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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. Systolic ejection click followed by crescendo - decrescendo murmur.
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Aortic stenosis
AD mutation in sarcomere proteins
PGE

2. How does transmural MI/ischemia present on EKG?
MI
ST- segment elevation
Cardiogenic shock - CHF - arrhythmia
Infantile coarctation of the aorta

3. What causes prinzmetal angina?
Libman - Sacks endocarditis
Large vegetations of S aureus
Coronary artery vasospasm
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

4. What is the definition of ischemia?
Decrease in blood flow to an organ
Prinzmetal angina - cocaine
1-3 days out
RCA

5. What is the murmur of mitral regurg?
Systolic ejection click followed by crescendo - decrescendo murmur
Holosystolic blowing murmur
Streptococcus viridans
Sudden cardiac death

6. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Aschoff bodies
Squatting - expiration
Low voltage EKG w/diminished QRS amplitude

7. What are the complications that occur months after an MI?
Infantile coarctation of the aorta PDA
Aneurysm - mural thrombus - Dressler syndrome
Ventricles cannot pump
NG or Ca channel blocker

8. What always follows necrosis?
Decreases LV dilation by decreasing volume
Acute inflammation
Blood vessels coming in from normal tissue
Atria and RV

9. What effect does chronic rheumatic heart disease have the mitral valve?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Thickening of chrodae tendinae and cusps - mitral stenosis
Libman - Sacks endocarditis

10. What is systolic dysfx?
Anitschow cell
Ventricles cannot pump
Loeffler syndrome
Migratory polyarthritis

11. Low voltage EKG w/diminished QRS amplitude.
Bacterial endocarditis
Ischemic heart disease
Restrictive cardiomyopathy
Positive blood cultures anemia of chronic disease

12. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Maternal diabetes
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Posterior wall of LV - posterior septum - papillary muscles

13. What is eythema marginatum? What parts of the body does it commonly involve?
Prinzmetal
Annular - non pruritic rash w/erythematous borders trunks and limbs
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

14. What type of ASD is associated w/Down syndrome?
Ostium primum
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Red border granulation tissue
Pedunculated mass in the LA that causes syncope due to obstruction of MV

15. What gross and microscopic changes occur 1-3 weeks after an MI?
Shunt
20 min
Red border granulation tissue
Myocarditis

16. What are the sx/complications of myocarditis?
Endocardial fibroelastosis
Decrease preload -->lowers myocardial stress
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
PDA

17. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Maternal diabetes
Atria and RV

18. How do beta blockers tx MI?
Stable angina
Reperfusion injury
Paradoxical emboli
Slow HR - decreasing O2 demand and risk for arrhythmia

19. Myofiber hypertrophy with disarray.
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Contraction band necrosis
Rhabdomyoma
Hypertrophic cardiomyopathy

20. L- to - R shunt switching to R- to - L shunt.
Intercostal arteries enlarged due to collateral circulation
Prinzmetal stable and unstable
Increased hydrostatic pressure
Eisenmenger syndrome

21. 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
4-24 hours
Adult coarctation of the aorta
Coronary artery vasospasm - emboli - vasculitis

22. What does chronic ischemic heart disease progress to?
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
Pancarditis
CHF
Surgical closure small defects may close spontaneously

23. What are the complications of mitral valve prolapse? Are they common?
Gelatinous - abundant ground substance
1-3 days
Infectious endocarditis - arrythmias - severe mitral regurg no
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

24. What is the most common form of cardiomyopathy?
RHF
Dilated
Nitroglycerin
VSD

25. What type of vegetations does Strep viridans cause?
Slow HR - decreasing O2 demand and risk for arrhythmia
Small - nondestructive vegetations (subacute endocarditis)
45%
Nonspecific - eg fever and elevated ESR

26. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Low voltage EKG w/diminished QRS amplitude
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Stable angina

27. Tender lesions on fingers or toes.
Breast and lung carcinoma - melanoma - lymphoma
Osler nodes (ouch - ouch Osler)
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

28. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Membrane damage
S aureus
LV dilation and eccentric hypertrophy

29. Erythematous nontender lesions on palms and soles.
Janeway lesions
Papillary muscle - free wall - IV septum
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Ventricular arrhythmia

30. What are the minor critera of the Jones criteria?
Coexisting mitral stenosis and fusion of commisures exist
Harmartoma
Months out fibrosis
Nonspecific - eg fever and elevated ESR

31. How does hypertension cause LHF?

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32. What are the causes of LHF?
Wear and tear
Systolic ejection click followed by crescendo - decrescendo murmur
Decreased forward perfusion pulmonary congestion
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

33. What causes the split S2 in ASD?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Increased blood in right heart delays closure of P valve
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

34. What causes unstable angina?
Holosystolic machine like murmur
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Large - destructive vegetations
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

35. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Degree of pulmonary artery stenosis
LAD
Holosystolic blowing murmur

36. Is scar tissue or myocardium stronger?
Split S2 on auscultation
R-->L
Systolic dysfx leading to biventricular CHF
Myocardium

37. What are the clinical features of endocarditis? What causes each feature?
Within the first day
Bounding pulse
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
Systemic venous congestion

38. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Shunt
Dark discoloration coagulative necrosis
Aschoff bodies
Granulation tissue

39. What is an important complication of ASD?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Paradoxical emboli
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pericarditits

40. What are Janeway lesions?
Ostium secundum (90%)
Erythematous nontender lesions on palms and soles.
Turner syndrome
Tuberous sclerosis

41. Dense layer of elastic and fibrotic tissue in the endocardium.
Ostium secundum (90%)
PDA
Preductal - post aortic arch
Endocardial fibroelastosis

42. What valves are most commonly involved in chronic rheumatic heart disease?
Tuberous sclerosis
Within the first day
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral mitral+aortic

43. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Colon cancer
Myofiber hypertrophy with disarray
Maternal diabetes
Nitroglycerin

44. What coronary arterysupplies the lateral wall of the LV?
PDA
Fibrosis and dystrophic calcification
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
Circumflex

45. What causes mitral valve prolapse?
Bounding pulse
Myxoid degeneration
Slow HR - decreasing O2 demand and risk for arrhythmia
LV dilation and eccentric hypertrophy

46. What causes angina and syncope in aortic stenosis?

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47. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Endocarditis of prosthetic valves
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Subendocardial

48. How does MI cause LHF?
Type I
Stable and unstable prinzmetal
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Loss of LV fx

49. What areas of the heart does the RCA supply?
Libman - Sacks endocarditis
Right -->left
Trisomy 21
Posterior wall of LV - posterior septum - papillary muscles

50. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Valve replacement AFTER the onset of complications
Sterile vegetations on surface and undersurface on mitral valve