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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 tests show prior group A beta - hemolytic strep infection?
Inability to fill ventricles
Elevated ASO anti - DNase B titers
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
PGE

2. What is the most common primary cardiac tumor in children? Is it malignant or benign?
LAD
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Rhadbomyoma - benign
Heart transplant

3. What causes acute endocarditis?
Chronic rheumatic heart disease
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Large vegetations of S aureus
Tuberous sclerosis

4. What causes the split S2 in ASD?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Months out fibrosis
Increased blood in right heart delays closure of P valve
Anterior wall of LV and anterior septum

5. What is the most common valve infected by S aureus?
Tricuspid
RCA
Granulation tissue
ST- segment depression

6. How do nitrates tx MI?
Migratory polyarthritis
LA
Decrease preload -->lowers myocardial stress
NG or Ca channel blocker

7. What gross and microscopic changes occur 1-3 weeks after an MI?
Dilated
Paradoxical emboli
Anitschow cell
Red border granulation tissue

8. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Mitral regurg
Degree of pulmonary artery stenosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
>70%

9. What is diastolic dysfx?
PGE
Tetralogy of fallot
Stable angina
Inability to fill ventricles

10. What are the major criteria of the Jones criteria?
PGE
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
S viridans
Libman - Sacks endocarditis

11. With what disease is Libman - Sacks endocarditis associated?
SLE
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
S aureus
ASD - R-->L

12. Opening snap followed by diastolic rumble.
Hypertophy of RV atrophy of LV
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
Aschoff bodies
Mitral stenosis

13. What increases the risk for chronic rheumatic heart disease?
Preductal - post aortic arch
ST- segment depression
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Chest pain <20 min brought on by exertion or emotional stress

14. What is the tx for mitral valve prolapse?
Valve replacement
Prinzmetal angina
20 min
Mitral regurgitation due to vegetations

15. What is the most common cause of death during the acute phase of rheumatic fever?
Adult coarctation of the aorta
Myocarditis
Yellow pallor neutrophils
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

16. L- to - R shunt switching to R- to - L shunt.
Tetralogy of fallot
Myocarditis
Eisenmenger syndrome
Small vegetations along the line of closure

17. What is the most common type of endocarditis?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Infectious
Dilated

18. What is the most comon cause of aortic regurg? What are the other causes?
Loss of fx
Mitral regurgitation due to vegetations
Congenital rubella
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

19. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Slow HR - decreasing O2 demand and risk for arrhythmia
Anitschow cell
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Right to left

20. What is the most common type of ASD? What %?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ostium secundum (90%)
Stable and unstable prinzmetal
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

21. What is the definition of ischemia?
Decrease in blood flow to an organ
Type I
Rhadbomyoma - benign
Open blocked vessels

22. What are the sx of right - to - left shunt?
Subendocardial
Cyanosis - RV hypertrophy - polycythemia - clubbing
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
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

23. What is the most common congenital heart defect?
Gelatinous - abundant ground substance
Hypertrophic cardiomyopathy
VSD
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

24. What does Libman - Sacks endocarditis cause?
Mitral regurg
Loss of fx
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
VSD

25. How does Eisenmeger syndrome occur?
Sterile vegetations on surface and undersurface on mitral valve
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
Ventricle
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

26. What causes wear and tear aortic stenosis?
Left -->right
Aneurysm - mural thrombus - Dressler syndrome
Fibrosis and dystrophic calcification
NG or Ca channel blocker

27. What does rupture of the IV septum cause?
ST- segment depression
Shunt
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
CHF

28. What effect does chronic rheumatic heart disease have the mitral valve?
Infectious
Contraction band necrosis - reperfusion injury
Squatting - increased systemic resistence decreases LV emptying
Thickening of chrodae tendinae and cusps - mitral stenosis

29. How does restrictive cardiomyopathy present?
Congestive heart failure
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Contraction band necrosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

30. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Myofiber hypertrophy with disarray
Right side - serotonin and other secretory products detoxified in the lung
Day 1-7

31. What are the laboratory findings of bacterial endocarditis?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Positive blood cultures anemia of chronic disease
Day 1-7
Posterior wall of LV - posterior septum - papillary muscles

32. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Aortic regurg
Gelatinous - abundant ground substance
PDA
Pericarditits

33. With what virus is PDA associated?
Gelatinous - abundant ground substance
Congenital rubella
4-6 hours - 24 hours - 72 hours
Preductal - post aortic arch

34. Why are cardiac enzymes elevated after an MI?
LV dilation and eccentric hypertrophy
Membrane damage
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

35. When is an MI pt at greatest risk for cardiogenic shock?
Thickening of chrodae tendinae and cusps - mitral stenosis
Coexisting mitral stenosis and fusion of commisures exist
First 4 hours
ST- segment depression

36. What type of shunt results in cyanosis at birth?
Membrane damage
Right to left
Eisenmenger syndrome
Limits thrombosis

37. What cardiac disease is associated with tuberous sclerosis?
Right -->left
Rhabdomyoma
RCA
Fetal alcohol syndrome

38. What are the complications of mitral valve prolapse? Are they common?
Anterior wall of LV and anterior septum
Aneurysm - mural thrombus - Dressler syndrome
Infectious endocarditis - arrythmias - severe mitral regurg no
Plump fibroblasts - collagen - blood vessels

39. What cardiac enzyme is useful for detecting reinfarction?
Day 1-7
Tender lesions on fingers or toes.
CK- MB
Endocarditis of prosthetic valves

40. What is molecular mimicry?
Endocardial fibroelastosis (rare)
When a bacterial protein resembles a protein in human tissue
Gelatinous - abundant ground substance
Harmartoma

41. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Tricuspid
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
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Contraction band necrosis

42. What are the clinical features of LHF due to?
Contraction band necrosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Valve replacement
Decreased forward perfusion pulmonary congestion

43. Why would cardiac enzymes continue to increase after the initial MI?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Reperfusion injury
Yellow pallor macrophages
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

44. How does O2 tx MI?
ST- segment depression
Minimizes ischemia
Stable angina
Day 1-7

45. How does restrictive cardiomyopathy cause LHF?

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46. What type of vegetations does Strep viridans cause?
Adult coarctation of the aorta
Shunt - PGE to maintain PDA until surgical repair can be performed
Left -->right
Small - nondestructive vegetations (subacute endocarditis)

47. What is the characteristic murmurr of mitral stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Left -->right
VSD
Opening snap followed by diastolic rumble

48. What causes endocarditis of prosthetic valves?
Posterior wall of LV - posterior septum - papillary muscles
S epidermidis
Preductal - post aortic arch
Paradoxical emboli

49. What are the clinical features of RHF due to?
1-3 days
Systemic venous congestion
Chronic ischemic heart disease
Congestive heart failure

50. What type of shunt does ASD cause?
Atherosclerosis of coronary arteries
Left -->right
Membrane damage
Infectious endocarditis