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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. Opening snap followed by diastolic rumble.
Mitral stenosis
Mitral mitral+aortic
PDA
Breast and lung carcinoma - melanoma - lymphoma

2. What are the sx of aortic regurg?
LA dilation
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Paradoxical emboli
Plump fibroblasts - collagen - blood vessels

3. What are the complications of aortic stenosis?
Atherosclerosis of coronary arteries
Valve replacement AFTER the onset of complications
Contraction band necrosis - reperfusion injury
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

4. What creates the immune reaction in acute rhuematic fever?

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5. What does chronic ischemic heart disease progress to?
Coexisting mitral stenosis and fusion of commisures exist
Rhadbomyoma - benign
Ostium primum
CHF

6. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Membrane damage
Hypertrophic cardiomyopathy
VSD

7. What are the causes of restrictive cardiomyopathy in adults?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Myocardium
Elevated ASO anti - DNase B titers

8. What type of shunt does a VSD cause?
Type I
LHF
L->R
S epidermidis

9. When does the heart have dark discoloration post MI?
4-24 hours
Turner syndrome
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Hypertophy of RV atrophy of LV

10. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Anitschow cell
Nitroglycerin
Reperfusion injury
Regurg vs stenosis

11. What is the most common cause of aortic stenosis?
Wear and tear
Decreases LV dilation by decreasing volume
Months out fibrosis
RCA

12. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Dressler syndrome
Papillary muscle - free wall - IV septum
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

13. What genetic conditions predispose a pt to mitral valve prolapse?
Reactive histiocyte with caterpillar nucleus
Ehlers - Danlow and Marfan syndrome
PDA
Asymptomatic

14. How does fibrinolysis/angioplasty tx MI?
MI
Low voltage EKG w/diminished QRS amplitude
Ehlers - Danlow and Marfan syndrome
Open blocked vessels

15. What is a water - hammer pulse?
Infantile coarctation of the aorta
Bounding pulse
Reactive histiocyte with caterpillar nucleus
Increased hydrostatic pressure

16. What is the most common valve infected by S aureus?
Tricuspid
ST- segment depression
Sterile vegetations on mitral valve along lines of closure
VSD

17. What complication occurs 1-3 days post MI?
Day 1-7
Red border granulation tissue
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Fibrinous pericarditis

18. What type of valvular vegetations does S aureus cause?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Concentric LV hypertophy
R-->L
Large - destructive vegetations

19. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Acute inflammation
Aschoff bodies
Libman - Sacks endocarditis

20. What is the most common cause of endocarditis in IV drug users?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Prinzmetal stable and unstable
S aureus
Anterior wall of LV and anterior septum

21. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Loss of LV fx
Stable and unstable prinzmetal
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

22. With what congenital heart defect is ADULT coarctation of the aorta associated?
Rupture of free wall - IV septum - or papillary muscle
Reactive histiocyte with caterpillar nucleus
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Bicuspid aortic valve

23. What causes angina and syncope in aortic stenosis?

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24. What effect does transposition of the great vessels have on the ventricles?
Restrictive cardiomyopathy
4-7 days macrophage infiltration
Group A beta - hemolytic streptococci
Hypertophy of RV atrophy of LV

25. What are the complications of mitral valve prolapse? Are they common?
Sterile vegetations on mitral valve along lines of closure
Infectious endocarditis - arrythmias - severe mitral regurg no
Aschoff bodies
Cyanosis - RV hypertrophy - polycythemia - clubbing

26. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Rhabdomyoma
SLE
Holosystolic blowing murmur

27. What are other (not atherosclerotic) causes of MI?
Cardiac tamponade
Red border granulation tissue
Aneurysm - mural thrombus - Dressler syndrome
Coronary artery vasospasm - emboli - vasculitis

28. Infects predamaged valves after transient bacteremia?
S viridans
Myxoma - benign
Dark discoloration coagulative necrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

29. What is the most common form of cardiomyopathy?
Aortic regurg
Prinzmetal angina
Small - nondestructive vegetations (subacute endocarditis)
Dilated

30. What causes the nutmeg color in nutmeg liver?
Myxoid degeneration
Congested central veins
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Indomethacin - decreases PGE

31. What are the sx of PDA at birth?
Janeway lesions
Preductal - post aortic arch
Asymptomatic
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

32. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
LA dilation
Pts w/previously damaged valves
Bacterial endocarditis
Infectious endocarditis - arrythmias - severe mitral regurg no

33. What are the clinical features of RHF due to?
Systemic venous congestion
Slow HR - decreasing O2 demand and risk for arrhythmia
Prinzmetal stable and unstable
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

34. How does reperfusion injury occur?
RBC damaged while crossing the calcified valve causing schistocytes
Mitral regurg
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Tuberous sclerosis

35. What is the definition of ischemia?
Decrease in blood flow to an organ
Circumflex
Hemosiderin laden macrophages
>70%

36. What is the characteristic finding on CXR in tetralogy of fallot?
LAD
Inability to fill ventricles
Boot shaped heart
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

37. What is the basic principle of CHF?
Rhadbomyoma - benign
NG or Ca channel blocker
Pump failure
Contraction band necrosis - reperfusion injury

38. What compensatory mechanism do tetralogy of fallot pts learn?
Mitral stenosis
Systolic dysfx leading to biventricular CHF
Regurg vs stenosis
Squat in response to cyanotic spell

39. Large vegetations on tricuspid valve?
S aureus
Stable and unstable prinzmetal
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
4-6 hours - 24 hours - 72 hours

40. What is the murmur of mitral regurg?
Anterior wall of LV and anterior septum
Holosystolic blowing murmur
Mitral mitral+aortic
Libman - Sacks endocarditis

41. What are the sx of pericardiits?
Friction rub and chest pain
Systolic dysfx leading to biventricular CHF
Chest pain <20 min brought on by exertion or emotional stress
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

42. What type of ischemia does stable angina cause?
Subendocardial
Left -->right
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Positive blood cultures anemia of chronic disease

43. How do you tx prinzmetal angina?
Bounding pulse
Elevated ASO anti - DNase B titers
NG or Ca channel blocker
>60 years - bicuspid aortic valve

44. L- to - R shunt switching to R- to - L shunt.
Pericardial effusion due to pericardial involvement
Eisenmenger syndrome
Myocardium
1-3 days

45. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Ventricles cannot pump
Reversible
VSD

46. At what point in development do congenital heart defects arise?
Louder - increased systemic resistence decreases LV emptying
3-8 wks
PDA
Paradoxical emboli

47. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Mitral regurg
3-8 wks
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

48. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
First 4 hours
Maternal diabetes
Myocarditis in acute rheumatic heart fever

49. When do neutrophils infiltrate the myocardium post MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral regurg
Libman - Sacks endocarditis
1-3 days

50. Is scar tissue or myocardium stronger?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Increased blood in right heart delays closure of P valve
Myocardium
Ostium primum