonbacterial thrombotic endocarditis?
Gelatinous - abundant ground substance
Hypercoagulable state or underlying adenocarcinoma
4-7 days macrophage infiltration
Day 1-7

25. What is the classic EKG finding of restrictive cardiomyopathy?
Infectious endocarditis - arrythmias - severe mitral regurg no
Low voltage EKG w/diminished QRS amplitude
Small - nondestructive vegetations (subacute endocarditis)
Mitral stenosis

26. What is the most common cause of myocarditis?
Surgical closure small defects may close spontaneously
Aortic stenosis
Coxsackie A or B
Increased blood in right heart delays closure of P valve

27. What are the sx of aortic regurg?
Rhabdomyoma
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Endocardial fibroelastosis

28. How does adult coarctation of the aorta present?
Myocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Annular - non pruritic rash w/erythematous borders trunks and limbs
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

29. What side of the heart do carcinoid tumors affect? Why?
Hypertophy of RV atrophy of LV
CK- MB
Trisomy 21
Right side - serotonin and other secretory products detoxified in the lung

30. What is the main cause of MV regurg? What are other causes?
Paradoxical emboli
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
ACE inhibitor
Sudden cardiac death

31. How does transmural MI/ischemia present on EKG?
Chronic rheumatic heart disease
Months out fibrosis
Hypertrophic cardiomyopathy
ST- segment elevation

32. What are heart failure cells?
Stretched muscle loses contractility
Hemosiderin laden macrophages
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Erythematous nontender lesions on palms and soles.

33. What is a Quincke pulse?
Elevated ASO anti - DNase B titers
Mitral regurg
Pulsating nail bed
Yellow pallor neutrophils

34. What causes the nutmeg color in nutmeg liver?
Congested central veins
Circumflex
L->R
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

35. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Hypercoagulable state or underlying adenocarcinoma
Fibrinous pericarditis
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

36. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Janeway lesions
Prinzmetal stable and unstable
Friction rub and chest pain

37. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Fibrinous pericarditis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Colon cancer

38. What coronary arterysupplies the lateral wall of the LV?
ACE inhibitor
Circumflex
Prinzmetal angina - cocaine
PDA

39. What causes the dependent pitting edema in RHF?
Myocarditis in acute rheumatic heart fever
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
Increased hydrostatic pressure
Loeffler syndrome

40. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
RHF
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

41. What are the two effects of ATII?
Paradoxical emboli
Dilated
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
IV drug users

42. How does contraction band necrosis occur?
Streptococcus viridans
Myocarditis in acute rheumatic heart fever
Months out fibrosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

43. How do you tx prinzmetal angina?
Small - nondestructive vegetations (subacute endocarditis)
Aortic regurg
NG or Ca channel blocker
Shunt

44. What does Libman - Sacks endocarditis cause?
Valve replacement
Mitral regurg
Posterior wall of LV - posterior septum - papillary muscles
Reactive histiocyte with caterpillar nucleus

45. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
R-->L
CHF
Stretched muscle loses contractility

46. What gross and microscopic changes occur months after an MI?
Ischemic heart disease
Dilation of all four chambers of the heart
White scar fibrosis
Janeway lesions

47. What is a water - hammer pulse?
Bounding pulse
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
ST- segment depression
Decreased forward perfusion pulmonary congestion

48. What effect does chronic rheumatic heart disease have the mitral valve?
Minimizes ischemia
Preductal - post aortic arch
Thickening of chrodae tendinae and cusps - mitral stenosis
>60 years - bicuspid aortic valve

49. What is the effect of mitral regurg on the heart?
Posterior wall of LV - posterior septum - papillary muscles
Volume overload and LHF
Months out fibrosis
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

50. What are the sx of right - to - left shunt?
Restrictive cardiomyopathy
Valve replacement
Cyanosis - RV hypertrophy - polycythemia - clubbing
Colon cancer