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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 most common valve infected by S aureus?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
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
Months out fibrosis
Tricuspid

2. What iis the tx for aortic regurg?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Mitral regurg
Valve replacement once LV dysfx develops
RBC damaged while crossing the calcified valve causing schistocytes

3. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Sterile vegetations on mitral valve along lines of closure
Aschoff bodies
Limits thrombosis
Doxorubicin - cocaine

4. How do ACE inhibitors tx MI?
Posterior wall of LV - posterior septum - papillary muscles
Small vegetations along the line of closure
Decreases LV dilation by decreasing volume
PDA

5. How does contraction band necrosis occur?
RCA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Maternal diabetes

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

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7. What typically causes hypertrophic cardiomyopathy?
Right to left
AD mutation in sarcomere proteins
Congested central veins
Split S2 on auscultation

8. What is the murmur of mitral valve prolapse?
Intercostal arteries enlarged due to collateral circulation
Mid - systolic click followed by regurgitation 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
Trisomy 21

9. With what disease is transposition of the great vessels associated?
Maternal diabetes
Reversible
Valve scarring that arises as a consequence of rheumatic fever
When a bacterial protein resembles a protein in human tissue

10. What type of vegetations are associated with Libman - Sacks endocarditis?
Tetralogy of fallot
Cyanosis - RV hypertrophy - polycythemia - clubbing
Sterile vegetations on surface and undersurface on mitral valve
Left -->right

11. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Transposition of the great vessels
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
4-7 days macrophage infiltration

12. What does rupture of a papillary muscle cause?
1-3 days
S aureus
Mitral insufficiency
R-->L

13. In which chamber of the heart are rhabdomyomas found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Rhabdomyoma
Ventricle
Endocarditis of prosthetic valves

14. What determines the extent of shunting and cyanosis in tetralogy of fallot?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Friction rub and chest pain
Degree of pulmonary artery stenosis
Coronary artery vasospasm

15. What are Osler nodes?
Tender lesions on fingers or toes.
Decreases LV dilation by decreasing volume
Coronary artery vasospasm
Yellow pallor neutrophils

16. What is the gross and microscopic appearance of cardiac myxomas?
3-8 wks
Pts w/previously damaged valves
Gelatinous - abundant ground substance
Fibrinous pericarditis

17. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Prinzmetal stable and unstable
4-7 days
Annular - non pruritic rash w/erythematous borders trunks and limbs

18. How does asprin/heparin tx MI?
Limits thrombosis
Tender lesions on fingers or toes.
Day 1-7
Membrane damage

19. What are the clinical features of LHF due to?
Circumflex
Streptococcus bovis/
Decreased forward perfusion pulmonary congestion
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

20. What does a biopsy of hypertrophic cardiomyopathy look like?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Myofiber hypertrophy with disarray
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Aneurysm - mural thrombus - Dressler syndrome

21. How does adult coarctation of the aorta present?
Valve replacement
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LA dilation
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

22. What causes wear and tear aortic stenosis?
Heart transplant
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Fibrosis and dystrophic calcification
>70%

23. What effect does chronic rheumatic heart disease have on the aortic valve?

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24. How does restrictive cardiomyopathy present?
Congestive heart failure
Stretched muscle loses contractility
Loeffler syndrome
Papillary muscle - free wall - IV septum

25. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Aortic regurg
Fibrosis and dystrophic calcification
Thickening of chrodae tendinae and cusps - mitral stenosis

26. What is eythema marginatum? What parts of the body does it commonly involve?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Annular - non pruritic rash w/erythematous borders trunks and limbs
Harmartoma
Chronic rheumatic heart disease

27. How does subendocardial MI/ischemia present on EKG?
RCA
ST- segment depression
Transposition of the great vessels
Aneurysm - mural thrombus - Dressler syndrome

28. What is the classic EKG finding of restrictive cardiomyopathy?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
1%
Mitral regurg
Low voltage EKG w/diminished QRS amplitude

29. What two things cause coronary artery vasospasm?
Nonspecific - eg fever and elevated ESR
Prinzmetal angina - cocaine
Tricuspid
Infantile coarctation of the aorta PDA

30. What type of ischemia does stable angina cause?
Valve replacement once LV dysfx develops
Subendocardial
Myofiber hypertrophy with disarray
Volume overload and LHF

31. With what developmental disorder is VSD associated?
Tender lesions on fingers or toes.
Small vegetations along the line of closure
Fetal alcohol syndrome
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

32. Pericarditis 6-8 wks post MI.
RBC damaged while crossing the calcified valve causing schistocytes
CK- MB
LHF
Dressler syndrome

33. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Backward LHF pulm htn and RHF - afib and associated mural thombis
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
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

34. What are the clinical features of endocarditis? What causes each feature?
Positive blood cultures anemia of chronic disease
Split S2 on auscultation
Limits thrombosis
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

35. What gross and microscopic changes occur months after an MI?
Osler nodes (ouch - ouch Osler)
Acute inflammation
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
White scar fibrosis

36. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Migratory polyarthritis
4-7 days macrophage infiltration
Ventricular arrhythmia

37. How does hypertension cause LHF?

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38. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Ventricles cannot pump
Fibrinous pericarditis
Coexisting mitral stenosis and fusion of commisures exist
Colon cancer

39. What shunt does tetralogy of fallot produce?
Right -->left
Pump failure
Anterior wall of LV and anterior septum
Tricuspid

40. What drug relieves stable angina?
Libman - Sacks endocarditis
RCA
Nitroglycerin
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

41. Which artery is most often occluded in an MI?
Endocardial fibroelastosis
PDA
Hypertophy of RV atrophy of LV
LAD

42. What side of the heart do carcinoid tumors affect? Why?
ASD - R-->L
Right side - serotonin and other secretory products detoxified in the lung
Low voltage EKG w/diminished QRS amplitude
Fetal alcohol syndrome

43. EKG for stable angina?
Coronary artery vasospasm
Hypertophy of RV atrophy of LV
Right -->left
ST- segment depression

44. What are the cancers that most commonly metastasize to the heart?
Mitral regurgitation due to vegetations
Breast and lung carcinoma - melanoma - lymphoma
Heart transplant
Day 1-7

45. What imaging test is useful for detecting lesions on valves?
Sterile vegetations on mitral valve along lines of closure
Transesophageal echo
Myofiber hypertrophy with disarray
Coronary artery vasospasm

46. What is chronic rheumatic heart disease?
Slow HR - decreasing O2 demand and risk for arrhythmia
Valve scarring that arises as a consequence of rheumatic fever
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Concentric LV hypertophy

47. What effect does transposition of the great vessels have on the ventricles?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Valve replacement AFTER the onset of complications
Hypertophy of RV atrophy of LV

48. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Asymptomatic
Mitral regurg
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

49. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Contraction band necrosis
Atherosclerosis of coronary arteries
Asymptomatic

50. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Myocarditis in acute rheumatic heart fever
Infantile coarctation of the aorta PDA
Myocardium