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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 determines the extent of shunting and cyanosis in tetralogy of fallot?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Reperfusion injury
Degree of pulmonary artery stenosis

2. What does Libman - Sacks endocarditis cause?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Mitral regurg
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
Mitral valve prolapse

3. What type of valvular vegetations does S aureus cause?
Pericardial effusion due to pericardial involvement
Large - destructive vegetations
Tricuspid
Volume overload and LHF

4. What gross and microscopic changes occur 4-7 days after an MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Yellow pallor macrophages
Opening snap followed by diastolic rumble
White scar fibrosis

5. What are the Jones criteria?
Shunt
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
Sterile vegetations on surface and undersurface on mitral valve

6. With what congenital heart defect is ADULT coarctation of the aorta associated?
Hypertophy of RV atrophy of LV
Systolic dysfx leading to biventricular CHF
Bicuspid aortic valve
Day 1-7

7. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Eisenmenger syndrome
Infectious endocarditis
Cardiac tamponade
Sudden cardiac death

8. What are the sx/complications of myocarditis?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
First 4 hours
Split S2 on auscultation
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

9. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
ST- segment depression
Libman - Sacks endocarditis
Heart can't fill

10. Myofiber hypertrophy with disarray.
Friction rub and chest pain
3-8 wks
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Hypertrophic cardiomyopathy

11. How does ischemia cause LHF?
Papillary muscle - free wall - IV septum
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Backward LHF pulm htn and RHF - afib and associated mural thombis
Loss of fx

12. What causes wear and tear aortic stenosis?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Cardiac tamponade
Erythematous nontender lesions on palms and soles.
Fibrosis and dystrophic calcification

13. How does reperfusion injury occur?
RCA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
PDA

14. What is the most common cause of dilated cardiomyopathy? What are other causes?
Reperfusion injury
Streptococcus bovis/
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Stable and unstable prinzmetal

15. How does O2 tx MI?
Streptococcus viridans
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Spontaneous
Minimizes ischemia

16. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Bounding pulse
Fibrosis and dystrophic calcification
S viridans

17. What is a common complication of cardiac metastasis?
Nonspecific - eg fever and elevated ESR
Pericardial effusion due to pericardial involvement
Mitral stenosis
Pump failure

18. What is the 1day-1wk -1mo mneumonic for MI?
Low voltage EKG w/diminished QRS amplitude
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Rhabdomyoma
Coxsackie A or B

19. What are the four defects in tetralogy of fallot?
Sterile vegetations on mitral valve along lines of closure
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Months out fibrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

20. What is the tx for LHF?
Prophylactic abx during dental procedures
ACE inhibitor
Nitroglycerin
Left -->right

21. What does chronic ischemic heart disease progress to?
CHF
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Streptococcus bovis/
Decreases LV dilation by decreasing volume

22. Tx for PDA?
Stable and unstable prinzmetal
When a bacterial protein resembles a protein in human tissue
Indomethacin - decreases PGE
Annular - non pruritic rash w/erythematous borders trunks and limbs

23. What is systolic dysfx?
Inability to fill ventricles
Mitral regurg
Within the first day
Ventricles cannot pump

24. What is the rate of congenital heart defects?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Contraction band necrosis - reperfusion injury
1%
Reperfusion injury

25. What is the murmur of mitral valve prolapse?
Endocarditis of prosthetic valves
White scar fibrosis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mid - systolic click followed by regurgitation murmur

26. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Acute inflammation
Mitral stenosis
RBC damaged while crossing the calcified valve causing schistocytes

27. Which congenital heart defect is associated with congenital rubella?
PDA
Reversible
4-7 days
Aneurysm - mural thrombus - Dressler syndrome

28. How does contraction band necrosis occur?
Concentric LV hypertophy
Sudden cardiac death
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Decreased forward perfusion pulmonary congestion

29. What drug relieves stable angina?
Myocarditis
Nitroglycerin
Pericarditits
NG or Ca channel blocker

30. What gross and microscopic changes occur 4-24 hours after an MI?
Limits thrombosis
Loss of fx
Dark discoloration coagulative necrosis
Erythematous nontender lesions on palms and soles.

31. Tender lesions on fingers or toes.
Bicuspid aortic valve
Osler nodes (ouch - ouch Osler)
Left -->right
ST- segment depression

32. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Left -->right
Harmartoma
Pancarditis

33. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Hypertrophic cardiomyopathy
Infantile coarctation of the aorta PDA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

34. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Wear and tear
Systolic dysfx leading to biventricular CHF
1%

35. What causes mitral valve prolapse?
Bounding pulse
Reversible
Myxoid degeneration
Coxsackie A or B

36. What % of MIs involve the LAD?
Subendocardial
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Concentric LV hypertophy
45%

37. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Intercostal arteries enlarged due to collateral circulation
Yellow pallor macrophages
Months out fibrosis
Tricuspid

38. What is the most common cause of mitral stenosis?
Ventricle
Chronic rheumatic heart disease
Sterile vegetations on mitral valve along lines of closure
Streptococcus viridans

39. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
S epidermidis
Chronic rheumatic heart disease
Adult coarctation of the aorta
Small vegetations along the line of closure

40. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Mitral regurg
RCA

41. Poor myocardial fx due to chronic ischemic damage?
LA
Nitroglycerin
Systolic dysfx leading to biventricular CHF
Chronic ischemic heart disease

42. What is the tx for mitral valve prolapse?
Valve replacement
Coronary artery vasospasm - emboli - vasculitis
Large vegetations of S aureus
Metastasis

43. What type of shunt does transposition of the great vessels cause?
Decrease preload -->lowers myocardial stress
Blood vessels coming in from normal tissue
LHF
R-->L

44. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Stable angina
PDA
AD mutation in sarcomere proteins
Nonbacterial thrombotic endocarditis (marantic endocarditis)

45. What is the most common type of ASD? What %?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
PDA
PDA
Ostium secundum (90%)

46. What are the clinical features of RHF?
Tricuspid
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Papillary muscle - free wall - IV septum
Prophylactic abx during dental procedures

47. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
PGE
Mitral regurg
VSD

48. What does nonbacterial thrombotic endocarditis cause?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Congested central veins
Mitral regurg
Large - destructive vegetations

49. What imaging test is useful for detecting lesions on valves?
Pericardial effusion due to pericardial involvement
Transesophageal echo
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
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

50. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
R-->L
Myocardium
Anterior wall of LV and anterior septum
20 min