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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 congenital heart defect often is present with infantile coarctation of the aorta?
S epidermidis
Friction rub and chest pain
PDA
Myocarditis in acute rheumatic heart fever

2. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Shunt - PGE to maintain PDA until surgical repair can be performed
LHF
Left -->right

3. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Limits thrombosis
Colon cancer
45%
NG or Ca channel blocker

4. What is the most common cause of myocarditis?
>70%
Coxsackie A or B
ST- segment depression
IV drug users

5. What is the rate of mitral valve prolapse in the US?
Prinzmetal angina
2-3%
Pump failure
Coexisting mitral stenosis and fusion of commisures exist

6. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
VSD
LA
Dense layer of elastic and fibrotic tissue in the endocardium - children

7. What valves are involved in rhuematic endocarditis?
Turner syndrome
Mitral mitral+aortic
First 4 hours
Valve replacement AFTER the onset of complications

8. 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.
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Stable angina
Myxoma - benign
Harmartoma

9. What is the most common valve infected by S aureus?
Tricuspid
Pedunculated mass in the LA that causes syncope due to obstruction of MV
LA dilation
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

10. How does O2 tx MI?
Ostium secundum (90%)
Tricuspid
Rupture of free wall - IV septum - or papillary muscle
Minimizes ischemia

11. Infects predamaged valves after transient bacteremia?
S viridans
Valve scarring that arises as a consequence of rheumatic fever
PDA
Positive blood cultures anemia of chronic disease

12. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Systolic dysfx leading to biventricular CHF
Intercostal arteries enlarged due to collateral circulation
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

13. What is migratory polyarthritis?
Infectious endocarditis - arrythmias - severe mitral regurg no
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Holosystolic blowing murmur
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

14. What imaging test is useful for detecting lesions on valves?
Anterior wall of LV and anterior septum
Mitral and tricuspid regurg - arrhythmia
Right to left
Transesophageal echo

15. What type of shunt does truncus arteriosus cause?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Group A beta - hemolytic streptococci
R-->L
1%

16. What heart sound manifest with an ASD?
RBC damaged while crossing the calcified valve causing schistocytes
Mitral regurg
Split S2 on auscultation
Membrane damage

17. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Aneurysm - mural thrombus - Dressler syndrome
Months out fibrosis

18. Pericarditis 6-8 wks post MI.
Autoimmune pericarditis 6-8 wks post MI
White scar fibrosis
Dressler syndrome
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

19. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Coxsackie A or B
20 min
Sterile vegetations on surface and undersurface on mitral valve

20. What is the characteristic finding on CXR in tetralogy of fallot?
Yellow pallor neutrophils
Metastasis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Boot shaped heart

21. What increases the risk for chronic rheumatic heart disease?
Janeway lesions
LA
Contraction band necrosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

22. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Stable angina
Stable and unstable prinzmetal
CHF
Months out fibrosis

23. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Ventricles cannot pump
R-->L

24. What % stenosis causes stable angina?
Open blocked vessels
Migratory polyarthritis
Mitral insufficiency
>70%

25. What is the most common cause of infectious endocarditis?
Valve replacement AFTER the onset of complications
Aortic regurg
Streptococcus viridans
Coronary artery vasospasm

26. Erythematous nontender lesions on palms and soles.
Janeway lesions
Right side - serotonin and other secretory products detoxified in the lung
Stretched muscle loses contractility
LV dilation and eccentric hypertrophy

27. With what disease is Libman - Sacks endocarditis associated?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
SLE
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
RCA

28. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Kawasaki disease
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
LA

29. What is an important complication of ASD?
Paradoxical emboli
Harmartoma
Pericardial effusion due to pericardial involvement
Decreased forward perfusion pulmonary congestion

30. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
LV dilation and eccentric hypertrophy
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
Large - destructive vegetations

31. What does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
MI
IV drug users
Increased blood in right heart delays closure of P valve

32. What is the most common cause of RHF? What are others?
Holosystolic machine like murmur
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Pericardial effusion due to pericardial involvement
Aneurysm - mural thrombus - Dressler syndrome

33. How does transmural MI/ischemia present on EKG?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
4-24 hours
ST- segment elevation
Cardiogenic shock - CHF - arrhythmia

34. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Mitral valve prolapse
Congested central veins
RHF
White scar fibrosis

35. How does asprin/heparin tx MI?
RBC damaged while crossing the calcified valve causing schistocytes
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Membrane damage
Limits thrombosis

36. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Months out fibrosis
Increased hydrostatic pressure
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

37. What are the clinical features of RHF due to?
Papillary muscle - free wall - IV septum
IV drug users
Systemic venous congestion
Bacterial endocarditis

38. Tender lesions on fingers or toes.
Spontaneous
Mitral valve prolapse
Osler nodes (ouch - ouch Osler)
Dark discoloration coagulative necrosis

39. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Elevated ASO anti - DNase B titers
Indomethacin - decreases PGE
S aureus

40. What is the leading cause of death in the US?
Doxorubicin - cocaine
Transposition of the great vessels
Ischemic heart disease
VSD

41. What is the rate of congenital heart defects?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Erythematous nontender lesions on palms and soles.
1%

42. What effect does mitral stenosis have on the heart chambers?
Ischemic heart disease
Rhabdomyoma
LA dilation
ST- segment depression

43. What vavular defect results from acute rheumatic fever?
Decrease in blood flow to an organ
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
PDA
Mitral regurgitation due to vegetations

44. Ostium primum ASD is associated with what congenital disorder?
Open blocked vessels
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Trisomy 21

45. What are the two effects of ATII?
Left -->right
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Reperfusion injury
Months out fibrosis

46. What are the forward and backward sx of LHF?
Ehlers - Danlow and Marfan syndrome
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
PDA
Minimizes ischemia

47. How does dilated cardiomyopathy cause LHF?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Day 1-7
Mitral mitral+aortic
Stretched muscle loses contractility

48. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Rupture of free wall - IV septum - or papillary muscle
Eisenmenger syndrome
2-4 hours - 24 hours - 7-10 days

49. What is the main cause of MV regurg? What are other causes?
Janeway lesions
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
>60 years - bicuspid aortic valve
Boot shaped heart

50. What is the characteristic murmur of aortic stenosis?
Boot shaped heart
Plump fibroblasts - collagen - blood vessels
Systolic ejection click followed by crescendo - decrescendo murmur
Endocardial fibroelastosis