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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 JOneS mneumonic?
Circumflex
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Metastasis
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea

2. What does nonbacterial thrombotic endocarditis cause?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Mitral regurg
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Right side - serotonin and other secretory products detoxified in the lung

3. What are the causes of restrictive cardiomyopathy in adults?
2-4 hours - 24 hours - 7-10 days
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dense layer of elastic and fibrotic tissue in the endocardium - children

4. What is eythema marginatum? What parts of the body does it commonly involve?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Annular - non pruritic rash w/erythematous borders trunks and limbs
Stable angina
RHF

5. How does contraction band necrosis occur?
S aureus
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Stable angina
Pedunculated mass in the LA that causes syncope due to obstruction of MV

6. Which coronary artery supplies the anterior wall and anterior septum?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Thickening of chrodae tendinae and cusps - mitral stenosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
LAD

7. Which chambers of the heart are generally spared in an MI?
Eisenmenger syndrome
Subendocardial
Atria and RV
Ventricular arrhythmia

8. What are Janeway lesions?
S aureus
Endocardial fibroelastosis (rare)
Posterior wall of LV - posterior septum - papillary muscles
Erythematous nontender lesions on palms and soles.

9. How does stable angina present?
Positive blood cultures anemia of chronic disease
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Chest pain <20 min brought on by exertion or emotional stress
Breast and lung carcinoma - melanoma - lymphoma

10. In what pt population does S aureus commonly cause valvular disease?
IV drug users
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
Ventricular arrhythmia
Sudden cardiac death

11. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Myxoma - benign
RCA
Blood vessels coming in from normal tissue

12. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
PDA
Large vegetations of S aureus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

13. Is injury due angina reversible or irreversible?
Reversible
Valve scarring that arises as a consequence of rheumatic fever
Dark discoloration coagulative necrosis
Contraction band necrosis

14. Which vasculitis can cause MI?
Fetal alcohol syndrome
Kawasaki disease
Cardiogenic shock - CHF - arrhythmia
Shunt - PGE to maintain PDA until surgical repair can be performed

15. Myofiber hypertrophy with disarray.
Fetal alcohol syndrome
Hypertrophic cardiomyopathy
Sterile vegetations on mitral valve along lines of closure
Libman - Sacks endocarditis

16. Why are cardiac enzymes elevated after an MI?
Large vegetations of S aureus
1%
Membrane damage
S aureus

17. What % of MIs involve the LAD?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Positive blood cultures anemia of chronic disease
45%
Friction rub and chest pain

18. What is the tx for mitral valve prolapse?
Day 1-7
Posterior wall of LV - posterior septum - papillary muscles
S aureus
Valve replacement

19. What are the complications of mitral valve prolapse? Are they common?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Cardiogenic shock - CHF - arrhythmia
Infectious endocarditis - arrythmias - severe mitral regurg no

20. What type of shunt results in cyanosis at birth?
Systemic venous congestion
Dilated
Right to left
Coronary artery vasospasm

21. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Systolic ejection click followed by crescendo - decrescendo murmur
PGE
Migratory polyarthritis

22. What causes an early - blowing diastolic murmur?
Mid - systolic click followed by regurgitation murmur
Blood vessels coming in from normal tissue
Aortic regurg
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

23. Turner syndrome is associated with which congenital heart defect?
Fibrinous pericarditis
Mitral regurg
Infantile coarctation of the aorta
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

24. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Autoimmune pericarditis 6-8 wks post MI
Squat in response to cyanotic spell
Rhabdomyoma

25. What type of shunt does truncus arteriosus cause?
R-->L
Cardiogenic shock - CHF - arrhythmia
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

26. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Aortic regurg
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Hypertophy of RV atrophy of LV

27. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Circumflex
Increased blood in right heart delays closure of P valve
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

28. When is an MI patent at highest risk for fibrionous pericarditis?
PDA
1-3 days out
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Cardiac tamponade

29. What is endocardial fibroelastosis? In what population is it found?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Dense layer of elastic and fibrotic tissue in the endocardium - children
Transposition of the great vessels
Mid - systolic click followed by regurgitation murmur

30. What is a complication of chronic rheumatic heart disease?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
VSD
Infectious endocarditis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

31. Which congenital heart defect is associated with congenital rubella?
Troponin I
L->R
Myocarditis
PDA

32. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
PGE
Inability to maintain systemic pressure w/lack of O2 to vital organs
Adult coarctation of the aorta
Membrane damage

33. What is the most common cause of aortic stenosis?
Wear and tear
MI
Adult coarctation of the aorta
Nonbacterial thrombotic endocarditis (marantic endocarditis)

34. What are the forward and backward sx of LHF?
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
Myocardium
Autoimmune pericarditis 6-8 wks post MI
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

35. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Restrictive cardiomyopathy
Thickening of chrodae tendinae and cusps - mitral stenosis
Blood vessels coming in from normal tissue

36. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Squatting - increased systemic resistence decreases LV emptying
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Dense layer of elastic and fibrotic tissue in the endocardium - children

37. What causes prinzmetal angina?
ST- segment depression
Coronary artery vasospasm
Systolic dysfx leading to biventricular CHF
Concentric LV hypertophy

38. What is systolic dysfx?
Ventricles cannot pump
Opening snap followed by diastolic rumble
Endocardial fibroelastosis
Right side - serotonin and other secretory products detoxified in the lung

39. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Erythematous nontender lesions on palms and soles.
Metastasis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

40. What are Osler nodes?
Transposition of the great vessels
Mitral insufficiency
Tender lesions on fingers or toes.
LHF

41. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Months out fibrosis
Chronic rheumatic heart disease
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

42. What are the sx of PDA at birth?
Asymptomatic
SLE
Cyanosis - RV hypertrophy - polycythemia - clubbing
Hypertophy of RV atrophy of LV

43. How does restrictive cardiomyopathy present?
Coronary artery vasospasm - emboli - vasculitis
Kawasaki disease
Congestive heart failure
Myofiber hypertrophy with disarray

44. What causes microangiopathic hemolytic anemia in aortic stenosis?
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
RBC damaged while crossing the calcified valve causing schistocytes
LAD
VSD

45. Dense layer of elastic and fibrotic tissue in the endocardium.
Aortic regurg
Endocardial fibroelastosis
>70%
Right to left

46. What is the classic EKG finding of restrictive cardiomyopathy?
Myocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Increased blood in right heart delays closure of P valve
Low voltage EKG w/diminished QRS amplitude

47. What is the most common valve infected by S aureus?
Regurg vs stenosis
Tricuspid
Valve scarring that arises as a consequence of rheumatic fever
L->R

48. What are the laboratory findings of bacterial endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Backward LHF pulm htn and RHF - afib and associated mural thombis
Positive blood cultures anemia of chronic disease
Limits thrombosis

49. How do ACE inhibitors tx MI?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decreases LV dilation by decreasing volume
R-->L
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

50. What type of shunt does ASD cause?
Left -->right
Volume overload and LHF
Mitral valve prolapse
Evidence of prior group A beta - hemolytic strep plus major and minor criteria