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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 is the main cause of MV regurg? What are other causes?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Erythematous nontender lesions on palms and soles.
Ventricles cannot pump
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

2. How does restrictive cardiomyopathy cause LHF?

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3. What typically causes hypertrophic cardiomyopathy?
Dilated
Prophylactic abx during dental procedures
AD mutation in sarcomere proteins
Pts w/previously damaged valves

4. What side of the heart do carcinoid tumors affect? Why?
Tetralogy of fallot
MI
Right side - serotonin and other secretory products detoxified in the lung
NG or Ca channel blocker

5. How does hypertension cause LHF?

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6. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Rhabdomyoma
S epidermidis
Low voltage EKG w/diminished QRS amplitude
Reperfusion injury

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

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8. What are heart failure cells?
Infantile coarctation of the aorta
Hemosiderin laden macrophages
Prinzmetal stable and unstable
R-->L

9. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Mitral mitral+aortic
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Months out fibrosis
Trisomy 21

10. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Indomethacin - decreases PGE
Dark discoloration coagulative necrosis
Anterior wall of LV and anterior septum

11. When does the heart have dark discoloration post MI?
4-24 hours
Degree of pulmonary artery stenosis
1-3 days out
Mitral and tricuspid regurg - arrhythmia

12. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Holosystolic blowing murmur
Mid - systolic click followed by regurgitation murmur
Shunt

13. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Asymptomatic
Endocardial fibroelastosis

14. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Coexisting mitral stenosis and fusion of commisures exist
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
VSD

15. Is scar tissue or myocardium stronger?
Myocardium
Anterior wall of LV and anterior septum
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Sterile vegetations on mitral valve along lines of closure

16. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Right side - serotonin and other secretory products detoxified in the lung
2-4 hours - 24 hours - 7-10 days
Restrictive cardiomyopathy

17. How does squating decrease hypoxemia in tetralogy of fallot?
Blood vessels coming in from normal tissue
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rhadbomyoma - benign
Reperfusion injury

18. In which chamber of the heart are rhabdomyomas found?
Ventricle
Shunt - PGE to maintain PDA until surgical repair can be performed
Wear and tear
Sudden cardiac death

19. What is the most common cause of endocarditis in IV drug users?
Heart transplant
Circumflex
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
S aureus

20. What is the gross and microscopic appearance of cardiac myxomas?
Fetal alcohol syndrome
Gelatinous - abundant ground substance
Yellow pallor macrophages
Pericardial effusion due to pericardial involvement

21. Which congenital heart defect is associated with congenital rubella?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
LHF
Red border granulation tissue
PDA

22. What congenital heart defect is associated with fetal alcohol syndrome?
Months out fibrosis
VSD
Subendocardial
Concentric LV hypertophy

23. What areas of the heart does the LAD supply?
Louder - increased systemic resistence decreases LV emptying
Fetal alcohol syndrome
Anterior wall of LV and anterior septum
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

24. With what congenital heart defect is ADULT coarctation of the aorta associated?
LAD
ST- segment depression
Bicuspid aortic valve
When a bacterial protein resembles a protein in human tissue

25. What disesase has Aschoff bodies?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Systolic dysfx leading to biventricular CHF
Myocarditis in acute rheumatic heart fever
Aortic stenosis

26. What causes a mid - systolic click followed by a regurgitation murmur?
Heart transplant
Membrane damage
Red border granulation tissue
Mitral valve prolapse

27. How do you tx prinzmetal angina?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Squat in response to cyanotic spell
Months out fibrosis
NG or Ca channel blocker

28. How does ischemia cause LHF?
Loss of fx
Congested central veins
1%
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

29. What causes wear and tear aortic stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Membrane damage
Colon cancer
Fibrosis and dystrophic calcification

30. What causes notching of the ribs in adult coarctation of the aorta?
Tender lesions on fingers or toes.
Mitral and tricuspid regurg - arrhythmia
Intercostal arteries enlarged due to collateral circulation
Fibrinous pericarditis

31. What are the tx for MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Volume overload and LHF
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
LA dilation

32. What effect does chronic rheumatic heart disease have the mitral valve?
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
Thickening of chrodae tendinae and cusps - mitral stenosis
Intercostal arteries enlarged due to collateral circulation
Valve replacement

33. When would arrhythmia occur after MI?
Systolic dysfx leading to biventricular CHF
Within the first day
Inability to fill ventricles
S viridans

34. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Chest pain <20 min brought on by exertion or emotional stress
Shunt - PGE to maintain PDA until surgical repair can be performed
Nonbacterial thrombotic endocarditis (marantic endocarditis)

35. What does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
Increased blood in right heart delays closure of P valve
Ventricles cannot pump
Myocarditis in acute rheumatic heart fever

36. When do CK- MB levels rise - peak - and return to normal?
Pancarditis
Right to left
4-6 hours - 24 hours - 72 hours
ST- segment depression

37. What is the characteristic murmurr of mitral stenosis?
Aortic regurg
Increased hydrostatic pressure
Decrease preload -->lowers myocardial stress
Opening snap followed by diastolic rumble

38. How long after pharyngitis does acute rheumatic fever occur?
Boot shaped heart
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Breast and lung carcinoma - melanoma - lymphoma
2-3 weeks

39. What is the cause of the red border around granulation tissue?
Thickening of chrodae tendinae and cusps - mitral stenosis
Valve replacement
Blood vessels coming in from normal tissue
VSD

40. How does asprin/heparin tx MI?
Limits thrombosis
Myxoid degeneration
Dense layer of elastic and fibrotic tissue in the endocardium - children
Right side - serotonin and other secretory products detoxified in the lung

41. What does nonbacterial thrombotic endocarditis cause?
Small - nondestructive vegetations (subacute endocarditis)
>70%
Left -->right
Mitral regurg

42. What is the basic principle of CHF?
Limits thrombosis
PDA
Shunt - PGE to maintain PDA until surgical repair can be performed
Pump failure

43. What are the complications of mitral stenosis?
>60 years - bicuspid aortic valve
Large - destructive vegetations
Backward LHF pulm htn and RHF - afib and associated mural thombis
3-8 wks

44. With what developmental disorder is VSD associated?
Pancarditis
PDA
Fetal alcohol syndrome
Aneurysm - mural thrombus - Dressler syndrome

45. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Congestive heart failure
Infectious endocarditis
Erythematous nontender lesions on palms and soles.

46. Boot - shaped heart on x- ray?
Tetralogy of fallot
Pancarditis
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
Troponin I

47. What are the sx of aortic regurg?
Mitral regurg
Granulation tissue
Tuberous sclerosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

48. What are the causes of restrictive cardiomyopathy in adults?
Myxoid degeneration
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
4-6 hours - 24 hours - 72 hours
Friction rub and chest pain

49. What always follows necrosis?
Acute inflammation
>70%
Blood vessels coming in from normal tissue
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

50. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Breast and lung carcinoma - melanoma - lymphoma
Intercostal arteries enlarged due to collateral circulation