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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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1. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Coronary artery vasospasm
Ventricles cannot pump
Months out fibrosis
Hypercoagulable state or underlying adenocarcinoma

2. Holosystolic blowing murmur that increases w/expiration?
Hypertophy of RV atrophy of LV
Mitral regurg
CHF
Fibrosis and dystrophic calcification

3. What are the sx of cardiac myxoma?
Mitral stenosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Bacterial endocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

4. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Pericarditits
Mid - systolic click followed by regurgitation murmur
Tetralogy of fallot

5. When do macrophagess infiltrate the myocardium post MI?
Aortic regurg
Concentric LV hypertophy
4-7 days
First 4 hours

6. What congenital heart defect presents later in life with lower extremity cyanosis?
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
Dark discoloration coagulative necrosis
Posterior wall of LV - posterior septum - papillary muscles
PDA

7. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
CHF
Reactive histiocyte with caterpillar nucleus
Myxoma - benign

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

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9. What are the sx of PDA at birth?
LAD
Myofiber hypertrophy with disarray
ST- segment depression
Asymptomatic

10. What is the gold standard blood marker for MI?
LAD
Fibrosis and dystrophic calcification
Troponin I
AD mutation in sarcomere proteins

11. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Dark discoloration coagulative necrosis
Congenital rubella
Anitschow cell

12. What type of shunt dose PDA cause?
Rupture of free wall - IV septum - or papillary muscle
AD mutation in sarcomere proteins
Left -->right
2-3 weeks

13. What makes the MV prolapse murmur louder? Why?
First 4 hours
Myocarditis in acute rheumatic heart fever
Squatting - increased systemic resistence decreases LV emptying
IV drug users

14. With what disease is Libman - Sacks endocarditis associated?
SLE
Posterior wall of LV - posterior septum - papillary muscles
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

15. What is the most common type of endocarditis?
Pericarditits
Limits thrombosis
Infectious
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

16. How do beta blockers tx MI?
Turner syndrome
Mitral mitral+aortic
Slow HR - decreasing O2 demand and risk for arrhythmia
Ischemic heart disease

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

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18. What is the most common congenital heart defect?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Coxsackie A or B
4-6 hours - 24 hours - 72 hours
VSD

19. What increases the volume of mitral regurg murmur?
Plump fibroblasts - collagen - blood vessels
Squatting - expiration
R-->L
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

20. How does restrictive cardiomyopathy cause LHF?

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21. How does hypertension cause LHF?

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22. What complications occur within 4 hrs post MI?
RBC damaged while crossing the calcified valve causing schistocytes
Cardiogenic shock - CHF - arrhythmia
Right to left
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

23. What always follows necrosis?
Acute inflammation
VSD
Pericardial effusion due to pericardial involvement
Volume overload and LHF

24. Is injury due angina reversible or irreversible?
Coronary artery vasospasm
Mitral stenosis
Split S2 on auscultation
Reversible

25. How does subendocardial MI/ischemia present on EKG?
L->R
ST- segment depression
LHF
Heart transplant

26. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Months out fibrosis
Heart can't fill
Reactive histiocyte with caterpillar nucleus

27. What gross and microscopic changes occur 1-3 weeks after an MI?
CK- MB
Aneurysm - mural thrombus - Dressler syndrome
Months out fibrosis
Red border granulation tissue

28. What type of ASD is associated w/Down syndrome?
1%
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
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Ostium primum

29. What are the causes of LHF?
Sudden cardiac death
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
PDA
Anterior wall of LV and anterior septum

30. How does MI cause LHF?
Decrease in blood flow to an organ
Loss of LV fx
VSD
Ventricular arrhythmia

31. What are the clinical features of LHF due to?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mid - systolic click followed by regurgitation murmur
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Decreased forward perfusion pulmonary congestion

32. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Squatting - increased systemic resistence decreases LV emptying
Volume overload and LHF
Tuberous sclerosis

33. Tx for PDA?
Indomethacin - decreases PGE
LAD
Months out fibrosis
Mitral regurgitation due to vegetations

34. What does chronic ischemic heart disease progress to?
VSD
Split S2 on auscultation
Libman - Sacks endocarditis
CHF

35. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
L->R
Limits thrombosis
Erythematous nontender lesions on palms and soles.

36. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Fibrosis and dystrophic calcification
Transposition of the great vessels
Prinzmetal angina

37. What does nonbacterial thrombotic endocarditis cause?
PGE
Mitral regurg
Dark discoloration coagulative necrosis
ACE inhibitor

38. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Tuberous sclerosis
Colon cancer
VSD

39. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
2-4 hours - 24 hours - 7-10 days
Tetralogy of fallot
Adult coarctation of the aorta

40. When does the heart have a yellow pallor post MI?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Ventricular arrhythmia
Surgical closure small defects may close spontaneously
Day 1-7

41. What causes notching of the ribs in adult coarctation of the aorta?
Pancarditis
Intercostal arteries enlarged due to collateral circulation
Cardiac tamponade
Adult coarctation of the aorta

42. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
PGE
4-6 hours - 24 hours - 72 hours
Myxoid degeneration

43. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Coronary artery vasospasm
Shunt
Nitroglycerin
Tetralogy of fallot

44. What causes an early - blowing diastolic murmur?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Rhabdomyoma
Aortic regurg
SLE

45. What is endocardial fibroelastosis? In what population is it found?
S viridans
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ostium primum

46. What are the major criteria of the Jones criteria?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Mitral mitral+aortic
1%

47. Opening snap followed by diastolic rumble.
Spontaneous
Mitral stenosis
Prinzmetal stable and unstable
Libman - Sacks endocarditis

48. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Janeway lesions
Doxorubicin - cocaine
Positive blood cultures anemia of chronic disease

49. What is dilated cardiomyopathy?
White scar fibrosis
Plump fibroblasts - collagen - blood vessels
Dilation of all four chambers of the heart
3-8 wks

50. What is the characteristic murmurr of mitral stenosis?
Atherosclerosis of coronary arteries
Annular - non pruritic rash w/erythematous borders trunks and limbs
Opening snap followed by diastolic rumble
Squatting - increased systemic resistence decreases LV emptying