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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 type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Congenital rubella
Doxorubicin - cocaine
Myofiber hypertrophy with disarray

2. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
VSD
ST- segment elevation
Reperfusion injury

3. Infects predamaged valves after transient bacteremia?
Sudden cardiac death
S viridans
Within the first day
Increased hydrostatic pressure

4. When does the heart have dark discoloration post MI?
4-24 hours
Mitral regurg
ST- segment depression
4-6 hours - 24 hours - 72 hours

5. What areas of the heart does the RCA supply?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Posterior wall of LV - posterior septum - papillary muscles
1%
Prinzmetal angina - cocaine

6. What artery is the 2nd most often occluded in an MI?
Decrease preload -->lowers myocardial stress
RCA
Aortic regurg
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

7. How does subendocardial MI/ischemia present on EKG?
RCA
ST- segment depression
Surgical closure small defects may close spontaneously
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

8. What effect does mitral stenosis have on the heart chambers?
Nitroglycerin
LA dilation
Decrease preload -->lowers myocardial stress
Endocarditis of prosthetic valves

9. EKG for stable angina?
Stable and unstable prinzmetal
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
ST- segment depression
Months out fibrosis

10. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
VSD
Chest pain <20 min brought on by exertion or emotional stress
Tuberous sclerosis

11. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Osler nodes (ouch - ouch Osler)
ASD - R-->L
PDA

12. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Increased hydrostatic pressure
Plump fibroblasts - collagen - blood vessels
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Months out fibrosis

13. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Valve scarring that arises as a consequence of rheumatic fever
Friction rub and chest pain
Positive blood cultures anemia of chronic disease

14. Poor myocardial fx due to chronic ischemic damage?
Posterior wall of LV - posterior septum - papillary muscles
Asymptomatic
Chronic ischemic heart disease
Nonbacterial thrombotic endocarditis (marantic endocarditis)

15. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Migratory polyarthritis
4-7 days macrophage infiltration
Rhadbomyoma - benign
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

16. What coronary artery supplies the mitral valve papillary muscles?
Left -->right
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Dilated
RCA

17. What are the clinical features of RHF?
Transesophageal echo
Fetal alcohol syndrome
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

18. What % of MIs involve the LAD?
Mitral valve prolapse
45%
Infectious
When a bacterial protein resembles a protein in human tissue

19. Is scar tissue or myocardium stronger?
Hypertophy of RV atrophy of LV
Bounding pulse
Myocardium
4-7 days

20. What is the gold standard blood marker for MI?
Mitral regurg
2-3 weeks
Myocarditis in acute rheumatic heart fever
Troponin I

21. What are the clinical features of endocarditis? What causes each feature?
Systemic venous congestion
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
PDA
Transposition of the great vessels

22. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Loeffler syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

23. What murmur ccan be heard in PDA?
2-3%
Holosystolic machine like murmur
Breast and lung carcinoma - melanoma - lymphoma
Turner syndrome

24. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
Metastasis
Anitschow cell
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

25. What are the causes of LHF?
Infectious endocarditis - arrythmias - severe mitral regurg no
Indomethacin - decreases PGE
VSD
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

26. What cardiac disease is associated with tuberous sclerosis?
Endocarditis of prosthetic valves
Rhabdomyoma
S aureus
Fetal alcohol syndrome

27. What is cardiogenic shock?
Dilation of all four chambers of the heart
Inability to maintain systemic pressure w/lack of O2 to vital organs
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Sterile vegetations on mitral valve along lines of closure

28. What causes wear and tear aortic stenosis?
ST- segment depression
Trisomy 21
Squatting - increased systemic resistence decreases LV emptying
Fibrosis and dystrophic calcification

29. What is the most common valve infected by S aureus?
Decreased forward perfusion pulmonary congestion
PDA
Tricuspid
RBC damaged while crossing the calcified valve causing schistocytes

30. What are the clinical features of RHF due to?
S viridans
Systemic venous congestion
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Reversible

31. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
NG or Ca channel blocker
Annular - non pruritic rash w/erythematous borders trunks and limbs
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

32. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
RBC damaged while crossing the calcified valve causing schistocytes
Erythematous nontender lesions on palms and soles.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

33. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
4-6 hours - 24 hours - 72 hours
Infectious endocarditis

34. What valves are most commonly involved in chronic rheumatic heart disease?
Loeffler syndrome
Coronary artery vasospasm - emboli - vasculitis
Mitral mitral+aortic
Anitschow cell

35. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Hemosiderin laden macrophages
Paradoxical emboli
Granulation tissue

36. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Fibrosis and dystrophic calcification
Sudden cardiac death
Transesophageal echo

37. What generally causes ischemic heart disease?
2-3%
Atherosclerosis of coronary arteries
Spontaneous
Sudden cardiac death

38. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Heart can't fill
Systolic ejection click followed by crescendo - decrescendo murmur
ACE inhibitor

39. What causes notching of the ribs in adult coarctation of the aorta?
4-7 days macrophage infiltration
Intercostal arteries enlarged due to collateral circulation
Eisenmenger syndrome
Subendocardial

40. Boot - shaped heart on x- ray?
Atria and RV
Increased blood in right heart delays closure of P valve
Tetralogy of fallot
Mitral and tricuspid regurg - arrhythmia

41. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Tetralogy of fallot
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
Infantile coarctation of the aorta PDA

42. What gross and microscopic changes occur months after an MI?
White scar fibrosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
ST- segment elevation

43. What heart sound manifest with an ASD?
Spontaneous
Ischemic heart disease
Nonspecific - eg fever and elevated ESR
Split S2 on auscultation

44. What type of valvular vegetations does S aureus cause?
Valve replacement AFTER the onset of complications
Friction rub and chest pain
Rhadbomyoma - benign
Large - destructive vegetations

45. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
ST- segment elevation
Coexisting mitral stenosis and fusion of commisures exist
Ventricular arrhythmia

46. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
RCA
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Myofiber hypertrophy with disarray

47. What type of collagen is involved in fibrosis?
AD mutation in sarcomere proteins
Rupture of free wall - IV septum - or papillary muscle
Type I
Streptococcus bovis/

48. What structures are susceptible to rupture post MI?
Type I
MI
Papillary muscle - free wall - IV septum
Elevated ASO anti - DNase B titers

49. What are Janeway lesions?
Tetralogy of fallot
Erythematous nontender lesions on palms and soles.
Restrictive cardiomyopathy
Plump fibroblasts - collagen - blood vessels

50. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Acute inflammation
Dark discoloration coagulative necrosis
RCA
Myxoid degeneration