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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. When would arrhythmia occur after MI?
Within the first day
ST- segment depression
S viridans
Holosystolic blowing murmur

2. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Mitral regurgitation due to vegetations
Congested central veins
2-3 weeks

3. With what congenital heart defect is ADULT coarctation of the aorta associated?
Pancarditis
S aureus
Loss of fx
Bicuspid aortic valve

4. What heart sound manifest with an ASD?
Hypertrophic cardiomyopathy
Rhadbomyoma - benign
Ostium secundum (90%)
Split S2 on auscultation

5. What is the foundation of a scar?
Infectious endocarditis - arrythmias - severe mitral regurg no
Granulation tissue
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

6. How does Eisenmeger syndrome occur?
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
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Colon cancer

7. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Ventricles cannot pump
Atherosclerosis of coronary arteries
Heart can't fill

8. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
2-3%
Hemosiderin laden macrophages
ASD - R-->L
Eisenmenger syndrome

9. What type of endocarditis is associated with SLE?
Dressler syndrome
Libman - Sacks endocarditis
Transesophageal echo
Pts w/previously damaged valves

10. What gross and microscopic changes occur 4-24 hours after an MI?
VSD
Dark discoloration coagulative necrosis
SLE
20 min

11. What causes notching of the ribs in adult coarctation of the aorta?
ST- segment elevation
Intercostal arteries enlarged due to collateral circulation
Breast and lung carcinoma - melanoma - lymphoma
NG or Ca channel blocker

12. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Congested central veins
Nonspecific - eg fever and elevated ESR
Prinzmetal angina - cocaine

13. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
LV dilation and eccentric hypertrophy
Large vegetations of S aureus
Prinzmetal angina
Kawasaki disease

14. When does the heart have dark discoloration post MI?
4-24 hours
Valve scarring that arises as a consequence of rheumatic fever
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Endocarditis of prosthetic valves

15. What side of the heart do carcinoid tumors affect? Why?
Chest pain <20 min brought on by exertion or emotional stress
Janeway lesions
Right side - serotonin and other secretory products detoxified in the lung
ACE inhibitor

16. What is the characteristic murmur of aortic stenosis?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Systolic ejection click followed by crescendo - decrescendo murmur
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Mitral mitral+aortic

17. What is the JOneS mneumonic?
Maternal diabetes
Chest pain <20 min brought on by exertion or emotional stress
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 epidermidis

18. What are the clinical features of RHF?
Left -->right
Limits thrombosis
Mitral mitral+aortic
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

19. What is the tx for VSD?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Contraction band necrosis
Surgical closure small defects may close spontaneously

20. Ostium primum ASD is associated with what congenital disorder?
Surgical closure small defects may close spontaneously
Paradoxical emboli
Loss of LV fx
Trisomy 21

21. With what condition are rhabdomyomas associated?
Ischemic heart disease
Tuberous sclerosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Nonspecific - eg fever and elevated ESR

22. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Bicuspid aortic valve
Fetal alcohol syndrome
Posterior wall of LV - posterior septum - papillary muscles

23. What causes the dependent pitting edema in RHF?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Pericardial effusion due to pericardial involvement
Increased hydrostatic pressure
When a bacterial protein resembles a protein in human tissue

24. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Backward LHF pulm htn and RHF - afib and associated mural thombis
Doxorubicin - cocaine
Annular - non pruritic rash w/erythematous borders trunks and limbs

25. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Aortic regurg
Aortic regurg
45%

26. What are the complications of mitral stenosis?
Ventricle
Backward LHF pulm htn and RHF - afib and associated mural thombis
Inability to fill ventricles
Ventricles cannot pump

27. What type of shunt does transposition of the great vessels cause?
ACE inhibitor
White scar fibrosis
R-->L
Transposition of the great vessels

28. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Hypertrophic cardiomyopathy
Right to left
Systolic ejection click followed by crescendo - decrescendo murmur

29. What areas of the heart does the RCA supply?
Mitral mitral+aortic
Posterior wall of LV - posterior septum - papillary muscles
Sudden cardiac death
Type I

30. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Adult coarctation of the aorta
Libman - Sacks endocarditis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

31. Tx for PDA?
Indomethacin - decreases PGE
Tetralogy of fallot
Elevated ASO anti - DNase B titers
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

32. What generally causes ischemic heart disease?
Pump failure
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
R-->L
Atherosclerosis of coronary arteries

33. What is the rate of congenital heart defects?
Small - nondestructive vegetations (subacute endocarditis)
Decrease in blood flow to an organ
1%
Ostium secundum (90%)

34. What is a complication of chronic rheumatic heart disease?
Atria and RV
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hemosiderin laden macrophages
Infectious endocarditis

35. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Libman - Sacks endocarditis
Holosystolic machine like murmur
Endocarditis of prosthetic valves
Bacterial endocarditis

36. What does a biopsy of hypertrophic cardiomyopathy look like?
Libman - Sacks endocarditis
Acute inflammation
Myofiber hypertrophy with disarray
Decreases LV dilation by decreasing volume

37. What type of vegetations are associated with Libman - Sacks endocarditis?
Cardiogenic shock - CHF - arrhythmia
SLE
Rhadbomyoma - benign
Sterile vegetations on surface and undersurface on mitral valve

38. What endocarditis is commonly found in patients with colon cancer?
Right -->left
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Yellow pallor neutrophils
Streptococcus bovis/

39. What is the most common cause of endocarditis in IV drug users?
Acute inflammation
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
S aureus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

40. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Mitral regurg
Plump fibroblasts - collagen - blood vessels
Aschoff bodies
Elevated ASO anti - DNase B titers

41. What type of shunt results in cyanosis at birth?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Right to left
Reperfusion injury
Asymptomatic

42. What vavular defect results from acute rheumatic fever?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mitral regurgitation due to vegetations
Mitral mitral+aortic
Nonbacterial thrombotic endocarditis (marantic endocarditis)

43. What coronary artery supplies the mitral valve papillary muscles?
Annular - non pruritic rash w/erythematous borders trunks and limbs
RCA
Membrane damage
Tetralogy of fallot

44. What are the complications of mitral valve prolapse? Are they common?
Coronary artery vasospasm
Positive blood cultures anemia of chronic disease
CHF
Infectious endocarditis - arrythmias - severe mitral regurg no

45. What causes wear and tear aortic stenosis?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Months out fibrosis
Fibrosis and dystrophic calcification
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

46. What is a Quincke pulse?
RCA
Day 1-7
Dense layer of elastic and fibrotic tissue in the endocardium - children
Pulsating nail bed

47. What causes angina and syncope in aortic stenosis?

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48. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Holosystolic machine like murmur
Myxoid degeneration
Prinzmetal stable and unstable

49. What causes the nutmeg color in nutmeg liver?
Myofiber hypertrophy with disarray
Congested central veins
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Mitral mitral+aortic

50. 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.
Stable angina
Pericarditits
Osler nodes (ouch - ouch Osler)
Positive blood cultures anemia of chronic disease