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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 endocarditis is commonly found in patients with colon cancer?
Wear and tear
Decrease in blood flow to an organ
Streptococcus bovis/
Pts w/previously damaged valves

2. What gross and microscopic changes occur 1-3 days after an MI?
Harmartoma
Congestive heart failure
Backward LHF pulm htn and RHF - afib and associated mural thombis
Yellow pallor neutrophils

3. How do ACE inhibitors tx MI?
Circumflex
Metastasis
Decreases LV dilation by decreasing volume
Stable and unstable prinzmetal

4. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Hypercoagulable state or underlying adenocarcinoma
Restrictive cardiomyopathy
>60 years - bicuspid aortic valve
Ventricular arrhythmia

5. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
VSD
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Decreased forward perfusion pulmonary congestion

6. Lower extremity cyanosis in infants? In adults?
Congestive heart failure
Stable and unstable prinzmetal
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Infantile coarctation of the aorta PDA

7. What is the classic EKG finding of restrictive cardiomyopathy?
Mitral insufficiency
Surgical closure small defects may close spontaneously
Dressler syndrome
Low voltage EKG w/diminished QRS amplitude

8. How does O2 tx MI?
Split S2 on auscultation
Papillary muscle - free wall - IV septum
Myocardium
Minimizes ischemia

9. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Squatting - increased systemic resistence decreases LV emptying
Harmartoma
Prinzmetal angina

10. Erythematous nontender lesions on palms and soles.
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Janeway lesions
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
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

11. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Limits thrombosis
Aortic stenosis
4-7 days
RCA

12. In which chamber of the heart are cardiac myxomas found?
Plump fibroblasts - collagen - blood vessels
LA
Squat in response to cyanotic spell
Squatting - expiration

13. What type of valvular vegetations does S aureus cause?
Myocardium
Right side - serotonin and other secretory products detoxified in the lung
2-3 weeks
Large - destructive vegetations

14. What type of endocarditis is associated with SLE?
Contraction band necrosis
Increased hydrostatic pressure
Membrane damage
Libman - Sacks endocarditis

15. What is the characteristic murmurr of mitral stenosis?
Fetal alcohol syndrome
Tender lesions on fingers or toes.
Opening snap followed by diastolic rumble
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

16. Which angina is relieved by Ca channel blockers?
SLE
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Prinzmetal
LA

17. What effect does aortic stenosis have on the chambers of the heart?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
ACE inhibitor
Concentric LV hypertophy

18. What is the murmur of mitral valve prolapse?
Chronic ischemic heart disease
Reversible
LA dilation
Mid - systolic click followed by regurgitation murmur

19. How does transmural MI/ischemia present on EKG?
Cardiogenic shock - CHF - arrhythmia
ST- segment elevation
3-8 wks
Sterile vegetations on mitral valve along lines of closure

20. What are the tx for MI?
Dilated
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Myocarditis

21. What causes mitral valve prolapse?
Myxoid degeneration
Mitral insufficiency
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Fetal alcohol syndrome

22. What is an Aschoff body?
Plump fibroblasts - collagen - blood vessels
Trisomy 21
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Restrictive cardiomyopathy

23. What does chronic ischemic heart disease progress to?
Asymptomatic
20 min
CHF
Sterile vegetations on mitral valve along lines of closure

24. What tests show prior group A beta - hemolytic strep infection?
Squat in response to cyanotic spell
RCA
Dilation of all four chambers of the heart
Elevated ASO anti - DNase B titers

25. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Months out fibrosis

26. What type of shunt does truncus arteriosus cause?
R-->L
Mitral mitral+aortic
3-8 wks
Nonbacterial thrombotic endocarditis (marantic endocarditis)

27. What type of shunt dose PDA cause?
Left -->right
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Ischemic heart disease
Positive blood cultures anemia of chronic disease

28. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Prinzmetal
Nitroglycerin
Mid - systolic click followed by regurgitation murmur
Prophylactic abx during dental procedures

29. With what disease is infantile coarctation of the aorta associated?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Inability to maintain systemic pressure w/lack of O2 to vital organs
Turner syndrome

30. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Sterile vegetations on mitral valve along lines of closure
Increased hydrostatic pressure
2-3%

31. What is a Quincke pulse?
Inability to fill ventricles
Pulsating nail bed
Aortic stenosis
Minimizes ischemia

32. What is the tx for dilated cardiomyopathy?
Heart transplant
Sterile vegetations on mitral valve along lines of closure
S viridans
Hypercoagulable state or underlying adenocarcinoma

33. 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
Libman - Sacks endocarditis
PGE
Mitral and tricuspid regurg - arrhythmia

34. What cardiac enzyme is useful for detecting reinfarction?
Membrane damage
Myofiber hypertrophy with disarray
CK- MB
Dilated

35. Which coronary artery supplies the anterior wall and anterior septum?
1%
Congestive heart failure
LAD
Mitral insufficiency

36. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Autoimmune pericarditis 6-8 wks post MI
Myxoma - benign
Loss of LV fx

37. What causes wear and tear aortic stenosis?
RCA
Holosystolic machine like murmur
Dressler syndrome
Fibrosis and dystrophic calcification

38. How does fibrinolysis/angioplasty tx MI?
Circumflex
Volume overload and LHF
Blood vessels coming in from normal tissue
Open blocked vessels

39. What is the most common cause of dilated cardiomyopathy? What are other causes?
Congestive heart failure
Fibrosis and dystrophic calcification
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Osler nodes (ouch - ouch Osler)

40. What is the major cause of MI?
Shunt - PGE to maintain PDA until surgical repair can be performed
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Circumflex
Dilation of all four chambers of the heart

41. What is the most common form of cardiomyopathy?
Paradoxical emboli
Dilated
Inability to maintain systemic pressure w/lack of O2 to vital organs
Tetralogy of fallot

42. Low voltage EKG w/diminished QRS amplitude.
Pts w/previously damaged valves
Restrictive cardiomyopathy
Mitral valve prolapse
Tricuspid

43. What are the sx of hypertrophic cardiomyopathy?
Infectious
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Circumflex
RCA

44. In what pt population does S aureus commonly cause valvular disease?
Circumflex
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
IV drug users

45. At what point in development do congenital heart defects arise?
Contraction band necrosis
Doxorubicin - cocaine
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
3-8 wks

46. What two things happen when a blocked vessel is opened after an MI?
Endocardial fibroelastosis
Contraction band necrosis - reperfusion injury
Increased blood in right heart delays closure of P valve
Right to left

47. Which vasculitis can cause MI?
Kawasaki disease
PGE
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Hemosiderin laden macrophages

48. What increases the volume of mitral regurg murmur?
RBC damaged while crossing the calcified valve causing schistocytes
Heart transplant
Squatting - expiration
3-8 wks

49. What is Dressler syndrome? When does it occur?
Decreased forward perfusion pulmonary congestion
4-7 days
Autoimmune pericarditis 6-8 wks post MI
Nonspecific - eg fever and elevated ESR

50. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Fibrosis and dystrophic calcification
Ehlers - Danlow and Marfan syndrome
Myxoma - benign