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Cardiac

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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 valves are involved in rhuematic endocarditis?
Rhabdomyoma
Degree of pulmonary artery stenosis
Bacterial endocarditis
Mitral mitral+aortic

2. How does contraction band necrosis occur?
Squatting - increased systemic resistence decreases LV emptying
Indomethacin - decreases PGE
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Chest pain <20 min brought on by exertion or emotional stress

3. What is the definition of ischemia?
VSD
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Decrease in blood flow to an organ
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

4. What type of vegetations are associated with Libman - Sacks endocarditis?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Sterile vegetations on surface and undersurface on mitral valve
Prinzmetal
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

5. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Aortic regurg
Fibrinous pericarditis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

6. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Cyanosis - RV hypertrophy - polycythemia - clubbing
Regurg vs stenosis
Bounding pulse

7. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Anitschow cell
PDA
S aureus
Osler nodes (ouch - ouch Osler)

8. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Bacterial endocarditis
Increased blood in right heart delays closure of P valve
Bounding pulse

9. What creates the immune reaction in acute rhuematic fever?

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10. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Friction rub and chest pain
RCA
Elevated ASO anti - DNase B titers

11. When do macrophagess infiltrate the myocardium post MI?
Libman - Sacks endocarditis
Turner syndrome
4-7 days
Backward LHF pulm htn and RHF - afib and associated mural thombis

12. When is an MI patent at highest risk for fibrionous pericarditis?
ACE inhibitor
1-3 days out
Mid - systolic click followed by regurgitation murmur
Anterior wall of LV and anterior septum

13. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Within the first day
Hypercoagulable state or underlying adenocarcinoma
Backward LHF pulm htn and RHF - afib and associated mural thombis
Loeffler syndrome

14. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
S viridans
Ventricle
Left -->right

15. What is the most common form of cardiomyopathy?
Dilated
Transposition of the great vessels
Mid - systolic click followed by regurgitation murmur
PDA

16. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Contraction band necrosis - reperfusion injury
Mitral and tricuspid regurg - arrhythmia
Dark discoloration coagulative necrosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

17. Which angina(s) show ST elevation on EKG? ST depression?
Turner syndrome
45%
Prinzmetal stable and unstable
Open blocked vessels

18. What bug causes acute rheumatic fever?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Sterile vegetations on mitral valve along lines of closure
Group A beta - hemolytic streptococci
Prinzmetal

19. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Shunt
Type I
Split S2 on auscultation

20. What effect does aortic regurg have on the pulse pressure? Why?
Myxoma - benign
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Concentric LV hypertophy
Holosystolic blowing murmur

21. What effect does dilated cardiomyopathy have on the heart?
Osler nodes (ouch - ouch Osler)
Systolic dysfx leading to biventricular CHF
Coronary artery vasospasm
RCA

22. With what virus is PDA associated?
Congenital rubella
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Infectious endocarditis
Chest pain <20 min brought on by exertion or emotional stress

23. What is Loeffler syndrome?
Dilation of all four chambers of the heart
Systemic venous congestion
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Reperfusion injury

24. What does granulation tissue contain?
Turner syndrome
Plump fibroblasts - collagen - blood vessels
Erythematous nontender lesions on palms and soles.
VSD

25. What is the effect of mitral regurg on the heart?
LA dilation
Stable angina
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Volume overload and LHF

26. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Pericardial effusion due to pericardial involvement
Hypertrophic cardiomyopathy
Months out fibrosis

27. What is the tx for dilated cardiomyopathy?
LA
Valve scarring that arises as a consequence of rheumatic fever
Heart transplant
Trisomy 21

28. What type of shunt does a VSD cause?
Systolic ejection click followed by crescendo - decrescendo murmur
L->R
Valve replacement AFTER the onset of complications
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

29. How does ischemia cause LHF?
Ventricles cannot pump
Loss of fx
Rhabdomyoma
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

30. What coronary artery supplies the mitral valve papillary muscles?
Endocardial fibroelastosis (rare)
Yellow pallor neutrophils
RCA
LA

31. What tests show prior group A beta - hemolytic strep infection?
Fibrosis and dystrophic calcification
Elevated ASO anti - DNase B titers
Split S2 on auscultation
LAD

32. Sudden death in a young athlete.
Congested central veins
Atria and RV
PDA
Hypertrophic cardiomyopathy

33. Tx for PDA?
Boot shaped heart
Squat in response to cyanotic spell
Indomethacin - decreases PGE
Reversible

34. What is an Anitschow cell?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Split S2 on auscultation
Reactive histiocyte with caterpillar nucleus
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

35. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Kawasaki disease
Rupture of free wall - IV septum - or papillary muscle
Type I

36. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Stable angina
RCA
Regurg vs stenosis
Aortic regurg

37. What makes the MV prolapse murmur louder? Why?
Myocarditis
S viridans
Mid - systolic click followed by regurgitation murmur
Squatting - increased systemic resistence decreases LV emptying

38. What increases the volume of mitral regurg murmur?
Squatting - expiration
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Chronic ischemic heart disease
Subendocardial

39. What is the most common type of ASD? What %?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Mitral stenosis
Pancarditis
Ostium secundum (90%)

40. What are the sx of PDA at birth?
S aureus
Infantile coarctation of the aorta
Asymptomatic
Metastasis

41. What type of ischemia does stable angina cause?
Endocarditis of prosthetic valves
Subendocardial
Mid - systolic click followed by regurgitation murmur
Infantile coarctation of the aorta PDA

42. 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
SLE
Squatting - expiration
Backward LHF pulm htn and RHF - afib and associated mural thombis

43. What is Dressler syndrome? When does it occur?
Tender lesions on fingers or toes.
Pancarditis
Autoimmune pericarditis 6-8 wks post MI
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

44. With what condition are rhabdomyomas associated?
Coexisting mitral stenosis and fusion of commisures exist
Coronary artery vasospasm - emboli - vasculitis
4-24 hours
Tuberous sclerosis

45. Is injury due angina reversible or irreversible?
Reversible
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
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Group A beta - hemolytic streptococci

46. What is a Quincke pulse?
Pulsating nail bed
PDA
Hypertophy of RV atrophy of LV
Stable angina

47. How does O2 tx MI?
Myocardium
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Minimizes ischemia
Granulation tissue

48. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Yellow pallor neutrophils
When a bacterial protein resembles a protein in human tissue

49. What is the gold standard blood marker for MI?
Minimizes ischemia
Months out fibrosis
Troponin I
Reactive histiocyte with caterpillar nucleus

50. How does hypertension cause LHF?

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