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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. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Sudden cardiac death
Stable and unstable prinzmetal
Tender lesions on fingers or toes.
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

2. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Granulation tissue
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
LAD
RHF

3. What cardiac disease is associated with tuberous sclerosis?
White scar fibrosis
Group A beta - hemolytic streptococci
Small vegetations along the line of closure
Rhabdomyoma

4. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Increased blood in right heart delays closure of P valve
AD mutation in sarcomere proteins
LHF

5. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
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
Libman - Sacks endocarditis

6. What is the JOneS mneumonic?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Hemosiderin laden macrophages
Plump fibroblasts - collagen - blood vessels
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

7. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Migratory polyarthritis
1-3 days
Louder - increased systemic resistence decreases LV emptying

8. What are the complications of mitral stenosis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
4-7 days macrophage infiltration
Backward LHF pulm htn and RHF - afib and associated mural thombis
Ischemic heart disease

9. What is the major cause of MI?
Congestive heart failure
Red border granulation tissue
Nitroglycerin
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

10. What is the most common tumor of the heart?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Metastasis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Small vegetations along the line of closure

11. What gross and microscopic changes occur 4-24 hours after an MI?
Harmartoma
Dark discoloration coagulative necrosis
Increased blood in right heart delays closure of P valve
Cyanosis - RV hypertrophy - polycythemia - clubbing

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

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

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14. Infects predamaged valves after transient bacteremia?
S viridans
Loeffler syndrome
Dressler syndrome
Squat in response to cyanotic spell

15. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Boot shaped heart
4-24 hours
Plump fibroblasts - collagen - blood vessels

16. What are Janeway lesions?
Janeway lesions
Aortic regurg
Erythematous nontender lesions on palms and soles.
Open blocked vessels

17. What are the sx of aortic regurg?
Volume overload and LHF
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Myocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

18. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Tender lesions on fingers or toes.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Heart transplant

19. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Streptococcus bovis/
Pulsating nail bed
Troponin I

20. What shunt does tetralogy of fallot produce?
Atherosclerosis of coronary arteries
Right -->left
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

21. With what virus is PDA associated?
Congenital rubella
1-3 days out
R-->L
Tetralogy of fallot

22. With what disease is infantile coarctation of the aorta associated?
Ischemic heart disease
When a bacterial protein resembles a protein in human tissue
3-8 wks
Turner syndrome

23. What type of endocarditis is associated with SLE?
R-->L
Fibrinous pericarditis
Libman - Sacks endocarditis
Louder - increased systemic resistence decreases LV emptying

24. When does the heart have dark discoloration post MI?
Myocardium
Papillary muscle - free wall - IV septum
Eisenmenger syndrome
4-24 hours

25. What type of collagen is involved in fibrosis?
CK- MB
Tender lesions on fingers or toes.
Type I
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

26. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
3-8 wks
Mitral mitral+aortic
CK- MB

27. What does Libman - Sacks endocarditis cause?
SLE
Mitral regurg
Myofiber hypertrophy with disarray
Decreased forward perfusion pulmonary congestion

28. What are the forward and backward sx of LHF?
LAD
Hemosiderin laden macrophages
Posterior wall of LV - posterior septum - papillary muscles
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

29. What effect does aortic regurg have on the pulse pressure? Why?
45%
LAD
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Prinzmetal stable and unstable

30. What is the murmur of mitral valve prolapse?
Pump failure
Mid - systolic click followed by regurgitation murmur
Tender lesions on fingers or toes.
PDA

31. How does hypertension cause LHF?

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32. What is the gold standard blood marker for MI?
Troponin I
>60 years - bicuspid aortic valve
Split S2 on auscultation
Hypertophy of RV atrophy of LV

33. What are heart failure cells?
Hemosiderin laden macrophages
Small - nondestructive vegetations (subacute endocarditis)
Pulsating nail bed
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

34. What causes wear and tear aortic stenosis?
Ventricular arrhythmia
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Fibrosis and dystrophic calcification
ST- segment depression

35. What is the leading cause of death in the US?
Within the first day
Months out fibrosis
Ischemic heart disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

36. Lower extremity cyanosis in infants? In adults?
2-4 hours - 24 hours - 7-10 days
Infantile coarctation of the aorta PDA
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Rupture of free wall - IV septum - or papillary muscle

37. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Fibrosis and dystrophic calcification
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

38. What are the sx/complications of myocarditis?
Prinzmetal angina - cocaine
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Concentric LV hypertophy
Streptococcus bovis/

39. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Indomethacin - decreases PGE
Coexisting mitral stenosis and fusion of commisures exist
Restrictive cardiomyopathy
Tender lesions on fingers or toes.

40. Boot - shaped heart on x- ray?
Tetralogy of fallot
Sterile vegetations on surface and undersurface on mitral valve
Decreases LV dilation by decreasing volume
Gelatinous - abundant ground substance

41. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LA dilation
LAD

42. When do troponin levels rise - peak - and return to normal?
LAD
Cardiogenic shock - CHF - arrhythmia
2-4 hours - 24 hours - 7-10 days
Ischemic heart disease

43. What is Loeffler syndrome?
When a bacterial protein resembles a protein in human tissue
Transposition of the great vessels
Months out fibrosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

44. What causes unstable angina?
Turner syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Hypercoagulable state or underlying adenocarcinoma
Pulsating nail bed

45. What is Dressler syndrome? When does it occur?
Harmartoma
Hypertrophic cardiomyopathy
Autoimmune pericarditis 6-8 wks post MI
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

46. What is the foundation of a scar?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Months out fibrosis
Granulation tissue
R-->L

47. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Surgical closure small defects may close spontaneously
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S viridans
Mitral mitral+aortic

48. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Prinzmetal stable and unstable
RBC damaged while crossing the calcified valve causing schistocytes
Small vegetations along the line of closure

49. Dilated cardiomyopathy is a late complication of what illness?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Loss of LV fx
S aureus
Myocarditis

50. Poor myocardial fx due to chronic ischemic damage?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pericarditits
Chronic ischemic heart disease
Circumflex