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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 conditions can cause nonbacterial thrombotic endocarditis?
Chronic ischemic heart disease
Preductal - post aortic arch
Mitral valve prolapse
Hypercoagulable state or underlying adenocarcinoma

2. What causes an early - blowing diastolic murmur?
Dressler syndrome
Aortic regurg
Coronary artery vasospasm
Nonspecific - eg fever and elevated ESR

3. What drug relieves stable angina?
Nitroglycerin
Squatting - increased systemic resistence decreases LV emptying
Wear and tear
Ehlers - Danlow and Marfan syndrome

4. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Months out fibrosis
Ostium primum
Myxoma - benign
Streptococcus bovis/

5. What congenital heart defect presents later in life with lower extremity cyanosis?
2-3%
VSD
Stable angina
PDA

6. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Atria and RV
Rhadbomyoma - benign
Inability to fill ventricles
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

7. What cardiac enzyme is useful for detecting reinfarction?
Myocarditis
LHF
CK- MB
Hypercoagulable state or underlying adenocarcinoma

8. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Opening snap followed by diastolic rumble
Rupture of free wall - IV septum - or papillary muscle
Atherosclerosis of coronary arteries
Nonbacterial thrombotic endocarditis (marantic endocarditis)

9. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Opening snap followed by diastolic rumble
1%
Infectious endocarditis - arrythmias - severe mitral regurg no

10. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Regurg vs stenosis
Tender lesions on fingers or toes.

11. Is injury due angina reversible or irreversible?
Chest pain <20 min brought on by exertion or emotional stress
Prinzmetal angina
Reversible
Bounding pulse

12. How does asprin/heparin tx MI?
Circumflex
Limits thrombosis
Congenital rubella
Mitral stenosis

13. How does Eisenmeger syndrome occur?
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
Posterior wall of LV - posterior septum - papillary muscles
Tetralogy of fallot
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

14. Opening snap followed by diastolic rumble.
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral stenosis
45%
Ventricular arrhythmia

15. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
R-->L
PDA
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

16. With what condition are rhabdomyomas associated?
Regurg vs stenosis
Tuberous sclerosis
Mitral and tricuspid regurg - arrhythmia
Valve replacement AFTER the onset of complications

17. What characterizes acute rheumatic fever endocarditiis?
Infectious endocarditis
Gelatinous - abundant ground substance
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Small vegetations along the line of closure

18. When does the heart have dark discoloration post MI?
4-24 hours
Harmartoma
Infantile coarctation of the aorta
Subendocardial

19. What complications occur within 4 hrs post MI?
Tricuspid
Opening snap followed by diastolic rumble
Cardiogenic shock - CHF - arrhythmia
4-7 days macrophage infiltration

20. What is the most common congenital heart defect?
VSD
Reversible
R-->L
Streptococcus viridans

21. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Tricuspid
Tetralogy of fallot
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

22. What is the most common cause of death during the acute phase of rheumatic fever?
Transesophageal echo
Myocarditis
Right -->left
Mid - systolic click followed by regurgitation murmur

23. What is the characteristic murmur of aortic stenosis?
Annular - non pruritic rash w/erythematous borders trunks and limbs
1-3 days out
Systolic ejection click followed by crescendo - decrescendo murmur
>70%

24. What are the sx of PDA at birth?
MI
Shunt
Asymptomatic
Tender lesions on fingers or toes.

25. Tender lesions on fingers or toes.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Osler nodes (ouch - ouch Osler)
Inability to maintain systemic pressure w/lack of O2 to vital organs
Anitschow cell

26. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Right side - serotonin and other secretory products detoxified in the lung
Within the first day
Hypercoagulable state or underlying adenocarcinoma

27. What are the forward and backward sx of LHF?
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral and tricuspid regurg - arrhythmia
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
Increased hydrostatic pressure

28. What type of ASD is associated w/Down syndrome?
Decreases LV dilation by decreasing volume
Pulsating nail bed
Rhabdomyoma
Ostium primum

29. Why are cardiac enzymes elevated after an MI?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Membrane damage
3-8 wks
>70%

30. What type of endocarditis is associated with SLE?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
S epidermidis
AD mutation in sarcomere proteins
Libman - Sacks endocarditis

31. How does hypertension cause LHF?

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32. What iis the tx for aortic regurg?
Prinzmetal angina - cocaine
Valve replacement once LV dysfx develops
Granulation tissue
Pulsating nail bed

33. What is the foundation of a scar?
Circumflex
Tricuspid
Granulation tissue
Migratory polyarthritis

34. What disesase has Aschoff bodies?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Myocarditis in acute rheumatic heart fever
S aureus

35. Sudden death in a young athlete.
Coronary artery vasospasm - emboli - vasculitis
Hypertrophic cardiomyopathy
Inability to fill ventricles
Mitral regurg

36. What maintains patency of the PDA?
Degree of pulmonary artery stenosis
VSD
PGE
Tetralogy of fallot

37. Which coronary artery supplies the anterior wall and anterior septum?
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
Myofiber hypertrophy with disarray
LAD
ACE inhibitor

38. What % stenosis causes stable angina?
>70%
Aneurysm - mural thrombus - Dressler syndrome
Decrease in blood flow to an organ
2-3%

39. What is the most common cause of infectious endocarditis?
Fetal alcohol syndrome
PDA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Streptococcus viridans

40. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Congestive heart failure
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Osler nodes (ouch - ouch Osler)

41. What areas of the heart does the LAD supply?
Congested central veins
Blood vessels coming in from normal tissue
Anterior wall of LV and anterior septum
PDA

42. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Bounding pulse
Infantile coarctation of the aorta
ASD - R-->L
S aureus

43. What is systolic dysfx?
Minimizes ischemia
Ventricles cannot pump
Ischemic heart disease
Valve replacement AFTER the onset of complications

44. How does MI cause LHF?
Loss of LV fx
2-3%
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Nitroglycerin

45. What type of shunt does ASD cause?
Left -->right
Tuberous sclerosis
Surgical closure small defects may close spontaneously
Stable and unstable prinzmetal

46. What is the main cause of MV regurg? What are other causes?
First 4 hours
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Sterile vegetations on surface and undersurface on mitral valve
1-3 days out

47. How does contraction band necrosis occur?
Right to left
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Yellow pallor macrophages
Squatting - increased systemic resistence decreases LV emptying

48. What is the tx for VSD?
S viridans
Day 1-7
Surgical closure small defects may close spontaneously
Sterile vegetations on surface and undersurface on mitral valve

49. What are the two effects of ATII?
CK- MB
ASD - R-->L
Holosystolic machine like murmur
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

50. What is the most common type of endocarditis?
Infectious
Transposition of the great vessels
Loss of fx
Pancarditis