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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. Erythematous nontender lesions on palms and soles.
Split S2 on auscultation
Loss of fx
Janeway lesions
Yellow pallor macrophages

2. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
MI
Autoimmune pericarditis 6-8 wks post MI
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
20 min

3. What is the only Jones criteria that doesn't resolve with time?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Osler nodes (ouch - ouch Osler)
Tetralogy of fallot
Pancarditis

4. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Metastasis
Inability to fill ventricles
Group A beta - hemolytic streptococci

5. What is the most common form of cardiomyopathy?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Dilated
2-4 hours - 24 hours - 7-10 days
Fibrinous pericarditis

6. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Squatting - increased systemic resistence decreases LV emptying
Congenital rubella
Yellow pallor macrophages

7. Which congenital heart defect is associated with congenital rubella?
Aortic regurg
Tricuspid
PDA
Prinzmetal angina

8. What is the definition of ischemia?
S aureus
Decrease in blood flow to an organ
Aortic stenosis
Erythematous nontender lesions on palms and soles.

9. What is the most common cause of dilated cardiomyopathy? What are other causes?
NG or Ca channel blocker
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Wear and tear

10. What are complications of dilated cardiomyopathy?
1-3 days out
Mitral and tricuspid regurg - arrhythmia
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Prinzmetal

11. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Hemosiderin laden macrophages
Open blocked vessels
LA
RCA

12. What is Loeffler syndrome?
Ostium primum
20 min
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Autoimmune pericarditis 6-8 wks post MI

13. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RBC damaged while crossing the calcified valve causing schistocytes

14. What is an important complication of ASD?
Eisenmenger syndrome
Paradoxical emboli
Libman - Sacks endocarditis
Prinzmetal angina

15. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Atherosclerosis of coronary arteries
Left -->right
Colon cancer

16. What drugs can cause dilated cardiomyopathy?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Bacterial endocarditis
Mitral regurg
Doxorubicin - cocaine

17. What type of collagen is involved in fibrosis?
Prinzmetal stable and unstable
Type I
20 min
Regurg vs stenosis

18. What are the sx of pericardiits?
Aschoff bodies
Squat in response to cyanotic spell
Friction rub and chest pain
Mid - systolic click followed by regurgitation murmur

19. What is the murmur of mitral valve prolapse?
Nonspecific - eg fever and elevated ESR
4-7 days
Mid - systolic click followed by regurgitation murmur
Decrease preload -->lowers myocardial stress

20. Friction rub and chest pain.
Pericarditits
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decreases LV dilation by decreasing volume
Heart can't fill

21. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Pulsating nail bed
Minimizes ischemia
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

22. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
First 4 hours
Red border granulation tissue
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

23. Systolic ejection click followed by crescendo - decrescendo murmur.
Day 1-7
Aortic stenosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
LA

24. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Janeway lesions
Indomethacin - decreases PGE
Anitschow cell
Myxoid degeneration

25. With what condition are rhabdomyomas associated?
Myocarditis
Tuberous sclerosis
20 min
Louder - increased systemic resistence decreases LV emptying

26. What causes mitral valve prolapse?
Myxoid degeneration
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Low voltage EKG w/diminished QRS amplitude
Mid - systolic click followed by regurgitation murmur

27. How does ischemia cause LHF?
Slow HR - decreasing O2 demand and risk for arrhythmia
Loss of fx
Small - nondestructive vegetations (subacute endocarditis)
Thickening of chrodae tendinae and cusps - mitral stenosis

28. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Yellow pallor macrophages
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Coexisting mitral stenosis and fusion of commisures exist
Mitral regurg

29. What are the sx of cardiac myxoma?
ST- segment elevation
Inability to fill ventricles
Infantile coarctation of the aorta
Pedunculated mass in the LA that causes syncope due to obstruction of MV

30. What vavular defect results from acute rheumatic fever?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Pericardial effusion due to pericardial involvement
Elevated ASO anti - DNase B titers
Mitral regurgitation due to vegetations

31. What increases the risk for chronic rheumatic heart disease?
Stretched muscle loses contractility
Mitral and tricuspid regurg - arrhythmia
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Anitschow cell

32. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Loss of fx
Dilation of all four chambers of the heart
ASD - R-->L

33. What is the tx for aortic stenosis?
When a bacterial protein resembles a protein in human tissue
Erythematous nontender lesions on palms and soles.
Valve replacement AFTER the onset of complications
Transposition of the great vessels

34. What heart sound manifest with an ASD?
Prinzmetal angina - cocaine
Split S2 on auscultation
RHF
Blood vessels coming in from normal tissue

35. How do you tx prinzmetal angina?
NG or Ca channel blocker
Nonspecific - eg fever and elevated ESR
MI
Yellow pallor neutrophils

36. With what disease is transposition of the great vessels associated?
Regurg vs stenosis
RCA
Maternal diabetes
Right to left

37. What conditions can cause nonbacterial thrombotic endocarditis?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Plump fibroblasts - collagen - blood vessels
Hypercoagulable state or underlying adenocarcinoma
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

38. What are the two effects of ATII?
Atria and RV
Valve replacement once LV dysfx develops
Prophylactic abx during dental procedures
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

39. How does dilated cardiomyopathy cause LHF?
Doxorubicin - cocaine
Stretched muscle loses contractility
1-3 days
Congested central veins

40. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Pancarditis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RCA

41. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Libman - Sacks endocarditis
L->R
Preductal - post aortic arch

42. In which chamber of the heart are rhabdomyomas found?
>70%
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
Months out fibrosis
Ventricle

43. What are the tx for MI?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Subendocardial
Louder - increased systemic resistence decreases LV emptying
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

44. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Acute inflammation
Sudden cardiac death
Bounding pulse
Pedunculated mass in the LA that causes syncope due to obstruction of MV

45. What is the classic EKG finding of restrictive cardiomyopathy?
Mitral valve prolapse
Endocardial fibroelastosis
Low voltage EKG w/diminished QRS amplitude
4-24 hours

46. Opening snap followed by diastolic rumble.
Streptococcus viridans
Heart transplant
1-3 days
Mitral stenosis

47. Are most congenital heart defects spontaneous or inherited?
Papillary muscle - free wall - IV septum
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
ST- segment depression
Spontaneous

48. Is injury due angina reversible or irreversible?
Reversible
Systemic venous congestion
Nonspecific - eg fever and elevated ESR
4-7 days macrophage infiltration

49. Infects predamaged valves after transient bacteremia?
Group A beta - hemolytic streptococci
S viridans
Migratory polyarthritis
ST- segment depression

50. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Coexisting mitral stenosis and fusion of commisures exist
Heart can't fill
Reactive histiocyte with caterpillar nucleus