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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 does chronic ischemic heart disease progress to?
Subendocardial
Nitroglycerin
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
CHF

2. How does squating decrease hypoxemia in tetralogy of fallot?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
4-6 hours - 24 hours - 72 hours
IV drug users

3. In transposition of the great vessels - What is required for survival? How is this achieved?
Fibrosis and dystrophic calcification
ST- segment depression
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Shunt - PGE to maintain PDA until surgical repair can be performed

4. What is the tx for mitral valve prolapse?
Valve replacement
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
RBC damaged while crossing the calcified valve causing schistocytes
Dressler syndrome

5. What gross and microscopic changes occur 1-3 days after an MI?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Within the first day
Janeway lesions
Yellow pallor neutrophils

6. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Paradoxical emboli
Thickening of chrodae tendinae and cusps - mitral stenosis
VSD
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

7. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Slow HR - decreasing O2 demand and risk for arrhythmia
Prinzmetal angina
Mitral regurg

8. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Sterile vegetations on surface and undersurface on mitral valve
Anterior wall of LV and anterior septum
Positive blood cultures anemia of chronic disease

9. Lower extremity cyanosis in infants? In adults?
Pump failure
Infantile coarctation of the aorta PDA
Atria and RV
Mitral regurgitation due to vegetations

10. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
Transesophageal echo
Valve replacement once LV dysfx develops
Autoimmune pericarditis 6-8 wks post MI

11. What typically causes hypertrophic cardiomyopathy?
Transposition of the great vessels
AD mutation in sarcomere proteins
Anitschow cell
1-3 days out

12. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Nitroglycerin
RCA
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

13. When does the heart have a yellow pallor post MI?
Migratory polyarthritis
Day 1-7
45%
Ventricle

14. What are the sx of cardiac myxoma?
PDA
Slow HR - decreasing O2 demand and risk for arrhythmia
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

15. How do you tx prinzmetal angina?
NG or Ca channel blocker
IV drug users
RCA
4-24 hours

16. What type of ASD is associated w/Down syndrome?
Asymptomatic
Cardiogenic shock - CHF - arrhythmia
Large - destructive vegetations
Ostium primum

17. What imaging test is useful for detecting lesions on valves?
Tuberous sclerosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Prinzmetal angina
Transesophageal echo

18. What is the JOneS mneumonic?
Day 1-7
Paradoxical emboli
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
Stable angina

19. Erythematous nontender lesions on palms and soles.
Split S2 on auscultation
Janeway lesions
Months out fibrosis
Systemic venous congestion

20. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Blood vessels coming in from normal tissue
S aureus
Loeffler syndrome
>70%

21. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Aortic regurg
Reperfusion injury
First 4 hours

22. What is an Anitschow cell?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Reactive histiocyte with caterpillar nucleus
Paradoxical emboli
Myofiber hypertrophy with disarray

23. What generally causes ischemic heart disease?
4-24 hours
Dark discoloration coagulative necrosis
LA
Atherosclerosis of coronary arteries

24. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Coexisting mitral stenosis and fusion of commisures exist
Holosystolic machine like murmur
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

25. What is the 1day-1wk -1mo mneumonic for MI?
Systemic venous congestion
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Dressler syndrome

26. What is the leading cause of death in the US?
PGE
Sterile vegetations on mitral valve along lines of closure
Ischemic heart disease
Pts w/previously damaged valves

27. What effect does aortic stenosis have on the chambers of the heart?
S aureus
Hypercoagulable state or underlying adenocarcinoma
Erythematous nontender lesions on palms and soles.
Concentric LV hypertophy

28. What are the Jones criteria?
Fibrosis and dystrophic calcification
Left -->right
Stable and unstable prinzmetal
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

29. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Stable angina
Boot shaped heart
Stretched muscle loses contractility

30. What coronary arterysupplies the lateral wall of the LV?
Right to left
Circumflex
Infectious endocarditis - arrythmias - severe mitral regurg no
Pump failure

31. What is the definition of ischemia?
>60 years - bicuspid aortic valve
Rhadbomyoma - benign
Decrease in blood flow to an organ
Nonbacterial thrombotic endocarditis (marantic endocarditis)

32. What are the clinical features of RHF due to?
45%
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Systemic venous congestion
Yellow pallor macrophages

33. What is the most common form of cardiomyopathy?
Months out fibrosis
White scar fibrosis
Dilated
Hypertrophic cardiomyopathy

34. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Myofiber hypertrophy with disarray
Holosystolic machine like murmur
Yellow pallor neutrophils

35. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
When a bacterial protein resembles a protein in human tissue
LAD
Systolic ejection click followed by crescendo - decrescendo murmur

36. What is the most common cause of infectious endocarditis?
Loeffler syndrome
Mitral mitral+aortic
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Streptococcus viridans

37. Is injury due angina reversible or irreversible?
Cardiac tamponade
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Reversible
Valve replacement once LV dysfx develops

38. Dense layer of elastic and fibrotic tissue in the endocardium.
RHF
Endocardial fibroelastosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Right -->left

39. What makes the MV prolapse murmur louder? Why?
Day 1-7
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
VSD
Squatting - increased systemic resistence decreases LV emptying

40. How does MI cause LHF?
First 4 hours
Chronic ischemic heart disease
Loss of LV fx
Right -->left

41. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Mitral regurgitation due to vegetations
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Rhadbomyoma - benign

42. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Nitroglycerin
Reperfusion injury
Bacterial endocarditis

43. How does transmural MI/ischemia present on EKG?
Prinzmetal stable and unstable
ST- segment elevation
White scar fibrosis
Ostium primum

44. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Aortic regurg
Contraction band necrosis - reperfusion injury
Volume overload and LHF

45. How does contraction band necrosis occur?
Nitroglycerin
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Inability to fill ventricles
Myocarditis in acute rheumatic heart fever

46. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Asymptomatic
Adult coarctation of the aorta
Surgical closure small defects may close spontaneously

47. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Anitschow cell
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
RCA

48. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Mitral mitral+aortic
Pulsating nail bed
Louder - increased systemic resistence decreases LV emptying
Months out fibrosis

49. How does restrictive cardiomyopathy cause LHF?

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50. What causes notching of the ribs in adult coarctation of the aorta?
Prinzmetal angina - cocaine
Intercostal arteries enlarged due to collateral circulation
Restrictive cardiomyopathy
3-8 wks