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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. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Transposition of the great vessels
Bounding pulse
3-8 wks
Aortic regurg

2. How does O2 tx MI?
R-->L
Minimizes ischemia
Small - nondestructive vegetations (subacute endocarditis)
1-3 days out

3. What are the laboratory findings of bacterial endocarditis?
RCA
Myocardium
MI
Positive blood cultures anemia of chronic disease

4. Is scar tissue or myocardium stronger?
Dilated
Prinzmetal angina - cocaine
Myocardium
Hypercoagulable state or underlying adenocarcinoma

5. Why are cardiac enzymes elevated after an MI?
Membrane damage
Squatting - increased systemic resistence decreases LV emptying
Increased hydrostatic pressure
Inability to fill ventricles

6. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LV dilation and eccentric hypertrophy
Prinzmetal angina
IV drug users
LHF

7. What causes acute endocarditis?
Posterior wall of LV - posterior septum - papillary muscles
Shunt - PGE to maintain PDA until surgical repair can be performed
Large vegetations of S aureus
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

8. What is the only Jones criteria that doesn't resolve with time?
Congested central veins
Reversible
Fetal alcohol syndrome
Pancarditis

9. Infects predamaged valves after transient bacteremia?
45%
S viridans
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Cardiogenic shock - CHF - arrhythmia

10. What does chronic ischemic heart disease progress to?
Pts w/previously damaged valves
Turner syndrome
CHF
Intercostal arteries enlarged due to collateral circulation

11. What % of MIs involve the LAD?
Degree of pulmonary artery stenosis
45%
Mitral regurgitation due to vegetations
LAD

12. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
LAD
Loss of LV fx
Louder - increased systemic resistence decreases LV emptying
Anitschow cell

13. What coronary artery supplies the mitral valve papillary muscles?
Coronary artery vasospasm - emboli - vasculitis
RCA
Pericarditits
2-4 hours - 24 hours - 7-10 days

14. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Boot shaped heart
2-3%
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

15. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Autoimmune pericarditis 6-8 wks post MI
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Nonspecific - eg fever and elevated ESR

16. What causes angina and syncope in aortic stenosis?

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17. What is molecular mimicry?
Mitral mitral+aortic
Surgical closure small defects may close spontaneously
When a bacterial protein resembles a protein in human tissue
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

18. How do you tx prinzmetal angina?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
NG or Ca channel blocker
Doxorubicin - cocaine
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

19. What is the most common type of ASD? What %?
Kawasaki disease
Ostium secundum (90%)
L->R
Type I

20. How does asprin/heparin tx MI?
45%
Limits thrombosis
RCA
Congested central veins

21. What artery is the 2nd most often occluded in an MI?
RCA
Chest pain <20 min brought on by exertion or emotional stress
Autoimmune pericarditis 6-8 wks post MI
Mid - systolic click followed by regurgitation murmur

22. How does restrictive cardiomyopathy present?
3-8 wks
Infectious endocarditis
Congestive heart failure
Transesophageal echo

23. What causes heart failure cells?
Degree of pulmonary artery stenosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Reperfusion injury
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

24. What complication occurs 1-3 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Osler nodes (ouch - ouch Osler)
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Fibrinous pericarditis

25. Tender lesions on fingers or toes.
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reperfusion injury
Osler nodes (ouch - ouch Osler)
ST- segment elevation

26. What is diastolic dysfx?
Acute inflammation
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
CK- MB
Inability to fill ventricles

27. What is the tx for aortic stenosis?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Valve replacement AFTER the onset of complications
Adult coarctation of the aorta
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

28. What drugs can cause dilated cardiomyopathy?
Ventricular arrhythmia
Stable angina
Turner syndrome
Doxorubicin - cocaine

29. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Bicuspid aortic valve
Degree of pulmonary artery stenosis
Infantile coarctation of the aorta

30. Vegetations on surface and undersurface of mitral valve.
Infectious
Libman - Sacks endocarditis
MI
Left -->right

31. How does hypertension cause LHF?

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32. What is the most common valve infected by S aureus?
Opening snap followed by diastolic rumble
Prinzmetal angina
Tricuspid
Decreased forward perfusion pulmonary congestion

33. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Doxorubicin - cocaine
Infectious endocarditis - arrythmias - severe mitral regurg no
PGE

34. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Yellow pallor macrophages
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Mitral mitral+aortic

35. What are the tx for MI?
Paradoxical emboli
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Positive blood cultures anemia of chronic disease

36. With what developmental disorder is VSD associated?
Autoimmune pericarditis 6-8 wks post MI
Decreased forward perfusion pulmonary congestion
Fetal alcohol syndrome
R-->L

37. What causes a mid - systolic click followed by a regurgitation murmur?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Colon cancer
Mitral valve prolapse
Reperfusion injury

38. Which congenital heart defect is associated with maternal diabetes?
VSD
Transposition of the great vessels
Infantile coarctation of the aorta PDA
VSD

39. What is the murmur of mitral regurg?
Ostium primum
Autoimmune pericarditis 6-8 wks post MI
Valve replacement
Holosystolic blowing murmur

40. When is an MI patent at highest risk for fibrionous pericarditis?
Holosystolic blowing murmur
Autoimmune pericarditis 6-8 wks post MI
1-3 days out
Circumflex

41. What are the sx of aortic regurg?
Turner syndrome
Mitral stenosis
Myocarditis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

42. How does adult coarctation of the aorta present?
Boot shaped heart
Kawasaki disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Pts w/previously damaged valves

43. What is the foundation of a scar?
Subendocardial
Ventricles cannot pump
Granulation tissue
Ostium secundum (90%)

44. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
L->R
Right to left
ACE inhibitor

45. How do you prevent S viridans endocarditis?
ST- segment depression
Valve replacement
Friction rub and chest pain
Prophylactic abx during dental procedures

46. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Inability to fill ventricles
20 min
VSD

47. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
>70%
PDA
RBC damaged while crossing the calcified valve causing schistocytes

48. With what endocarditis is S epidermidis associated?
White scar fibrosis
Endocarditis of prosthetic valves
Restrictive cardiomyopathy
PDA

49. What are the cancers that most commonly metastasize to the heart?
NG or Ca channel blocker
Myocarditis
Breast and lung carcinoma - melanoma - lymphoma
Janeway lesions

50. What are the complications of mitral valve prolapse? Are they common?
Mitral stenosis
Low voltage EKG w/diminished QRS amplitude
Infectious endocarditis - arrythmias - severe mitral regurg no
Evidence of prior group A beta - hemolytic strep plus major and minor criteria