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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. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Autoimmune pericarditis 6-8 wks post MI
Myofiber hypertrophy with disarray

2. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Indomethacin - decreases PGE
RBC damaged while crossing the calcified valve causing schistocytes
PDA

3. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Stable and unstable prinzmetal
Eisenmenger syndrome
Prinzmetal angina - cocaine

4. What causes the nutmeg color in nutmeg liver?
Prinzmetal
Nonspecific - eg fever and elevated ESR
Membrane damage
Congested central veins

5. What iis the tx for aortic regurg?
Trisomy 21
Loss of fx
Valve replacement once LV dysfx develops
NG or Ca channel blocker

6. What is the most common cause of RHF? What are others?
PDA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Myocarditis
Ventricle

7. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
S viridans
Opening snap followed by diastolic rumble

8. What is the most common valve infected by S aureus?
Troponin I
Granulation tissue
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Tricuspid

9. What is a Quincke pulse?
Boot shaped heart
Pulsating nail bed
Type I
Yellow pallor neutrophils

10. Turner syndrome is associated with which congenital heart defect?
RCA
PDA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infantile coarctation of the aorta

11. What gross and microscopic changes occur 1-3 weeks after an MI?
Limits thrombosis
Red border granulation tissue
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Streptococcus bovis/

12. What conditions can cause nonbacterial thrombotic endocarditis?
Ostium secundum (90%)
Right -->left
ASD - R-->L
Hypercoagulable state or underlying adenocarcinoma

13. What type of shunt does ASD cause?
VSD
Left -->right
Minimizes ischemia
LAD

14. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Wear and tear
Left -->right
Anitschow cell
Ventricle

15. What are the minor critera of the Jones criteria?
2-3%
Prophylactic abx during dental procedures
Decreases LV dilation by decreasing volume
Nonspecific - eg fever and elevated ESR

16. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LV dilation and eccentric hypertrophy
20 min

17. What is molecular mimicry?
Loss of fx
Coexisting mitral stenosis and fusion of commisures exist
Colon cancer
When a bacterial protein resembles a protein in human tissue

18. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Dilated
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Prophylactic abx during dental procedures

19. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Preductal - post aortic arch
Pericarditits
Cardiac tamponade

20. When does the heart have a yellow pallor post MI?
ST- segment elevation
Day 1-7
Reperfusion injury
ASD - R-->L

21. What are the sx of hypertrophic cardiomyopathy?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Prinzmetal stable and unstable
Right to left
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

22. What are the two effects of ATII?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Thickening of chrodae tendinae and cusps - mitral stenosis

23. What is cardiogenic shock?
Ostium secundum (90%)
Inability to maintain systemic pressure w/lack of O2 to vital organs
Reactive histiocyte with caterpillar nucleus
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

24. How does aortic regurg affect the heart chambers?
Wear and tear
Regurg vs stenosis
LV dilation and eccentric hypertrophy
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

25. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Prinzmetal angina - cocaine
Intercostal arteries enlarged due to collateral circulation
Ostium primum

26. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Trisomy 21
Fibrinous pericarditis
Streptococcus viridans
Migratory polyarthritis

27. What type of tumor is a rhabdomyoma?
Hypertophy of RV atrophy of LV
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Harmartoma

28. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
2-4 hours - 24 hours - 7-10 days
RCA
Aortic regurg
2-3 weeks

29. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Mitral regurg
Preductal - post aortic arch
When a bacterial protein resembles a protein in human tissue

30. Why would cardiac enzymes continue to increase after the initial MI?
Adult coarctation of the aorta
Atria and RV
Reperfusion injury
>60 years - bicuspid aortic valve

31. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
45%
Annular - non pruritic rash w/erythematous borders trunks and limbs
Aneurysm - mural thrombus - Dressler syndrome

32. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Mitral valve prolapse
Prinzmetal angina
Papillary muscle - free wall - IV septum
Holosystolic machine like murmur

33. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Circumflex
Rhabdomyoma
Mitral mitral+aortic

34. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Large vegetations of S aureus
Valve replacement once LV dysfx develops
Rhadbomyoma - benign
Open blocked vessels

35. What causes prinzmetal angina?
Myocardium
Prinzmetal stable and unstable
Mitral regurg
Coronary artery vasospasm

36. What is the basic principle of CHF?
Pump failure
S aureus
Hypertrophic cardiomyopathy
Valve replacement

37. What causes heart failure cells?
Opening snap followed by diastolic rumble
Large vegetations of S aureus
Transposition of the great vessels
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

38. What cardiac disease is associated with tuberous sclerosis?
Minimizes ischemia
Chest pain <20 min brought on by exertion or emotional stress
Transesophageal echo
Rhabdomyoma

39. What type of vegetations are associated with Libman - Sacks endocarditis?
Mitral regurgitation due to vegetations
Concentric LV hypertophy
Ischemic heart disease
Sterile vegetations on surface and undersurface on mitral valve

40. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
CHF
Chronic rheumatic heart disease
4-7 days

41. What type of shunt dose PDA cause?
Nitroglycerin
PDA
Left -->right
Rupture of free wall - IV septum - or papillary muscle

42. How does reperfusion injury occur?
Tender lesions on fingers or toes.
Boot shaped heart
Chronic ischemic heart disease
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

43. Which coronary artery supplies the anterior wall and anterior septum?
Thickening of chrodae tendinae and cusps - mitral stenosis
Decrease preload -->lowers myocardial stress
Valve replacement once LV dysfx develops
LAD

44. What is the most common cause of aortic stenosis?
Wear and tear
IV drug users
Shunt
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

45. Dense layer of elastic and fibrotic tissue in the endocardium.
Infectious
Ostium primum
PDA
Endocardial fibroelastosis

46. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
ACE inhibitor
MI
Intercostal arteries enlarged due to collateral circulation
LAD

47. How does ischemia cause LHF?
Congested central veins
Loss of fx
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Nonbacterial thrombotic endocarditis (marantic endocarditis)

48. With what endocarditis is S epidermidis associated?
First 4 hours
Endocarditis of prosthetic valves
4-24 hours
Sterile vegetations on surface and undersurface on mitral valve

49. What % of MIs involve the LAD?
45%
Regurg vs stenosis
Decreased forward perfusion pulmonary congestion
Dressler syndrome

50. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Autoimmune pericarditis 6-8 wks post MI
Rupture of free wall - IV septum - or papillary muscle
VSD