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Cardiac

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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 gross and microscopic changes occur 4-24 hours after an MI?
Migratory polyarthritis
PDA
Autoimmune pericarditis 6-8 wks post MI
Dark discoloration coagulative necrosis

2. What heart sound manifest with an ASD?
Dilation of all four chambers of the heart
Split S2 on auscultation
Prinzmetal angina
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

3. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
PDA
Squat in response to cyanotic spell
Pericardial effusion due to pericardial involvement

4. When do CK- MB levels rise - peak - and return to normal?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
S epidermidis
4-6 hours - 24 hours - 72 hours

5. Pericarditis 6-8 wks post MI.
Concentric LV hypertophy
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Contraction band necrosis - reperfusion injury
Dressler syndrome

6. What is the most common cause of myocarditis?
Holosystolic machine like murmur
Trisomy 21
Coxsackie A or B
Granulation tissue

7. Tx for PDA?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Heart transplant
Indomethacin - decreases PGE

8. What is the most common congenital heart defect?
VSD
Colon cancer
Tuberous sclerosis
Valve replacement

9. What is the tx for LHF?
RCA
SLE
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
ACE inhibitor

10. What is a Quincke pulse?
ST- segment elevation
Granulation tissue
Rhadbomyoma - benign
Pulsating nail bed

11. How does contraction band necrosis occur?
Sudden cardiac death
Infantile coarctation of the aorta PDA
Positive blood cultures anemia of chronic disease
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

12. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
First 4 hours
Tetralogy of fallot
Colon cancer
4-24 hours

13. What type of ischemia does stable angina cause?
LA dilation
Tricuspid
Mitral regurg
Subendocardial

14. What is an Aschoff body?
Stable angina
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Reperfusion injury
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

15. How do ACE inhibitors tx MI?
IV drug users
Decreases LV dilation by decreasing volume
Endocardial fibroelastosis
Pericardial effusion due to pericardial involvement

16. How does MI cause LHF?
Open blocked vessels
ST- segment depression
Loss of LV fx
Hemosiderin laden macrophages

17. What shunt does tetralogy of fallot produce?
IV drug users
Sterile vegetations on mitral valve along lines of closure
Tuberous sclerosis
Right -->left

18. What % stenosis causes stable angina?
>70%
Pulsating nail bed
Congenital rubella
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

19. What causes acute endocarditis?
Large vegetations of S aureus
Endocardial fibroelastosis (rare)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Coronary artery vasospasm - emboli - vasculitis

20. What bug causes acute rheumatic fever?
Posterior wall of LV - posterior septum - papillary muscles
Group A beta - hemolytic streptococci
Myocarditis
Inability to maintain systemic pressure w/lack of O2 to vital organs

21. What gross and microscopic changes occur 1-3 weeks after an MI?
4-24 hours
Red border granulation tissue
Group A beta - hemolytic streptococci
Limits thrombosis

22. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
IV drug users
RBC damaged while crossing the calcified valve causing schistocytes
Wear and tear

23. What imaging test is useful for detecting lesions on valves?
Months out fibrosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LV dilation and eccentric hypertrophy
Transesophageal echo

24. When is an MI patent at highest risk for fibrionous pericarditis?
Cardiac tamponade
1-3 days out
1-3 days
Congestive heart failure

25. Which vasculitis can cause MI?
Kawasaki disease
Contraction band necrosis
3-8 wks
Tuberous sclerosis

26. Large vegetations on tricuspid valve?
S aureus
Indomethacin - decreases PGE
Cardiogenic shock - CHF - arrhythmia
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

27. What are the clinical features of endocarditis? What causes each feature?
Prinzmetal
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
Acute inflammation
White scar fibrosis

28. What is the most common tumor of the heart?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
LHF
Metastasis
Tetralogy of fallot

29. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Cardiogenic shock - CHF - arrhythmia
Asymptomatic
Nitroglycerin
ST- segment depression

30. What does Libman - Sacks endocarditis cause?
Infantile coarctation of the aorta PDA
Mitral regurg
Mitral mitral+aortic
Nitroglycerin

31. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aortic regurg
LV dilation and eccentric hypertrophy
Decreased forward perfusion pulmonary congestion

32. Is injury due angina reversible or irreversible?
Dark discoloration coagulative necrosis
>60 years - bicuspid aortic valve
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Reversible

33. Opening snap followed by diastolic rumble.
Pts w/previously damaged valves
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Mitral stenosis
Reactive histiocyte with caterpillar nucleus

34. Why are cardiac enzymes elevated after an MI?
Degree of pulmonary artery stenosis
Ventricles cannot pump
Membrane damage
Holosystolic blowing murmur

35. With what disease is infantile coarctation of the aorta associated?
Degree of pulmonary artery stenosis
Pts w/previously damaged valves
Harmartoma
Turner syndrome

36. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Degree of pulmonary artery stenosis
VSD
Libman - Sacks endocarditis
4-7 days macrophage infiltration

37. What makes the MV prolapse murmur louder? Why?
Myxoma - benign
ST- segment depression
Squatting - increased systemic resistence decreases LV emptying
Hemosiderin laden macrophages

38. Which congenital heart defect is associated with maternal diabetes?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
R-->L
Transposition of the great vessels
Holosystolic blowing murmur

39. How does aortic regurg affect the heart chambers?
Valve replacement once LV dysfx develops
Cyanosis - RV hypertrophy - polycythemia - clubbing
LV dilation and eccentric hypertrophy
Papillary muscle - free wall - IV septum

40. What is chronic rheumatic heart disease?
Spontaneous
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Infectious endocarditis
Valve scarring that arises as a consequence of rheumatic fever

41. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
LAD
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Congestive heart failure

42. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Dressler syndrome
Myocardium
Infantile coarctation of the aorta

43. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Months out fibrosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
2-3 weeks

44. What is cardiogenic shock?
Endocardial fibroelastosis (rare)
Cardiac tamponade
Inability to maintain systemic pressure w/lack of O2 to vital organs
Rupture of free wall - IV septum - or papillary muscle

45. What type of shunt dose PDA cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Libman - Sacks endocarditis
Systolic dysfx leading to biventricular CHF
Left -->right

46. What is eythema marginatum? What parts of the body does it commonly involve?
ACE inhibitor
First 4 hours
Annular - non pruritic rash w/erythematous borders trunks and limbs
Indomethacin - decreases PGE

47. What characterizes acute rheumatic fever endocarditiis?
Months out fibrosis
Small vegetations along the line of closure
Janeway lesions
CK- MB

48. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PGE
Low voltage EKG w/diminished QRS amplitude
ASD - R-->L

49. What is the tx for aortic stenosis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Valve replacement AFTER the onset of complications
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ehlers - Danlow and Marfan syndrome

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

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