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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. With what virus is PDA associated?
Congenital rubella
Loss of LV fx
Mitral and tricuspid regurg - arrhythmia
White scar fibrosis

2. What is the most common cause of myocarditis?
Mitral valve prolapse
Coxsackie A or B
SLE
Type I

3. What gross and microscopic changes occur 4-7 days after an MI?
Group A beta - hemolytic streptococci
Concentric LV hypertophy
Yellow pallor macrophages
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

4. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Breast and lung carcinoma - melanoma - lymphoma
RHF
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
PDA

5. What gross and microscopic changes occur 1-3 days after an MI?
Myocarditis
Systolic ejection click followed by crescendo - decrescendo murmur
Left -->right
Yellow pallor neutrophils

6. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Preductal - post aortic arch
Ventricles cannot pump
Large vegetations of S aureus

7. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Breast and lung carcinoma - melanoma - lymphoma
Day 1-7
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

8. What are the Jones criteria?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
45%
RHF
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

9. What type of vegetations are associated with Libman - Sacks endocarditis?
Months out fibrosis
Mitral valve prolapse
Sterile vegetations on surface and undersurface on mitral valve
Limits thrombosis

10. What type of vegetations does Strep viridans cause?
Congestive heart failure
Hypertrophic cardiomyopathy
Small - nondestructive vegetations (subacute endocarditis)
Regurg vs stenosis

11. What are the clinical features of LHF due to?
Autoimmune pericarditis 6-8 wks post MI
Decreased forward perfusion pulmonary congestion
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Cyanosis - RV hypertrophy - polycythemia - clubbing

12. What is the rate of mitral valve prolapse in the US?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Nonspecific - eg fever and elevated ESR
2-3%
Stable angina

13. What is the characteristic murmur of aortic stenosis?
Atria and RV
Systolic ejection click followed by crescendo - decrescendo murmur
Backward LHF pulm htn and RHF - afib and associated mural thombis
Cardiac tamponade

14. What type of valvular vegetations does S aureus cause?
Prinzmetal
Autoimmune pericarditis 6-8 wks post MI
Large - destructive vegetations
Low voltage EKG w/diminished QRS amplitude

15. How do ACE inhibitors tx MI?
Fibrinous pericarditis
Decreases LV dilation by decreasing volume
Dilated
Systemic venous congestion

16. What gross and microscopic changes occur months after an MI?
Prinzmetal angina - cocaine
White scar fibrosis
Ostium primum
Transesophageal echo

17. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Chronic ischemic heart disease
RCA
4-6 hours - 24 hours - 72 hours

18. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Janeway lesions
>60 years - bicuspid aortic valve
Reperfusion injury
Systolic ejection click followed by crescendo - decrescendo murmur

19. What causes a mid - systolic click followed by a regurgitation murmur?
Opening snap followed by diastolic rumble
Mitral valve prolapse
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Libman - Sacks endocarditis

20. What areas of the heart does the LAD supply?
Myxoid degeneration
Anterior wall of LV and anterior septum
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Prinzmetal

21. What congenital heart defect presents later in life with lower extremity cyanosis?
Rhabdomyoma
PDA
Squatting - expiration
When a bacterial protein resembles a protein in human tissue

22. When would arrhythmia occur after MI?
2-3 weeks
Day 1-7
4-7 days
Within the first day

23. How does restrictive cardiomyopathy cause LHF?

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24. 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.
Yellow pallor neutrophils
Stable angina
Concentric LV hypertophy
Aschoff bodies

25. What is the characteristic murmurr of mitral stenosis?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Opening snap followed by diastolic rumble
3-8 wks
Group A beta - hemolytic streptococci

26. Infects predamaged valves after transient bacteremia?
When a bacterial protein resembles a protein in human tissue
S viridans
RCA
LA

27. What causes microangiopathic hemolytic anemia in aortic stenosis?
Boot shaped heart
Group A beta - hemolytic streptococci
RBC damaged while crossing the calcified valve causing schistocytes
Myocarditis

28. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Congestive heart failure
CHF
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

29. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
RBC damaged while crossing the calcified valve causing schistocytes
Prinzmetal angina - cocaine

30. What type of shunt does ASD cause?
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
Ostium primum
Valve scarring that arises as a consequence of rheumatic fever
Left -->right

31. What two things happen when a blocked vessel is opened after an MI?
Sterile vegetations on surface and undersurface on mitral valve
Contraction band necrosis - reperfusion injury
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

32. L- to - R shunt switching to R- to - L shunt.
Pericardial effusion due to pericardial involvement
Hypercoagulable state or underlying adenocarcinoma
Eisenmenger syndrome
Positive blood cultures anemia of chronic disease

33. How does reperfusion injury occur?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Preductal - post aortic arch
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Myocarditis in acute rheumatic heart fever

34. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Months out fibrosis
Erythematous nontender lesions on palms and soles.
CHF

35. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Pericardial effusion due to pericardial involvement
Red border granulation tissue
Squatting - expiration

36. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Red border granulation tissue
>70%
S viridans

37. What are the forward and backward sx of LHF?
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
Reversible
Myocarditis
Restrictive cardiomyopathy

38. What endocarditis is commonly found in patients with colon cancer?
Loss of fx
Myofiber hypertrophy with disarray
Streptococcus bovis/
Pts w/previously damaged valves

39. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Stretched muscle loses contractility
Dilation of all four chambers of the heart
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Months out fibrosis

40. What are the complications of mitral valve prolapse? Are they common?
Hypertophy of RV atrophy of LV
Cardiogenic shock - CHF - arrhythmia
Infectious endocarditis - arrythmias - severe mitral regurg no
Congenital rubella

41. What are the complications that occur months after an MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Aneurysm - mural thrombus - Dressler syndrome
IV drug users
Paradoxical emboli

42. What causes an early - blowing diastolic murmur?
Posterior wall of LV - posterior septum - papillary muscles
Tender lesions on fingers or toes.
Asymptomatic
Aortic regurg

43. How does subendocardial MI/ischemia present on EKG?
Bounding pulse
ST- segment depression
PDA
LV dilation and eccentric hypertrophy

44. How does Eisenmeger syndrome occur?
Ventricle
Fibrosis and dystrophic calcification
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
Myxoid degeneration

45. What is the most common cause of infectious endocarditis?
Streptococcus viridans
LAD
Tricuspid
Pericardial effusion due to pericardial involvement

46. In which chamber of the heart are rhabdomyomas found?
Left -->right
Ventricle
Anitschow cell
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

47. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Months out fibrosis
Autoimmune pericarditis 6-8 wks post MI
Adult coarctation of the aorta
Infectious

48. What are the laboratory findings of bacterial endocarditis?
Pericarditits
Positive blood cultures anemia of chronic disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LA

49. Which artery is most often occluded in an MI?
LAD
Anitschow cell
PDA
Restrictive cardiomyopathy

50. What type of shunt dose PDA cause?
Thickening of chrodae tendinae and cusps - mitral stenosis
Left -->right
Small - nondestructive vegetations (subacute endocarditis)
R-->L