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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 collagen is involved in fibrosis?
Endocardial fibroelastosis (rare)
Regurg vs stenosis
Type I
Congested central veins

2. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Contraction band necrosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Prinzmetal stable and unstable
Infantile coarctation of the aorta

3. What are Janeway lesions?
45%
Endocarditis of prosthetic valves
Erythematous nontender lesions on palms and soles.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

4. Are most congenital heart defects spontaneous or inherited?
Contraction band necrosis
Maternal diabetes
2-3 weeks
Spontaneous

5. What is a complication of chronic rheumatic heart disease?
Stretched muscle loses contractility
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Type I
Infectious endocarditis

6. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral stenosis
Reperfusion injury

7. What type of ASD is associated w/Down syndrome?
2-4 hours - 24 hours - 7-10 days
Sterile vegetations on mitral valve along lines of closure
Pericardial effusion due to pericardial involvement
Ostium primum

8. What are the clinical features of LHF due to?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
2-3%
Decreased forward perfusion pulmonary congestion
Restrictive cardiomyopathy

9. What valves are most commonly involved in chronic rheumatic heart disease?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral mitral+aortic
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Endocardial fibroelastosis

10. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Turner syndrome
Reperfusion injury
Stable angina
Infectious

11. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
When a bacterial protein resembles a protein in human tissue
Reperfusion injury
VSD
Myxoma - benign

12. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Cardiac tamponade
Right -->left
White scar fibrosis

13. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Circumflex
Ehlers - Danlow and Marfan syndrome
4-7 days macrophage infiltration
Increased blood in right heart delays closure of P valve

14. What is systolic dysfx?
Ventricles cannot pump
Asymptomatic
VSD
4-6 hours - 24 hours - 72 hours

15. How long after pharyngitis does acute rheumatic fever occur?
Troponin I
PDA
2-3 weeks
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

16. What is endocardial fibroelastosis? In what population is it found?
Pulsating nail bed
Surgical closure small defects may close spontaneously
Dense layer of elastic and fibrotic tissue in the endocardium - children
Endocardial fibroelastosis (rare)

17. When do CK- MB levels rise - peak - and return to normal?
Nitroglycerin
RBC damaged while crossing the calcified valve causing schistocytes
4-6 hours - 24 hours - 72 hours
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

18. How does adult coarctation of the aorta present?
2-3%
PDA
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Sterile vegetations on surface and undersurface on mitral valve

19. Ostium primum ASD is associated with what congenital disorder?
Pericardial effusion due to pericardial involvement
Trisomy 21
Myxoma - benign
Mitral stenosis

20. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Gelatinous - abundant ground substance
Rupture of free wall - IV septum - or papillary muscle
Mitral regurg

21. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Ventricle
Valve replacement AFTER the onset of complications
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

22. Pericarditis 6-8 wks post MI.
Slow HR - decreasing O2 demand and risk for arrhythmia
Prinzmetal stable and unstable
Dressler syndrome
ASD - R-->L

23. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Wear and tear
RCA
Limits thrombosis

24. What are the causes of LHF?
Decreases LV dilation by decreasing volume
Degree of pulmonary artery stenosis
Osler nodes (ouch - ouch Osler)
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

25. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Holosystolic blowing murmur
Tetralogy of fallot
Loss of fx

26. When does the heart have a yellow pallor post MI?
Transposition of the great vessels
Trisomy 21
Day 1-7
4-7 days macrophage infiltration

27. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
LA dilation
Nitroglycerin
Membrane damage

28. What effect does transposition of the great vessels have on the ventricles?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Subendocardial
Hypertophy of RV atrophy of LV
1%

29. What is an Anitschow cell?
Pump failure
Opening snap followed by diastolic rumble
Reactive histiocyte with caterpillar nucleus
Large - destructive vegetations

30. How does restrictive cardiomyopathy present?
Congestive heart failure
Tetralogy of fallot
Posterior wall of LV - posterior septum - papillary muscles
LHF

31. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Dense layer of elastic and fibrotic tissue in the endocardium - children
S aureus
Prinzmetal angina - cocaine

32. How does hypertension cause LHF?

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33. What are the major criteria of the Jones criteria?
Concentric LV hypertophy
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Asymptomatic
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

34. What type of valvular vegetations does S aureus cause?
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
Infantile coarctation of the aorta
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Large - destructive vegetations

35. What are the minor critera of the Jones criteria?
Loeffler syndrome
Nonspecific - eg fever and elevated ESR
Ventricles cannot pump
Pump failure

36. What is Loeffler syndrome?
>60 years - bicuspid aortic valve
Sterile vegetations on mitral valve along lines of closure
Volume overload and LHF
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

37. What causes prinzmetal angina?
Endocarditis of prosthetic valves
Contraction band necrosis - reperfusion injury
Coronary artery vasospasm
Paradoxical emboli

38. What is the definition of ischemia?
Decrease in blood flow to an organ
2-4 hours - 24 hours - 7-10 days
Surgical closure small defects may close spontaneously
Preductal - post aortic arch

39. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Hypertrophic cardiomyopathy
PDA
Louder - increased systemic resistence decreases LV emptying

40. What congenital heart defect is associated with fetal alcohol syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
VSD
Nonbacterial thrombotic endocarditis (marantic endocarditis)
PDA

41. Erythematous nontender lesions on palms and soles.
Sudden cardiac death
Backward LHF pulm htn and RHF - afib and associated mural thombis
Stable and unstable prinzmetal
Janeway lesions

42. What does rupture of the IV septum cause?
PDA
Shunt
Systolic dysfx leading to biventricular CHF
Reperfusion injury

43. What is the only Jones criteria that doesn't resolve with time?
Gelatinous - abundant ground substance
Pancarditis
PDA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

44. Opening snap followed by diastolic rumble.
Mitral stenosis
Myocarditis
Nitroglycerin
LV dilation and eccentric hypertrophy

45. What effect does aortic regurg have on the pulse pressure? Why?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Stable angina
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

46. What congenital heart defect does indomethacin tx?
Transesophageal echo
PDA
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
Aneurysm - mural thrombus - Dressler syndrome

47. What is diastolic dysfx?
Inability to fill ventricles
Ischemic heart disease
Rhadbomyoma - benign
L->R

48. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
4-6 hours - 24 hours - 72 hours
Posterior wall of LV - posterior septum - papillary muscles

49. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Ventricular arrhythmia
Mitral regurgitation due to vegetations
1-3 days out
ASD - R-->L

50. What does rupture of a papillary muscle cause?
Valve scarring that arises as a consequence of rheumatic fever
Osler nodes (ouch - ouch Osler)
Bicuspid aortic valve
Mitral insufficiency