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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 vegetations form in nonbacterial thrombotic endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
LA
Increased hydrostatic pressure
Sterile vegetations on mitral valve along lines of closure

2. How does hypertension cause LHF?

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3. What endocarditis is commonly found in patients with colon cancer?
RCA
Rhadbomyoma - benign
Valve replacement once LV dysfx develops
Streptococcus bovis/

4. What % of MIs involve the LAD?
45%
Prinzmetal angina - cocaine
Aneurysm - mural thrombus - Dressler syndrome
2-4 hours - 24 hours - 7-10 days

5. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Squatting - increased systemic resistence decreases LV emptying
1%
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Louder - increased systemic resistence decreases LV emptying

6. With what virus is PDA associated?
Congenital rubella
Low voltage EKG w/diminished QRS amplitude
2-4 hours - 24 hours - 7-10 days
Right side - serotonin and other secretory products detoxified in the lung

7. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
ACE inhibitor

8. Where is the coarctation in infantile coarctation of the aorta?
Rupture of free wall - IV septum - or papillary muscle
Coexisting mitral stenosis and fusion of commisures exist
Preductal - post aortic arch
Months out fibrosis

9. What is the foundation of a scar?
Shunt
Infectious endocarditis - arrythmias - severe mitral regurg no
Stable angina
Granulation tissue

10. What is the gross and microscopic appearance of cardiac myxomas?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Left -->right
Gelatinous - abundant ground substance

11. What is the murmur of mitral regurg?
Sterile vegetations on surface and undersurface on mitral valve
Endocardial fibroelastosis (rare)
Holosystolic blowing murmur
Metastasis

12. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Holosystolic machine like murmur
Months out fibrosis
Wear and tear
Bicuspid aortic valve

13. What type of collagen is involved in fibrosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Contraction band necrosis
Type I
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

14. Which vasculitis can cause MI?
Aortic stenosis
Transesophageal echo
Kawasaki disease
LHF

15. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Hemosiderin laden macrophages
Minimizes ischemia
Sterile vegetations on mitral valve along lines of closure

16. What are Osler nodes?
Red border granulation tissue
Tender lesions on fingers or toes.
MI
Systolic dysfx leading to biventricular CHF

17. What is the leading cause of death in the US?
Valve replacement AFTER the onset of complications
Ischemic heart disease
Myxoid degeneration
Mitral regurg

18. What does rupture of a papillary muscle cause?
Mitral insufficiency
Heart can't fill
Osler nodes (ouch - ouch Osler)
LHF

19. What are the sx of pericardiits?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Friction rub and chest pain
Concentric LV hypertophy
Reperfusion injury

20. What increases the risk for chronic rheumatic heart disease?
Congestive heart failure
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
VSD
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

21. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Heart can't fill
Contraction band necrosis
Libman - Sacks endocarditis
Restrictive cardiomyopathy

22. Is injury due angina reversible or irreversible?
Hypercoagulable state or underlying adenocarcinoma
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Reversible
Limits thrombosis

23. What effect does chronic rheumatic heart disease have the mitral valve?
PDA
Harmartoma
Bounding pulse
Thickening of chrodae tendinae and cusps - mitral stenosis

24. What are the sx of aortic regurg?
Preductal - post aortic arch
Elevated ASO anti - DNase B titers
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

25. What always follows necrosis?
Squatting - expiration
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Prinzmetal angina - cocaine
Acute inflammation

26. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Subendocardial
Hypertrophic cardiomyopathy

27. How does transmural MI/ischemia present on EKG?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
ST- segment elevation
Mitral regurgitation due to vegetations
Loss of LV fx

28. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Coronary artery vasospasm
Hypertophy of RV atrophy of LV
Myofiber hypertrophy with disarray

29. In which chamber of the heart are rhabdomyomas found?
Dilation of all four chambers of the heart
Systolic dysfx leading to biventricular CHF
Volume overload and LHF
Ventricle

30. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
ST- segment depression
Degree of pulmonary artery stenosis
Decreased forward perfusion pulmonary congestion

31. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Coronary artery vasospasm - emboli - vasculitis
Minimizes ischemia
VSD

32. What is the most common cause of death during the acute phase of rheumatic fever?
4-24 hours
Endocardial fibroelastosis
RCA
Myocarditis

33. What are the causes of restrictive cardiomyopathy in adults?
Atherosclerosis of coronary arteries
Myocarditis in acute rheumatic heart fever
Mitral stenosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

34. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Squat in response to cyanotic spell
Aortic regurg
Day 1-7
Dressler syndrome

35. What is the definition of ischemia?
Decrease in blood flow to an organ
Streptococcus bovis/
Ventricle
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

36. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
CHF
Hypertrophic cardiomyopathy
Nonbacterial thrombotic endocarditis (marantic endocarditis)
PDA

37. What is the tx for dilated cardiomyopathy?
Coronary artery vasospasm - emboli - vasculitis
Heart transplant
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

38. What is the tx for VSD?
Large vegetations of S aureus
4-24 hours
Surgical closure small defects may close spontaneously
Erythematous nontender lesions on palms and soles.

39. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Sterile vegetations on mitral valve along lines of closure
Dilation of all four chambers of the heart
Tetralogy of fallot

40. What complications occur 4-7 days post MI?
Intercostal arteries enlarged due to collateral circulation
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
1-3 days
Rupture of free wall - IV septum - or papillary muscle

41. What drug relieves stable angina?
Opening snap followed by diastolic rumble
Limits thrombosis
Dark discoloration coagulative necrosis
Nitroglycerin

42. How do you tx prinzmetal angina?
PDA
Coronary artery vasospasm
Sudden cardiac death
NG or Ca channel blocker

43. What tests show prior group A beta - hemolytic strep infection?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Elevated ASO anti - DNase B titers
Type I
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

44. What causes unstable angina?
Transesophageal echo
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Hypertrophic cardiomyopathy
Ventricular arrhythmia

45. What causes the nutmeg color in nutmeg liver?
Congested central veins
Subendocardial
Shunt - PGE to maintain PDA until surgical repair can be performed
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

46. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
S aureus
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Myocarditis in acute rheumatic heart fever

47. What is the JOneS mneumonic?
Slow HR - decreasing O2 demand and risk for arrhythmia
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
S aureus
R-->L

48. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
S aureus
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Plump fibroblasts - collagen - blood vessels

49. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Myxoid degeneration
Ventricles cannot pump
VSD

50. What is the tx for LHF?
Mitral insufficiency
Gelatinous - abundant ground substance
ACE inhibitor
Systolic dysfx leading to biventricular CHF