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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. Myofiber hypertrophy with disarray.
Prinzmetal
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
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Hypertrophic cardiomyopathy

2. What is cardiogenic shock?
Infectious endocarditis - arrythmias - severe mitral regurg no
Inability to maintain systemic pressure w/lack of O2 to vital organs
NG or Ca channel blocker
PDA

3. What type of vegetations does Strep viridans cause?
Systemic venous congestion
Erythematous nontender lesions on palms and soles.
Systolic dysfx leading to biventricular CHF
Small - nondestructive vegetations (subacute endocarditis)

4. Which congenital heart defect is associated with congenital rubella?
Increased blood in right heart delays closure of P valve
LHF
2-3 weeks
PDA

5. What is the most common congenital heart defect?
CK- MB
Concentric LV hypertophy
Left -->right
VSD

6. What type of shunt results in cyanosis at birth?
Fibrinous pericarditis
Right to left
Annular - non pruritic rash w/erythematous borders trunks and limbs
Nitroglycerin

7. What is the classic EKG finding of restrictive cardiomyopathy?
Reperfusion injury
Low voltage EKG w/diminished QRS amplitude
SLE
Backward LHF pulm htn and RHF - afib and associated mural thombis

8. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
PDA
Reperfusion injury
Contraction band necrosis - reperfusion injury

9. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Gelatinous - abundant ground substance
Transesophageal echo

10. What is the only Jones criteria that doesn't resolve with time?
LA
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
Pancarditis
ASD - R-->L

11. With what congenital heart defect is ADULT coarctation of the aorta associated?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Bicuspid aortic valve
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Concentric LV hypertophy

12. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Louder - increased systemic resistence decreases LV emptying
S viridans
Months out fibrosis

13. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Gelatinous - abundant ground substance
Papillary muscle - free wall - IV septum
Prinzmetal

14. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Maternal diabetes
Indomethacin - decreases PGE
Bounding pulse

15. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Acute inflammation
Metastasis
Right -->left
Regurg vs stenosis

16. What is migratory polyarthritis?
20 min
Congested central veins
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
45%

17. What is the main cause of MV regurg? What are other causes?
Reperfusion injury
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
1%
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

18. What are Janeway lesions?
PDA
Heart transplant
Erythematous nontender lesions on palms and soles.
R-->L

19. EKG for stable angina?
ST- segment depression
Ehlers - Danlow and Marfan syndrome
Inability to fill ventricles
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

20. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Squatting - expiration
LA
Membrane damage

21. What causes wear and tear aortic stenosis?
When a bacterial protein resembles a protein in human tissue
Fibrosis and dystrophic calcification
Prinzmetal angina - cocaine
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

22. What is the tx for aortic stenosis?
Ostium secundum (90%)
Day 1-7
Months out fibrosis
Valve replacement AFTER the onset of complications

23. What causes endocarditis of prosthetic valves?
Boot shaped heart
Nonbacterial thrombotic endocarditis (marantic endocarditis)
VSD
S epidermidis

24. What increases the volume of mitral regurg murmur?
Loss of LV fx
Squatting - expiration
Restrictive cardiomyopathy
Elevated ASO anti - DNase B titers

25. What cardiac disease is associated with tuberous sclerosis?
Mitral and tricuspid regurg - arrhythmia
Low voltage EKG w/diminished QRS amplitude
S aureus
Rhabdomyoma

26. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Pts w/previously damaged valves
Hypercoagulable state or underlying adenocarcinoma
Right -->left

27. What areas of the heart does the LAD supply?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Anterior wall of LV and anterior septum
Louder - increased systemic resistence decreases LV emptying
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

28. What conditions can cause nonbacterial thrombotic endocarditis?
Erythematous nontender lesions on palms and soles.
LHF
Hypercoagulable state or underlying adenocarcinoma
Large - destructive vegetations

29. What congenital heart defect presents later in life with lower extremity cyanosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
CHF
PDA
Pump failure

30. In what pt population does S aureus commonly cause valvular disease?
Left -->right
Holosystolic blowing murmur
IV drug users
Right to left

31. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Thickening of chrodae tendinae and cusps - mitral stenosis
Mitral regurg
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

32. What does Libman - Sacks endocarditis cause?
Coronary artery vasospasm
Reversible
Mitral regurg
Ventricular arrhythmia

33. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Infantile coarctation of the aorta
Months out fibrosis
Prinzmetal

34. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Blood vessels coming in from normal tissue
Chronic ischemic heart disease
Regurg vs stenosis

35. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
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
Increased hydrostatic pressure
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

36. How does transmural MI/ischemia present on EKG?
Contraction band necrosis - reperfusion injury
Infectious endocarditis - arrythmias - severe mitral regurg no
ST- segment elevation
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

37. What generally causes ischemic heart disease?
Prophylactic abx during dental procedures
Fibrinous pericarditis
Atherosclerosis of coronary arteries
Loeffler syndrome

38. With what disease is Libman - Sacks endocarditis associated?
SLE
Inability to fill ventricles
Thickening of chrodae tendinae and cusps - mitral stenosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

39. What is diastolic dysfx?
White scar fibrosis
ST- segment depression
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Inability to fill ventricles

40. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Pericardial effusion due to pericardial involvement
Large vegetations of S aureus
Aortic regurg
Months out fibrosis

41. How does hypertension cause LHF?

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42. What compensatory mechanism do tetralogy of fallot pts learn?
Mitral regurg
Squat in response to cyanotic spell
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Right side - serotonin and other secretory products detoxified in the lung

43. Systolic ejection click followed by crescendo - decrescendo murmur.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Aortic stenosis
IV drug users
Stable and unstable prinzmetal

44. In which chamber of the heart are cardiac myxomas found?
Stable and unstable prinzmetal
Tuberous sclerosis
LA
Preductal - post aortic arch

45. What is the most comon cause of aortic regurg? What are the other causes?
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
Dressler syndrome
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Transesophageal echo

46. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Decrease preload -->lowers myocardial stress
Libman - Sacks endocarditis
Aortic stenosis

47. L- to - R shunt switching to R- to - L shunt.
Aortic regurg
Pulsating nail bed
Eisenmenger syndrome
Chest pain <20 min brought on by exertion or emotional stress

48. What is the most common tumor of the heart?
Boot shaped heart
PDA
Metastasis
Congestive heart failure

49. With what virus is PDA associated?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Congenital rubella
LA
Osler nodes (ouch - ouch Osler)

50. What vavular defect results from acute rheumatic fever?
PDA
Mitral regurgitation due to vegetations
Chronic ischemic heart disease
PDA

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