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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 causes the nutmeg color in nutmeg liver?
Hypercoagulable state or underlying adenocarcinoma
Eisenmenger syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Congested central veins

2. What are the clinical features of RHF?
Group A beta - hemolytic streptococci
Annular - non pruritic rash w/erythematous borders trunks and limbs
Inability to maintain systemic pressure w/lack of O2 to vital organs
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

3. What two things cause coronary artery vasospasm?
Left -->right
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Preductal - post aortic arch
Prinzmetal angina - cocaine

4. What congenital heart defect does indomethacin tx?
PDA
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
R-->L
Trisomy 21

5. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Within the first day
Myxoma - benign
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
ST- segment elevation

6. What is the effect of mitral regurg on the heart?
Contraction band necrosis - reperfusion injury
Volume overload and LHF
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

7. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Ehlers - Danlow and Marfan syndrome
Mitral stenosis
>70%

8. What side of the heart do carcinoid tumors affect? Why?
S epidermidis
Right side - serotonin and other secretory products detoxified in the lung
Right to left
Mitral valve prolapse

9. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Thickening of chrodae tendinae and cusps - mitral stenosis
Red border granulation tissue
Autoimmune pericarditis 6-8 wks post MI

10. What is the only Jones criteria that doesn't resolve with time?
Endocardial fibroelastosis
Pancarditis
Cardiogenic shock - CHF - arrhythmia
4-24 hours

11. What is the rate of congenital heart defects?
Concentric LV hypertophy
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
1%
When a bacterial protein resembles a protein in human tissue

12. How does ischemia cause LHF?
Tuberous sclerosis
Holosystolic machine like murmur
Loss of fx
Pump failure

13. What is eythema marginatum? What parts of the body does it commonly involve?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
>60 years - bicuspid aortic valve
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pts w/previously damaged valves

14. What are the sx of cardiac myxoma?
Right to left
Backward LHF pulm htn and RHF - afib and associated mural thombis
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

15. What congenital heart defect often is present with infantile coarctation of the aorta?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Plump fibroblasts - collagen - blood vessels
Colon cancer
PDA

16. What is the gross and microscopic appearance of cardiac myxomas?
SLE
Gelatinous - abundant ground substance
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Prinzmetal angina

17. What always follows necrosis?
Streptococcus bovis/
Acute inflammation
Dilated
Bacterial endocarditis

18. What does Libman - Sacks endocarditis cause?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mitral regurg
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Within the first day

19. What is typically the mechanims of sudden cardiac death?
Mid - systolic click followed by regurgitation murmur
Ventricular arrhythmia
Intercostal arteries enlarged due to collateral circulation
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

20. How do nitrates tx MI?
AD mutation in sarcomere proteins
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
Decrease preload -->lowers myocardial stress
R-->L

21. What makes the MV prolapse murmur louder? Why?
Reactive histiocyte with caterpillar nucleus
Nonspecific - eg fever and elevated ESR
Squatting - increased systemic resistence decreases LV emptying
Coronary artery vasospasm - emboli - vasculitis

22. What type of shunt does truncus arteriosus cause?
Restrictive cardiomyopathy
PDA
Hemosiderin laden macrophages
R-->L

23. What artery is the 2nd most often occluded in an MI?
PDA
Cyanosis - RV hypertrophy - polycythemia - clubbing
RCA
S epidermidis

24. Friction rub and chest pain.
4-24 hours
Boot shaped heart
Holosystolic machine like murmur
Pericarditits

25. What increases the volume of mitral regurg murmur?
Myxoid degeneration
Mitral insufficiency
Squatting - expiration
Sterile vegetations on surface and undersurface on mitral valve

26. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
S epidermidis
Months out fibrosis
Nonspecific - eg fever and elevated ESR

27. What % of MIs involve the LAD?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
45%
PDA
>60 years - bicuspid aortic valve

28. What is the most common type of endocarditis?
Infectious
Hypertrophic cardiomyopathy
Increased hydrostatic pressure
4-7 days

29. How does aortic regurg affect the heart chambers?
Maternal diabetes
Aortic regurg
LV dilation and eccentric hypertrophy
Degree of pulmonary artery stenosis

30. In which pts does S viridans cause endocarditits?
Autoimmune pericarditis 6-8 wks post MI
Decreases LV dilation by decreasing volume
Pts w/previously damaged valves
Fibrinous pericarditis

31. What type of vegetations does Strep viridans cause?
Libman - Sacks endocarditis
Mitral stenosis
Small - nondestructive vegetations (subacute endocarditis)
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

32. What type of shunt does ASD cause?
Left -->right
Dilation of all four chambers of the heart
Metastasis
Contraction band necrosis

33. Systolic ejection click followed by crescendo - decrescendo murmur.
Infectious endocarditis - arrythmias - severe mitral regurg no
Volume overload and LHF
Minimizes ischemia
Aortic stenosis

34. What is the most common tumor of the heart?
Osler nodes (ouch - ouch Osler)
Metastasis
Pericarditits
Boot shaped heart

35. What type of shunt dose PDA cause?
Indomethacin - decreases PGE
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Left -->right
Granulation tissue

36. How does MI cause LHF?
Maternal diabetes
Intercostal arteries enlarged due to collateral circulation
Streptococcus viridans
Loss of LV fx

37. What are the four defects in tetralogy of fallot?
Mitral and tricuspid regurg - arrhythmia
1-3 days
Indomethacin - decreases PGE
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

38. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Loss of fx
Valve replacement once LV dysfx develops

39. Pericarditis 6-8 wks post MI.
Cyanosis - RV hypertrophy - polycythemia - clubbing
Dressler syndrome
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Months out fibrosis

40. What is the characteristic murmur of aortic stenosis?
Red border granulation tissue
Systolic ejection click followed by crescendo - decrescendo murmur
Prinzmetal stable and unstable
Coronary artery vasospasm

41. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Stretched muscle loses contractility
LHF
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Surgical closure small defects may close spontaneously

42. What type of valvular vegetations does S aureus cause?
Rhabdomyoma
Large - destructive vegetations
Small - nondestructive vegetations (subacute endocarditis)
Decreases LV dilation by decreasing volume

43. 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.
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Stable angina
RHF
Fetal alcohol syndrome

44. What type of shunt does transposition of the great vessels cause?
Tender lesions on fingers or toes.
ASD - R-->L
R-->L
LAD

45. What is the most common valve infected by S aureus?
Tricuspid
Posterior wall of LV - posterior septum - papillary muscles
Mitral and tricuspid regurg - arrhythmia
LA dilation

46. What is the gold standard blood marker for MI?
Thickening of chrodae tendinae and cusps - mitral stenosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
RCA
Troponin I

47. What causes wear and tear aortic stenosis?
S aureus
Aschoff bodies
Fibrosis and dystrophic calcification
Left -->right

48. What gross and microscopic changes occur 4-7 days after an MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Elevated ASO anti - DNase B titers
Bicuspid aortic valve
Yellow pallor macrophages

49. When does the heart have dark discoloration post MI?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myocardium
4-24 hours
Mitral stenosis

50. Boot - shaped heart on x- ray?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
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
Valve replacement once LV dysfx develops
Tetralogy of fallot