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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 is the most common congenital heart defect?
Membrane damage
IV drug users
VSD
Breast and lung carcinoma - melanoma - lymphoma

2. What is an Anitschow cell?
4-7 days macrophage infiltration
1-3 days
Reactive histiocyte with caterpillar nucleus
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

3. What does a biopsy of hypertrophic cardiomyopathy look like?
Asymptomatic
Myofiber hypertrophy with disarray
Bounding pulse
Streptococcus viridans

4. Why would cardiac enzymes continue to increase after the initial MI?
Harmartoma
Reperfusion injury
Myxoid degeneration
Nitroglycerin

5. What areas of the heart does the RCA supply?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Prinzmetal stable and unstable
Posterior wall of LV - posterior septum - papillary muscles
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

6. What are the complications that occur months after an MI?
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
Paradoxical emboli
Tricuspid
Aneurysm - mural thrombus - Dressler syndrome

7. What is the most common cause of endocarditis in IV drug users?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Left -->right
S aureus
Spontaneous

8. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Coronary artery vasospasm
Aschoff bodies
When a bacterial protein resembles a protein in human tissue
LAD

9. What are the cancers that most commonly metastasize to the heart?
MI
Breast and lung carcinoma - melanoma - lymphoma
Bicuspid aortic valve
LA dilation

10. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Low voltage EKG w/diminished QRS amplitude
Fibrosis and dystrophic calcification
Congenital rubella

11. Tx for PDA?
Chest pain <20 min brought on by exertion or emotional stress
Mid - systolic click followed by regurgitation murmur
Wear and tear
Indomethacin - decreases PGE

12. What effect does mitral stenosis have on the heart chambers?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
LA dilation
Gelatinous - abundant ground substance
Systemic venous congestion

13. What drug relieves stable angina?
R-->L
Valve replacement
Cardiogenic shock - CHF - arrhythmia
Nitroglycerin

14. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
PGE
LAD

15. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Adult coarctation of the aorta
CHF
Squatting - expiration

16. What causes an early - blowing diastolic murmur?
CK- MB
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Aortic regurg
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

17. What is the basic principle of CHF?
Pump failure
LAD
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

18. What is eythema marginatum? What parts of the body does it commonly involve?
Infectious endocarditis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Blood vessels coming in from normal tissue
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

19. With what congenital heart defect is ADULT coarctation of the aorta associated?
Hypercoagulable state or underlying adenocarcinoma
Bicuspid aortic valve
Valve replacement once LV dysfx develops
PDA

20. Which vasculitis can cause MI?
Myxoma - benign
RCA
Anterior wall of LV and anterior septum
Kawasaki disease

21. How does adult coarctation of the aorta present?
SLE
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Large vegetations of S aureus
Metastasis

22. What is a water - hammer pulse?
Migratory polyarthritis
Bounding pulse
Heart can't fill
Nitroglycerin

23. What iis the tx for aortic regurg?
Ventricle
Valve replacement once LV dysfx develops
Prinzmetal
Ostium secundum (90%)

24. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
VSD
Coronary artery vasospasm
Doxorubicin - cocaine

25. What two things happen when a blocked vessel is opened after an MI?
Colon cancer
Heart can't fill
Contraction band necrosis - reperfusion injury
Stable angina

26. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Opening snap followed by diastolic rumble
Mitral regurg
Louder - increased systemic resistence decreases LV emptying

27. What are the clinical features of RHF due to?
2-3 weeks
20 min
Mitral regurg
Systemic venous congestion

28. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Myxoma - benign
Gelatinous - abundant ground substance

29. What is the tx for LHF?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
ACE inhibitor
Loeffler syndrome
LAD

30. What are the clinical features of endocarditis? What causes each feature?
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
4-6 hours - 24 hours - 72 hours
Aneurysm - mural thrombus - Dressler syndrome
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

31. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Aortic regurg
Reperfusion injury

32. Are most congenital heart defects spontaneous or inherited?
Ostium secundum (90%)
Spontaneous
L->R
Low voltage EKG w/diminished QRS amplitude

33. What is the most common valve infected by S aureus?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Tricuspid
Osler nodes (ouch - ouch Osler)
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

34. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
IV drug users
Valve scarring that arises as a consequence of rheumatic fever
Louder - increased systemic resistence decreases LV emptying

35. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Tender lesions on fingers or toes.
Circumflex

36. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Prinzmetal stable and unstable
Nonspecific - eg fever and elevated ESR
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

37. How do you tx prinzmetal angina?
NG or Ca channel blocker
1-3 days
Rhadbomyoma - benign
Endocarditis of prosthetic valves

38. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Contraction band necrosis - reperfusion injury
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

39. What causes notching of the ribs in adult coarctation of the aorta?
LV dilation and eccentric hypertrophy
Intercostal arteries enlarged due to collateral circulation
>60 years - bicuspid aortic valve
Myocardium

40. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Bounding pulse
Mitral and tricuspid regurg - arrhythmia
Pancarditis

41. What causes prinzmetal angina?
Coronary artery vasospasm
Prinzmetal stable and unstable
Systemic venous congestion
MI

42. What is systolic dysfx?
S aureus
Rhadbomyoma - benign
Ventricles cannot pump
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

43. What murmur ccan be heard in PDA?
Ehlers - Danlow and Marfan syndrome
IV drug users
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Holosystolic machine like murmur

44. What causes acute endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Large vegetations of S aureus
Infectious endocarditis
Increased hydrostatic pressure

45. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Troponin I
Inability to maintain systemic pressure w/lack of O2 to vital organs
First 4 hours

46. What is the tx for VSD?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Surgical closure small defects may close spontaneously
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

47. What are the tx for MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
4-24 hours
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Valve scarring that arises as a consequence of rheumatic fever

48. What are the sx of PDA at birth?
Aschoff bodies
Group A beta - hemolytic streptococci
Asymptomatic
Rhabdomyoma

49. What type of shunt does ASD cause?
1%
Cardiogenic shock - CHF - arrhythmia
Positive blood cultures anemia of chronic disease
Left -->right

50. What coronary arterysupplies the lateral wall of the LV?
Mid - systolic click followed by regurgitation murmur
Loeffler syndrome
Circumflex
Libman - Sacks endocarditis