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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 type of endocarditis is associated w/metastatic cancer and wasting conditions?
Shunt
Congested central veins
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

2. Which angina(s) show ST elevation on EKG? ST depression?
Paradoxical emboli
Prinzmetal stable and unstable
Right side - serotonin and other secretory products detoxified in the lung
MI

3. What type of shunt does ASD cause?
Contraction band necrosis
Left -->right
Myocardium
Kawasaki disease

4. How does O2 tx MI?
Group A beta - hemolytic streptococci
Minimizes ischemia
ACE inhibitor
LV dilation and eccentric hypertrophy

5. What is the JOneS mneumonic?
CHF
Squatting - expiration
ASD - R-->L
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

6. What is typically the mechanims of sudden cardiac death?
Dressler syndrome
Ventricular arrhythmia
Inability to fill ventricles
Decrease preload -->lowers myocardial stress

7. What are Osler nodes?
Ostium primum
ST- segment depression
Tender lesions on fingers or toes.
Transposition of the great vessels

8. What is the gold standard blood marker for MI?
Troponin I
Shunt - PGE to maintain PDA until surgical repair can be performed
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
PGE

9. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Loeffler syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pulsating nail bed

10. What causes microangiopathic hemolytic anemia in aortic stenosis?
Circumflex
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
RBC damaged while crossing the calcified valve causing schistocytes
Heart transplant

11. What are complications of dilated cardiomyopathy?
Endocardial fibroelastosis (rare)
Myocarditis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Mitral and tricuspid regurg - arrhythmia

12. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Increased blood in right heart delays closure of P valve
Pts w/previously damaged valves
Paradoxical emboli

13. What % of MIs involve the LAD?
Mitral regurg
Hypertrophic cardiomyopathy
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
45%

14. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Membrane damage
VSD
Kawasaki disease

15. What is the most common type of ASD? What %?
20 min
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Ostium secundum (90%)
Prinzmetal

16. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Paradoxical emboli
>60 years - bicuspid aortic valve
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
1%

17. What type of vegetations are associated with Libman - Sacks endocarditis?
Infantile coarctation of the aorta PDA
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Sterile vegetations on surface and undersurface on mitral valve

18. What structures are susceptible to rupture post MI?
Right to left
Papillary muscle - free wall - IV septum
Ischemic heart disease
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

19. What is a common complication of cardiac metastasis?
Autoimmune pericarditis 6-8 wks post MI
Pericardial effusion due to pericardial involvement
CHF
Valve replacement

20. What type of ischemia does stable angina cause?
Tricuspid
Troponin I
Inability to fill ventricles
Subendocardial

21. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Trisomy 21
Infantile coarctation of the aorta
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

22. What are the sx of pericardiits?
Thickening of chrodae tendinae and cusps - mitral stenosis
Pancarditis
Friction rub and chest pain
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

23. What is an important complication of ASD?
Pts w/previously damaged valves
Myocardium
Paradoxical emboli
Ostium secundum (90%)

24. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Hypertrophic cardiomyopathy
Bicuspid aortic valve
LHF
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

25. What drugs can cause dilated cardiomyopathy?
Shunt - PGE to maintain PDA until surgical repair can be performed
Doxorubicin - cocaine
Ehlers - Danlow and Marfan syndrome
LAD

26. Friction rub and chest pain.
Subendocardial
Prinzmetal angina - cocaine
Pericarditits
Reactive histiocyte with caterpillar nucleus

27. What increases the risk for chronic rheumatic heart disease?
Right -->left
Maternal diabetes
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Indomethacin - decreases PGE

28. What are the sx of hypertrophic cardiomyopathy?
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
2-3%
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Coexisting mitral stenosis and fusion of commisures exist

29. What is the most common cause of myocarditis?
Hypertrophic cardiomyopathy
Coxsackie A or B
Infectious endocarditis - arrythmias - severe mitral regurg no
Nonbacterial thrombotic endocarditis (marantic endocarditis)

30. Systolic ejection click followed by crescendo - decrescendo murmur.
Osler nodes (ouch - ouch Osler)
Aortic stenosis
Fetal alcohol syndrome
>60 years - bicuspid aortic valve

31. What is a water - hammer pulse?
Stable and unstable prinzmetal
Bounding pulse
R-->L
Low voltage EKG w/diminished QRS amplitude

32. What is the leading cause of death in the US?
>60 years - bicuspid aortic valve
Ischemic heart disease
Hypercoagulable state or underlying adenocarcinoma
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

33. What is a complication of chronic rheumatic heart disease?
VSD
Infectious endocarditis
Sterile vegetations on mitral valve along lines of closure
R-->L

34. What is the tx for LHF?
Cardiogenic shock - CHF - arrhythmia
Libman - Sacks endocarditis
ACE inhibitor
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

35. Holosystolic blowing murmur that increases w/expiration?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral regurg
Doxorubicin - cocaine
Large vegetations of S aureus

36. What type of shunt does a VSD cause?
Valve replacement once LV dysfx develops
L->R
Type I
Maternal diabetes

37. What gross and microscopic changes occur 4-24 hours after an MI?
Congenital rubella
Dark discoloration coagulative necrosis
Anterior wall of LV and anterior septum
Sterile vegetations on mitral valve along lines of closure

38. What is the most common congenital heart defect?
VSD
CK- MB
Streptococcus viridans
Left -->right

39. What is the foundation of a scar?
Granulation tissue
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

40. What type of collagen is involved in fibrosis?
Type I
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RCA
Posterior wall of LV - posterior septum - papillary muscles

41. What is diastolic dysfx?
Inability to fill ventricles
Group A beta - hemolytic streptococci
Months out fibrosis
Shunt - PGE to maintain PDA until surgical repair can be performed

42. Opening snap followed by diastolic rumble.
3-8 wks
Mitral stenosis
Fibrinous pericarditis
Low voltage EKG w/diminished QRS amplitude

43. What is a Quincke pulse?
Cardiogenic shock - CHF - arrhythmia
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Pulsating nail bed
Aneurysm - mural thrombus - Dressler syndrome

44. What congenital heart defect is associated with fetal alcohol syndrome?
Heart can't fill
Nitroglycerin
Positive blood cultures anemia of chronic disease
VSD

45. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Coronary artery vasospasm
>70%
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

46. What type of vegetations does Strep viridans cause?
LAD
Tuberous sclerosis
Small - nondestructive vegetations (subacute endocarditis)
Eisenmenger syndrome

47. With what disease is infantile coarctation of the aorta associated?
LAD
Mitral regurg
Ostium primum
Turner syndrome

48. What are the cancers that most commonly metastasize to the heart?
RCA
Streptococcus bovis/
Split S2 on auscultation
Breast and lung carcinoma - melanoma - lymphoma

49. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Rhadbomyoma - benign
Decreased forward perfusion pulmonary congestion
Dilation of all four chambers of the heart

50. What does rupture of a papillary muscle cause?
Sterile vegetations on surface and undersurface on mitral valve
Concentric LV hypertophy
Mitral insufficiency
Mitral and tricuspid regurg - arrhythmia