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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 increases the risk for chronic rheumatic heart disease?
CK- MB
Spontaneous
Ischemic heart disease
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

2. Where is the coarctation in infantile coarctation of the aorta?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Preductal - post aortic arch
Myocardium
RCA

3. What is dilated cardiomyopathy?
Coexisting mitral stenosis and fusion of commisures exist
Dilation of all four chambers of the heart
AD mutation in sarcomere proteins
IV drug users

4. What is a Quincke pulse?
ACE inhibitor
Split S2 on auscultation
Pericarditits
Pulsating nail bed

5. What is Loeffler syndrome?
Increased hydrostatic pressure
2-3%
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

6. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
2-3%
Streptococcus bovis/

7. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Limits thrombosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Turner syndrome

8. What coronary artery supplies the mitral valve papillary muscles?
Doxorubicin - cocaine
Libman - Sacks endocarditis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
RCA

9. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Red border granulation tissue
Valve replacement once LV dysfx develops
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

10. What increases the volume of mitral regurg murmur?
Plump fibroblasts - collagen - blood vessels
LA
Squatting - expiration
IV drug users

11. What gross and microscopic changes occur months after an MI?
SLE
White scar fibrosis
Friction rub and chest pain
4-24 hours

12. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Metastasis
Asymptomatic
Volume overload and LHF
>60 years - bicuspid aortic valve

13. What congenital heart defect does indomethacin tx?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
R-->L
PDA
Migratory polyarthritis

14. What type of shunt does ASD cause?
Pericardial effusion due to pericardial involvement
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
ASD - R-->L
Left -->right

15. What is chronic rheumatic heart disease?
Myxoma - benign
Valve scarring that arises as a consequence of rheumatic fever
Spontaneous
Bacterial endocarditis

16. Vegetations on surface and undersurface of mitral valve.
Pulsating nail bed
Nitroglycerin
Libman - Sacks endocarditis
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

17. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Autoimmune pericarditis 6-8 wks post MI
Intercostal arteries enlarged due to collateral circulation

18. What is the most common congenital heart defect?
Kawasaki disease
VSD
Large - destructive vegetations
Congenital rubella

19. Large vegetations on tricuspid valve?
Wear and tear
S aureus
Increased hydrostatic pressure
RHF

20. Is scar tissue or myocardium stronger?
Myocardium
Hemosiderin laden macrophages
Bounding pulse
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

21. What endocarditis is commonly found in patients with colon cancer?
Acute inflammation
Aneurysm - mural thrombus - Dressler syndrome
Streptococcus bovis/
Squat in response to cyanotic spell

22. Which vasculitis can cause MI?
Atherosclerosis of coronary arteries
Kawasaki disease
Annular - non pruritic rash w/erythematous borders trunks and limbs
Split S2 on auscultation

23. Tx for PDA?
Indomethacin - decreases PGE
Holosystolic machine like murmur
Streptococcus viridans
Squatting - expiration

24. What are the clinical features of LHF due to?
Right -->left
Decreased forward perfusion pulmonary congestion
Pericarditits
Large - destructive vegetations

25. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Myxoid degeneration
Holosystolic blowing murmur
Ventricle

26. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
PDA
Congested central veins
Cyanosis - RV hypertrophy - polycythemia - clubbing

27. What does rupture of the LV free wall cause?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
4-7 days macrophage infiltration
Cardiac tamponade
Plump fibroblasts - collagen - blood vessels

28. With what disease is infantile coarctation of the aorta associated?
Dilated
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
Turner syndrome
Cardiac tamponade

29. What are the four defects in tetralogy of fallot?
Myofiber hypertrophy with disarray
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
>70%
S aureus

30. Which coronary artery supplies the anterior wall and anterior septum?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Colon cancer
LV dilation and eccentric hypertrophy
LAD

31. What is the rate of mitral valve prolapse in the US?
RCA
2-3%
Bicuspid aortic valve
Restrictive cardiomyopathy

32. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Myxoma - benign
Bounding pulse
Left -->right

33. Is injury due angina reversible or irreversible?
Reversible
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
PGE
NG or Ca channel blocker

34. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Reperfusion injury
PGE
Infectious

35. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Janeway lesions
Reversible
Hypertrophic cardiomyopathy

36. Why are cardiac enzymes elevated after an MI?
Infectious
Myocarditis
Membrane damage
Increased blood in right heart delays closure of P valve

37. With what developmental disorder is VSD associated?
L->R
Fetal alcohol syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
CHF

38. EKG for stable angina?
Reactive histiocyte with caterpillar nucleus
Libman - Sacks endocarditis
ST- segment depression
Troponin I

39. When does the heart have a yellow pallor post MI?
Tuberous sclerosis
Pts w/previously damaged valves
1-3 days
Day 1-7

40. What is molecular mimicry?
Hypertophy of RV atrophy of LV
Mitral stenosis
When a bacterial protein resembles a protein in human tissue
S epidermidis

41. In which chamber of the heart are rhabdomyomas found?
Papillary muscle - free wall - IV septum
Backward LHF pulm htn and RHF - afib and associated mural thombis
Ventricle
>70%

42. What causes heart failure cells?
Autoimmune pericarditis 6-8 wks post MI
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
>60 years - bicuspid aortic valve
Doxorubicin - cocaine

43. What side of the heart do carcinoid tumors affect? Why?
Heart transplant
Right side - serotonin and other secretory products detoxified in the lung
Mitral stenosis
Myocarditis

44. What is the most common cause of aortic stenosis?
AD mutation in sarcomere proteins
Wear and tear
3-8 wks
Preductal - post aortic arch

45. Myofiber hypertrophy with disarray.
Autoimmune pericarditis 6-8 wks post MI
Holosystolic blowing murmur
Hypertrophic cardiomyopathy
Troponin I

46. How does asprin/heparin tx MI?
Aortic regurg
ACE inhibitor
Reperfusion injury
Limits thrombosis

47. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Mitral regurgitation due to vegetations
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
NG or Ca channel blocker

48. What does chronic ischemic heart disease progress to?
Aneurysm - mural thrombus - Dressler syndrome
Mitral stenosis
CK- MB
CHF

49. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Prinzmetal stable and unstable
20 min
Valve replacement once LV dysfx develops
Minimizes ischemia

50. What gross and microscopic changes occur 1-3 days after an MI?
Group A beta - hemolytic streptococci
Yellow pallor neutrophils
PDA
Decreased forward perfusion pulmonary congestion