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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. What type of vegetations are associated with Libman - Sacks endocarditis?
Fibrinous pericarditis
Sterile vegetations on surface and undersurface on mitral valve
Autoimmune pericarditis 6-8 wks post MI
Backward LHF pulm htn and RHF - afib and associated mural thombis

2. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Squat in response to cyanotic spell
Chest pain <20 min brought on by exertion or emotional stress
Degree of pulmonary artery stenosis

3. When does the heart have dark discoloration post MI?
4-24 hours
Blood vessels coming in from normal tissue
Positive blood cultures anemia of chronic disease
Fibrosis and dystrophic calcification

4. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Split S2 on auscultation
Ostium secundum (90%)
Trisomy 21

5. How do ACE inhibitors tx MI?
MI
Maternal diabetes
>60 years - bicuspid aortic valve
Decreases LV dilation by decreasing volume

6. With what disease is Libman - Sacks endocarditis associated?
CK- MB
SLE
Eisenmenger syndrome
Mitral regurg

7. With what disease is infantile coarctation of the aorta associated?
Myocarditis in acute rheumatic heart fever
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Turner syndrome

8. Pericarditis 6-8 wks post MI.
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Dressler syndrome
1-3 days out
Bounding pulse

9. With what developmental disorder is VSD associated?
>60 years - bicuspid aortic valve
Fetal alcohol syndrome
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Myocardium

10. How does transmural MI/ischemia present on EKG?
Tetralogy of fallot
Months out fibrosis
Coxsackie A or B
ST- segment elevation

11. What are heart failure cells?
Hemosiderin laden macrophages
1%
Atria and RV
Loeffler syndrome

12. What are the clinical features of RHF due to?
Aneurysm - mural thrombus - Dressler syndrome
RHF
Tender lesions on fingers or toes.
Systemic venous congestion

13. What gross and microscopic changes occur 4-24 hours after an MI?
Cyanosis - RV hypertrophy - polycythemia - clubbing
RCA
Dark discoloration coagulative necrosis
Mitral regurg

14. What is chronic rheumatic heart disease?
Intercostal arteries enlarged due to collateral circulation
Nitroglycerin
Months out fibrosis
Valve scarring that arises as a consequence of rheumatic fever

15. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Transesophageal echo
Right -->left
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

16. Which angina(s) show ST elevation on EKG? ST depression?
NG or Ca channel blocker
Prinzmetal stable and unstable
Ventricle
Bicuspid aortic valve

17. What is the rate of mitral valve prolapse in the US?
Cardiac tamponade
Backward LHF pulm htn and RHF - afib and associated mural thombis
2-3%
Left -->right

18. What are Janeway lesions?
LV dilation and eccentric hypertrophy
Months out fibrosis
Aortic regurg
Erythematous nontender lesions on palms and soles.

19. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
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
>60 years - bicuspid aortic valve
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

20. What type of ASD is associated w/Down syndrome?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ostium primum
Infectious endocarditis - arrythmias - severe mitral regurg no
Tetralogy of fallot

21. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Systemic venous congestion
Sudden cardiac death
Mitral regurg
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

22. When do CK- MB levels rise - peak - and return to normal?
45%
Acute inflammation
RCA
4-6 hours - 24 hours - 72 hours

23. How does reperfusion injury occur?
SLE
Dark discoloration coagulative necrosis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

24. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Tetralogy of fallot
Ischemic heart disease
Coronary artery vasospasm - emboli - vasculitis
Myxoma - benign

25. What is the JOneS mneumonic?
Bounding pulse
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
Tetralogy of fallot
Pump failure

26. What type of vegetations does Strep viridans cause?
Chest pain <20 min brought on by exertion or emotional stress
LAD
Small - nondestructive vegetations (subacute endocarditis)
Months out fibrosis

27. What valves are most commonly involved in chronic rheumatic heart disease?
When a bacterial protein resembles a protein in human tissue
Coxsackie A or B
LAD
Mitral mitral+aortic

28. Erythematous nontender lesions on palms and soles.
Janeway lesions
Prophylactic abx during dental procedures
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

29. What typically causes hypertrophic cardiomyopathy?
Contraction band necrosis - reperfusion injury
Cyanosis - RV hypertrophy - polycythemia - clubbing
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
AD mutation in sarcomere proteins

30. Tx for PDA?
>60 years - bicuspid aortic valve
Indomethacin - decreases PGE
Aortic regurg
Acute inflammation

31. When would arrhythmia occur after MI?
Within the first day
Reactive histiocyte with caterpillar nucleus
VSD
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

32. Turner syndrome is associated with which congenital heart defect?
Myxoid degeneration
Minimizes ischemia
Valve scarring that arises as a consequence of rheumatic fever
Infantile coarctation of the aorta

33. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Contraction band necrosis - reperfusion injury
RCA
Restrictive cardiomyopathy

34. What effect does mitral stenosis have on the heart chambers?
LA dilation
Systolic ejection click followed by crescendo - decrescendo murmur
ST- segment depression
Myocarditis

35. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Increased blood in right heart delays closure of P valve
Mitral regurgitation due to vegetations
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

36. What are the clinical features of RHF?
Systemic venous congestion
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Eisenmenger syndrome

37. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Sterile vegetations on surface and undersurface on mitral valve
Myocarditis
Valve replacement

38. What is an important complication of ASD?
PGE
Paradoxical emboli
Contraction band necrosis
Coexisting mitral stenosis and fusion of commisures exist

39. What is the cause of the red border around granulation tissue?
Rhadbomyoma - benign
Blood vessels coming in from normal tissue
Fibrinous pericarditis
Right side - serotonin and other secretory products detoxified in the lung

40. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Degree of pulmonary artery stenosis
S aureus
Reperfusion injury
Cardiac tamponade

41. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
2-3%
Maternal diabetes
Reperfusion injury

42. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
2-4 hours - 24 hours - 7-10 days
Holosystolic machine like murmur
Stable and unstable prinzmetal
LA dilation

43. How does asprin/heparin tx MI?
Prinzmetal
Turner syndrome
IV drug users
Limits thrombosis

44. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
R-->L
Subendocardial

45. What does nonbacterial thrombotic endocarditis cause?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Mitral regurg
Valve replacement once LV dysfx develops
Endocardial fibroelastosis

46. What type of shunt does a VSD cause?
Posterior wall of LV - posterior septum - papillary muscles
Sterile vegetations on surface and undersurface on mitral valve
1-3 days
L->R

47. What is the most common type of endocarditis?
LV dilation and eccentric hypertrophy
Large vegetations of S aureus
Infectious
1%

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

49. What is the most common congenital heart defect?
Troponin I
Decreases LV dilation by decreasing volume
VSD
Loss of fx

50. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Ehlers - Danlow and Marfan syndrome
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
MI
Atria and RV