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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 is the basic principle of CHF?
LAD
Pump failure
Mitral regurg
Shunt - PGE to maintain PDA until surgical repair can be performed

2. What is the main cause of MV regurg? What are other causes?
Chronic rheumatic heart disease
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
LHF
Increased hydrostatic pressure

3. What are the laboratory findings of bacterial endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Coronary artery vasospasm - emboli - vasculitis
Stretched muscle loses contractility
Positive blood cultures anemia of chronic disease

4. What are heart failure cells?
Hemosiderin laden macrophages
ST- segment depression
Right side - serotonin and other secretory products detoxified in the lung
Type I

5. How do ACE inhibitors tx MI?
Myofiber hypertrophy with disarray
Decreases LV dilation by decreasing volume
>70%
Congestive heart failure

6. When do CK- MB levels rise - peak - and return to normal?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
4-6 hours - 24 hours - 72 hours
ST- segment depression
ST- segment elevation

7. What structures are susceptible to rupture post MI?
>70%
Papillary muscle - free wall - IV septum
Contraction band necrosis
Decreased forward perfusion pulmonary congestion

8. What is a water - hammer pulse?
Bounding pulse
Doxorubicin - cocaine
Within the first day
Prinzmetal angina - cocaine

9. What is the most common cause of mitral stenosis?
Minimizes ischemia
Prinzmetal angina - cocaine
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Chronic rheumatic heart disease

10. What is diastolic dysfx?
1%
1-3 days out
Systemic venous congestion
Inability to fill ventricles

11. What causes prinzmetal angina?
Myxoid degeneration
Coronary artery vasospasm
PDA
Decrease in blood flow to an organ

12. What is a Quincke pulse?
Streptococcus viridans
Pulsating nail bed
Myofiber hypertrophy with disarray
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

13. What bug causes acute rheumatic fever?
Libman - Sacks endocarditis
Group A beta - hemolytic streptococci
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Membrane damage

14. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Contraction band necrosis
Infectious endocarditis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

15. What is the most common cause of dilated cardiomyopathy? What are other causes?
Coxsackie A or B
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ventricles cannot pump
Low voltage EKG w/diminished QRS amplitude

16. What is the most common valve infected by S aureus?
Tricuspid
Sterile vegetations on mitral valve along lines of closure
Hypercoagulable state or underlying adenocarcinoma
Louder - increased systemic resistence decreases LV emptying

17. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Squat in response to cyanotic spell
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
>60 years - bicuspid aortic valve
Rhadbomyoma - benign

18. What is the classic EKG finding of restrictive cardiomyopathy?
Inability to fill ventricles
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
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
Low voltage EKG w/diminished QRS amplitude

19. What maintains patency of the PDA?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
PDA
PGE
3-8 wks

20. What causes the split S2 in ASD?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Breast and lung carcinoma - melanoma - lymphoma
Increased blood in right heart delays closure of P valve
Mitral regurg

21. What are the HACEK organisms? With what condition are they associated?
Mitral stenosis
2-3 weeks
ST- segment depression
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

22. What are the causes of LHF?
Congestive heart failure
ST- segment depression
Shunt
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

23. What are Osler nodes?
Inability to fill ventricles
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Tender lesions on fingers or toes.
Inability to maintain systemic pressure w/lack of O2 to vital organs

24. What areas of the heart does the RCA supply?
>60 years - bicuspid aortic valve
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Granulation tissue
Posterior wall of LV - posterior septum - papillary muscles

25. How does Eisenmeger syndrome occur?
Increased hydrostatic pressure
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
Cardiogenic shock - CHF - arrhythmia

26. In transposition of the great vessels - What is required for survival? How is this achieved?
Holosystolic machine like murmur
Shunt - PGE to maintain PDA until surgical repair can be performed
Thickening of chrodae tendinae and cusps - mitral stenosis
Myocarditis in acute rheumatic heart fever

27. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Coronary artery vasospasm - emboli - vasculitis
Valve replacement
Ehlers - Danlow and Marfan syndrome
Reperfusion injury

28. Is injury due angina reversible or irreversible?
Mitral stenosis
4-24 hours
Reversible
Transposition of the great vessels

29. What is the rate of mitral valve prolapse in the US?
2-3%
4-6 hours - 24 hours - 72 hours
Mitral stenosis
Paradoxical emboli

30. What two things cause coronary artery vasospasm?
Opening snap followed by diastolic rumble
ST- segment elevation
Papillary muscle - free wall - IV septum
Prinzmetal angina - cocaine

31. What is the tx for mitral valve prolapse?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Valve replacement
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Doxorubicin - cocaine

32. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Fetal alcohol syndrome
Aortic regurg
20 min
Blood vessels coming in from normal tissue

33. What increases the risk for chronic rheumatic heart disease?
>70%
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Backward LHF pulm htn and RHF - afib and associated mural thombis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

34. What is the most common cause of myocarditis?
Coxsackie A or B
4-7 days macrophage infiltration
Limits thrombosis
Trisomy 21

35. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Volume overload and LHF
Regurg vs stenosis
ST- segment depression
Group A beta - hemolytic streptococci

36. What is the foundation of a scar?
Granulation tissue
Infantile coarctation of the aorta PDA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Libman - Sacks endocarditis

37. Pericarditis 6-8 wks post MI.
Left -->right
Janeway lesions
Dressler syndrome
S aureus

38. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Hypertrophic cardiomyopathy
Tricuspid
Holosystolic machine like murmur
Bacterial endocarditis

39. What is the most common type of endocarditis?
Infectious
AD mutation in sarcomere proteins
Split S2 on auscultation
ST- segment elevation

40. What are the four defects in tetralogy of fallot?
S viridans
Inability to fill ventricles
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Infectious endocarditis - arrythmias - severe mitral regurg no

41. How does subendocardial MI/ischemia present on EKG?
1%
Mitral regurgitation due to vegetations
ST- segment depression
Blood vessels coming in from normal tissue

42. What is the most common type of ASD? What %?
Aortic stenosis
R-->L
Mitral regurg
Ostium secundum (90%)

43. What causes mitral valve prolapse?
S aureus
Myxoid degeneration
Squatting - expiration
Acute inflammation

44. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Migratory polyarthritis
4-6 hours - 24 hours - 72 hours
Reperfusion injury

45. What does chronic ischemic heart disease progress to?
>70%
CHF
Group A beta - hemolytic streptococci
Prinzmetal angina

46. How does hypertension cause LHF?

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47. What does granulation tissue contain?
Prinzmetal angina - cocaine
Aneurysm - mural thrombus - Dressler syndrome
Preductal - post aortic arch
Plump fibroblasts - collagen - blood vessels

48. What are the clinical features of RHF due to?
Day 1-7
Aortic stenosis
Systemic venous congestion
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

49. What is the most common tumor of the heart?
ST- segment depression
Holosystolic blowing murmur
Reperfusion injury
Metastasis

50. What % stenosis causes stable angina?
>70%
Indomethacin - decreases PGE
Restrictive cardiomyopathy
Mitral regurg