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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. Is injury due angina reversible or irreversible?
RCA
Coxsackie A or B
Reversible
Pericarditits

2. What are the cancers that most commonly metastasize to the heart?
Mitral regurgitation due to vegetations
4-6 hours - 24 hours - 72 hours
Breast and lung carcinoma - melanoma - lymphoma
Aneurysm - mural thrombus - Dressler syndrome

3. With what endocarditis is S epidermidis associated?
Streptococcus bovis/
Mitral insufficiency
When a bacterial protein resembles a protein in human tissue
Endocarditis of prosthetic valves

4. EKG for stable angina?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Large vegetations of S aureus
Heart can't fill
ST- segment depression

5. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
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
Erythematous nontender lesions on palms and soles.
First 4 hours

6. What are the major criteria of the Jones criteria?
Dark discoloration coagulative necrosis
Group A beta - hemolytic streptococci
Mitral regurg
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

7. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
>70%
Endocardial fibroelastosis
Nonspecific - eg fever and elevated ESR

8. With what disease is infantile coarctation of the aorta associated?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Turner syndrome
Contraction band necrosis - reperfusion injury
Infectious

9. With what congenital heart defect is ADULT coarctation of the aorta associated?
L->R
Reperfusion injury
Bicuspid aortic valve
Congenital rubella

10. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Myocardium
Subendocardial
Prinzmetal

11. Boot - shaped heart on x- ray?
Coexisting mitral stenosis and fusion of commisures exist
Janeway lesions
Surgical closure small defects may close spontaneously
Tetralogy of fallot

12. How does transmural MI/ischemia present on EKG?
PDA
Inability to maintain systemic pressure w/lack of O2 to vital organs
VSD
ST- segment elevation

13. What are heart failure cells?
Decrease in blood flow to an organ
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Hemosiderin laden macrophages

14. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Doxorubicin - cocaine
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LA dilation
>60 years - bicuspid aortic valve

15. What bug causes acute rheumatic fever?
Restrictive cardiomyopathy
CK- MB
Group A beta - hemolytic streptococci
Regurg vs stenosis

16. What causes an early - blowing diastolic murmur?
Squatting - increased systemic resistence decreases LV emptying
Aortic regurg
Chronic ischemic heart disease
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

17. With what developmental disorder is VSD associated?
Decrease preload -->lowers myocardial stress
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Fetal alcohol syndrome
Infantile coarctation of the aorta PDA

18. What are the HACEK organisms? With what condition are they associated?
>70%
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Endocarditis of prosthetic valves
Blood vessels coming in from normal tissue

19. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Contraction band necrosis - reperfusion injury
Janeway lesions
Chronic rheumatic heart disease

20. What gross and microscopic changes occur months after an MI?
Pancarditis
White scar fibrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Volume overload and LHF

21. What genetic conditions predispose a pt to mitral valve prolapse?
Hypertrophic cardiomyopathy
Coxsackie A or B
Ehlers - Danlow and Marfan syndrome
Streptococcus viridans

22. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Nitroglycerin
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Preductal - post aortic arch
Indomethacin - decreases PGE

23. Pericarditis 6-8 wks post MI.
Dressler syndrome
Gelatinous - abundant ground substance
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
Turner syndrome

24. Which coronary artery supplies the anterior wall and anterior septum?
Loss of LV fx
LAD
PDA
Fetal alcohol syndrome

25. What type of shunt dose PDA cause?
MI
3-8 wks
Left -->right
Opening snap followed by diastolic rumble

26. What is diastolic dysfx?
Aneurysm - mural thrombus - Dressler syndrome
Inability to fill ventricles
Coexisting mitral stenosis and fusion of commisures exist
Restrictive cardiomyopathy

27. What is the most common cause of dilated cardiomyopathy? What are other causes?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Wear and tear
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reversible

28. What complications occur within 4 hrs post MI?
VSD
Cardiogenic shock - CHF - arrhythmia
Breast and lung carcinoma - melanoma - lymphoma
L->R

29. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Stable and unstable prinzmetal
PDA
Shunt - PGE to maintain PDA until surgical repair can be performed
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

30. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Turner syndrome
Loeffler syndrome

31. Which artery is most often occluded in an MI?
1-3 days
LAD
Small - nondestructive vegetations (subacute endocarditis)
MI

32. What type of ischemia does stable angina cause?
Decreases LV dilation by decreasing volume
Aneurysm - mural thrombus - Dressler syndrome
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Subendocardial

33. What always follows necrosis?
Left -->right
Acute inflammation
Elevated ASO anti - DNase B titers
Erythematous nontender lesions on palms and soles.

34. What is the effect of mitral regurg on the heart?
2-3 weeks
Positive blood cultures anemia of chronic disease
Volume overload and LHF
Valve replacement

35. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Mitral regurg
Reversible
Shunt
Adult coarctation of the aorta

36. What causes the dependent pitting edema in RHF?
Right side - serotonin and other secretory products detoxified in the lung
Doxorubicin - cocaine
Dilation of all four chambers of the heart
Increased hydrostatic pressure

37. What congenital heart defect presents later in life with lower extremity cyanosis?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Turner syndrome
Squatting - increased systemic resistence decreases LV emptying
PDA

38. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Ventricles cannot pump
20 min
Doxorubicin - cocaine
Inability to fill ventricles

39. What congenital heart defect does indomethacin tx?
Reperfusion injury
45%
PDA
L->R

40. How does restrictive cardiomyopathy cause LHF?

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

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42. What typically causes hypertrophic cardiomyopathy?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
AD mutation in sarcomere proteins
R-->L
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

43. What type of shunt does transposition of the great vessels cause?
Months out fibrosis
Turner syndrome
R-->L
Dilated

44. Which vasculitis can cause MI?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Anitschow cell
Congested central veins
Kawasaki disease

45. What is the gold standard blood marker for MI?
Coronary artery vasospasm
Plump fibroblasts - collagen - blood vessels
RCA
Troponin I

46. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
PDA
Opening snap followed by diastolic rumble
S aureus

47. What shunt does tetralogy of fallot produce?
Yellow pallor macrophages
S aureus
Right -->left
Adult coarctation of the aorta

48. Lower extremity cyanosis in infants? In adults?
45%
Infantile coarctation of the aorta PDA
Mid - systolic click followed by regurgitation murmur
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

49. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Left -->right
CHF
Anitschow cell
Acute inflammation

50. What are Janeway lesions?
Chronic rheumatic heart disease
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
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Erythematous nontender lesions on palms and soles.