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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 prinzmetal angina?
Indomethacin - decreases PGE
Dilation of all four chambers of the heart
S aureus
Coronary artery vasospasm

2. Tx for PDA?
Right -->left
Within the first day
Indomethacin - decreases PGE
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

3. What type of valvular vegetations does S aureus cause?
Months out fibrosis
Large - destructive vegetations
Cardiac tamponade
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

4. What are the causes of LHF?
Within the first day
2-4 hours - 24 hours - 7-10 days
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

5. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Squatting - increased systemic resistence decreases LV emptying
Yellow pallor macrophages
Ostium secundum (90%)

6. What effect does aortic regurg have on the pulse pressure? Why?
Nitroglycerin
Red border granulation tissue
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

7. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
RBC damaged while crossing the calcified valve causing schistocytes
Myxoma - benign
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Systemic venous congestion

8. What tests show prior group A beta - hemolytic strep infection?
Pulsating nail bed
Elevated ASO anti - DNase B titers
Streptococcus viridans
Myocarditis

9. What is the rate of mitral valve prolapse in the US?
2-3%
2-4 hours - 24 hours - 7-10 days
Myocarditis in acute rheumatic heart fever
Aortic stenosis

10. What are the clinical features of endocarditis? What causes each feature?
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
Pump failure
Infectious endocarditis
Opening snap followed by diastolic rumble

11. What is cardiogenic shock?
Aortic stenosis
Boot shaped heart
Inability to maintain systemic pressure w/lack of O2 to vital organs
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

12. How does squating decrease hypoxemia in tetralogy of fallot?
Tetralogy of fallot
Right -->left
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Mitral regurg

13. What congenital heart defect presents later in life with lower extremity cyanosis?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Bounding pulse
PDA
Nitroglycerin

14. When do macrophagess infiltrate the myocardium post MI?
Prinzmetal stable and unstable
S aureus
4-7 days
Stretched muscle loses contractility

15. Lower extremity cyanosis in infants? In adults?
Loeffler syndrome
Endocardial fibroelastosis
Infantile coarctation of the aorta PDA
Indomethacin - decreases PGE

16. What is the cause of restrictive cardiomyopathy in children?
Migratory polyarthritis
Endocardial fibroelastosis (rare)
Within the first day
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

17. What is systolic dysfx?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
LV dilation and eccentric hypertrophy
Degree of pulmonary artery stenosis
Ventricles cannot pump

18. What effect does mitral stenosis have on the heart chambers?
LA dilation
Degree of pulmonary artery stenosis
Aneurysm - mural thrombus - Dressler syndrome
PDA

19. What type of ischemia does stable angina cause?
Regurg vs stenosis
ASD - R-->L
Libman - Sacks endocarditis
Subendocardial

20. What are the sx of pericardiits?
ASD - R-->L
Endocardial fibroelastosis (rare)
Friction rub and chest pain
Pulsating nail bed

21. 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
Hypertrophic cardiomyopathy
Ostium secundum (90%)
Endocardial fibroelastosis (rare)

22. When do neutrophils infiltrate the myocardium post MI?
Nitroglycerin
Restrictive cardiomyopathy
1-3 days
Infectious endocarditis

23. What % stenosis causes stable angina?
Valve replacement once LV dysfx develops
Myofiber hypertrophy with disarray
>70%
Fetal alcohol syndrome

24. What are the four defects in tetralogy of fallot?
Streptococcus viridans
Prinzmetal stable and unstable
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
White scar fibrosis

25. What is typically the mechanims of sudden cardiac death?
1-3 days
Hypercoagulable state or underlying adenocarcinoma
Ventricular arrhythmia
Chronic ischemic heart disease

26. What is the tx for dilated cardiomyopathy?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
20 min
Inability to maintain systemic pressure w/lack of O2 to vital organs
Heart transplant

27. Poor myocardial fx due to chronic ischemic damage?
1-3 days
Left -->right
Chronic ischemic heart disease
Osler nodes (ouch - ouch Osler)

28. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
RHF
Regurg vs stenosis
Ischemic heart disease
Prinzmetal angina - cocaine

29. What is the gold standard blood marker for MI?
Troponin I
Chest pain <20 min brought on by exertion or emotional stress
Holosystolic blowing murmur
Infectious endocarditis

30. What is the gross and microscopic appearance of cardiac myxomas?
Loss of fx
Gelatinous - abundant ground substance
Split S2 on auscultation
ACE inhibitor

31. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Systolic ejection click followed by crescendo - decrescendo murmur
Maternal diabetes
Nitroglycerin

32. What is the major cause of MI?
Group A beta - hemolytic streptococci
Stretched muscle loses contractility
Hemosiderin laden macrophages
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

33. What is the 1day-1wk -1mo mneumonic for MI?
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
Systolic ejection click followed by crescendo - decrescendo murmur
Pts w/previously damaged valves
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

34. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Tuberous sclerosis
Myofiber hypertrophy with disarray
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Sudden cardiac death

35. How does restrictive cardiomyopathy cause LHF?

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36. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Reversible
Dressler syndrome
>60 years - bicuspid aortic valve

37. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
ST- segment depression
Prinzmetal stable and unstable
Hypertrophic cardiomyopathy

38. Which chambers of the heart are generally spared in an MI?
Within the first day
Posterior wall of LV - posterior septum - papillary muscles
Kawasaki disease
Atria and RV

39. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Troponin I
ST- segment depression

40. What is migratory polyarthritis?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Turner syndrome
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
LAD

41. How does O2 tx MI?
Right -->left
Endocarditis of prosthetic valves
Minimizes ischemia
Posterior wall of LV - posterior septum - papillary muscles

42. What are the causes of restrictive cardiomyopathy in adults?
Eisenmenger syndrome
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Open blocked vessels

43. What is the tx for mitral valve prolapse?
Ostium secundum (90%)
VSD
Valve replacement
Stable and unstable prinzmetal

44. With what disease is infantile coarctation of the aorta associated?
Anitschow cell
ST- segment depression
Turner syndrome
Breast and lung carcinoma - melanoma - lymphoma

45. How does stable angina present?
CHF
Hypertrophic cardiomyopathy
Shunt
Chest pain <20 min brought on by exertion or emotional stress

46. What are the laboratory findings of bacterial endocarditis?
RCA
Holosystolic blowing murmur
Sterile vegetations on surface and undersurface on mitral valve
Positive blood cultures anemia of chronic disease

47. What disesase has Aschoff bodies?
ASD - R-->L
Mitral regurg
Myocarditis in acute rheumatic heart fever
Dressler syndrome

48. What gross and microscopic changes occur 1-3 days after an MI?
Systemic venous congestion
Yellow pallor neutrophils
Valve replacement once LV dysfx develops
Mitral regurg

49. What is a water - hammer pulse?
4-7 days
Bounding pulse
Sudden cardiac death
Chronic rheumatic heart disease

50. What is dilated cardiomyopathy?
Squatting - expiration
Dilation of all four chambers of the heart
Preductal - post aortic arch
Chronic ischemic heart disease