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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 effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Day 1-7
Myxoid degeneration
Pulsating nail bed

2. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Anitschow cell

3. What compensatory mechanism do tetralogy of fallot pts learn?
Atherosclerosis of coronary arteries
Squat in response to cyanotic spell
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Intercostal arteries enlarged due to collateral circulation

4. How does restrictive cardiomyopathy cause LHF?

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5. What is the most comon cause of aortic regurg? What are the other causes?
1%
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Myocarditis
LAD

6. What causes an early - blowing diastolic murmur?
ST- segment depression
MI
Systolic ejection click followed by crescendo - decrescendo murmur
Aortic regurg

7. What determines the extent of shunting and cyanosis in tetralogy of fallot?
ACE inhibitor
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Degree of pulmonary artery stenosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

8. What artery is the 2nd most often occluded in an MI?
RCA
Prinzmetal angina
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Valve replacement

9. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
NG or Ca channel blocker
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
MI

10. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Pulsating nail bed
Intercostal arteries enlarged due to collateral circulation
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

11. Why would cardiac enzymes continue to increase after the initial MI?
2-3%
Acute inflammation
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Reperfusion injury

12. With what condition are rhabdomyomas associated?
Posterior wall of LV - posterior septum - papillary muscles
Migratory polyarthritis
Mitral and tricuspid regurg - arrhythmia
Tuberous sclerosis

13. What are the sx of pericardiits?
Large - destructive vegetations
Bacterial endocarditis
Slow HR - decreasing O2 demand and risk for arrhythmia
Friction rub and chest pain

14. What causes notching of the ribs in adult coarctation of the aorta?
Coxsackie A or B
Intercostal arteries enlarged due to collateral circulation
Left -->right
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

15. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Indomethacin - decreases PGE
Pts w/previously damaged valves
Volume overload and LHF

16. Large vegetations on tricuspid valve?
S aureus
Nonbacterial thrombotic endocarditis (marantic endocarditis)
2-3 weeks
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

17. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Low voltage EKG w/diminished QRS amplitude
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Yellow pallor neutrophils

18. EKG for stable angina?
ST- segment depression
Restrictive cardiomyopathy
Pulsating nail bed
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

19. What effect does mitral stenosis have on the heart chambers?
Prinzmetal
LA dilation
Doxorubicin - cocaine
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

20. What is eythema marginatum? What parts of the body does it commonly involve?
Myocarditis in acute rheumatic heart fever
2-3 weeks
Annular - non pruritic rash w/erythematous borders trunks and limbs
Heart transplant

21. What is endocardial fibroelastosis? In what population is it found?
Pump failure
Tricuspid
Dense layer of elastic and fibrotic tissue in the endocardium - children
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

22. What is the most common form of cardiomyopathy?
Heart transplant
Dilated
Myocarditis in acute rheumatic heart fever
Minimizes ischemia

23. What vavular defect results from acute rheumatic fever?
Tetralogy of fallot
Mitral regurgitation due to vegetations
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

24. What type of vegetations does Strep viridans cause?
Valve replacement once LV dysfx develops
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Small - nondestructive vegetations (subacute endocarditis)
Anitschow cell

25. When do CK- MB levels rise - peak - and return to normal?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Ostium primum
White scar fibrosis
4-6 hours - 24 hours - 72 hours

26. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Hypertrophic cardiomyopathy
Low voltage EKG w/diminished QRS amplitude
VSD

27. Erythematous nontender lesions on palms and soles.
Janeway lesions
Paradoxical emboli
Trisomy 21
Split S2 on auscultation

28. What are other (not atherosclerotic) causes of MI?
1%
Coronary artery vasospasm - emboli - vasculitis
Libman - Sacks endocarditis
Cardiogenic shock - CHF - arrhythmia

29. What valves are most commonly involved in chronic rheumatic heart disease?
2-3 weeks
Mitral mitral+aortic
Sudden cardiac death
1-3 days

30. What murmur ccan be heard in PDA?
Breast and lung carcinoma - melanoma - lymphoma
Day 1-7
Intercostal arteries enlarged due to collateral circulation
Holosystolic machine like murmur

31. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Pts w/previously damaged valves
Restrictive cardiomyopathy
IV drug users
RCA

32. With what congenital heart defect is ADULT coarctation of the aorta associated?
Increased blood in right heart delays closure of P valve
Bicuspid aortic valve
IV drug users
First 4 hours

33. What conditions can cause nonbacterial thrombotic endocarditis?
Spontaneous
Dilation of all four chambers of the heart
Pulsating nail bed
Hypercoagulable state or underlying adenocarcinoma

34. What causes wear and tear aortic stenosis?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Fibrosis and dystrophic calcification
MI
Regurg vs stenosis

35. In what pt population does S aureus commonly cause valvular disease?
Dressler syndrome
Indomethacin - decreases PGE
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
IV drug users

36. What is dilated cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Dilation of all four chambers of the heart
Elevated ASO anti - DNase B titers
Volume overload and LHF

37. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Systolic ejection click followed by crescendo - decrescendo murmur
ACE inhibitor
Congestive heart failure
Months out fibrosis

38. What is the foundation of a scar?
Granulation tissue
Mitral valve prolapse
Sterile vegetations on mitral valve along lines of closure
Preductal - post aortic arch

39. What type of collagen is involved in fibrosis?
Type I
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Shunt - PGE to maintain PDA until surgical repair can be performed
Infectious

40. What is the 1day-1wk -1mo mneumonic for MI?
Intercostal arteries enlarged due to collateral circulation
Decreases LV dilation by decreasing volume
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
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

41. Is injury due angina reversible or irreversible?
Reversible
Turner syndrome
Kawasaki disease
Reperfusion injury

42. What increases the risk for chronic rheumatic heart disease?
Pericardial effusion due to pericardial involvement
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Erythematous nontender lesions on palms and soles.
PGE

43. How does adult coarctation of the aorta present?
1-3 days
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Bacterial endocarditis
Reperfusion injury

44. What is the main cause of MV regurg? What are other causes?
Squatting - expiration
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Systolic dysfx leading to biventricular CHF
Doxorubicin - cocaine

45. What effect does chronic rheumatic heart disease have the mitral valve?
Squatting - increased systemic resistence decreases LV emptying
Thickening of chrodae tendinae and cusps - mitral stenosis
Infantile coarctation of the aorta
Heart transplant

46. L- to - R shunt switching to R- to - L shunt.
Thickening of chrodae tendinae and cusps - mitral stenosis
Eisenmenger syndrome
>60 years - bicuspid aortic valve
Restrictive cardiomyopathy

47. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
RBC damaged while crossing the calcified valve causing schistocytes
Limits thrombosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

48. Which angina is relieved by Ca channel blockers?
Increased hydrostatic pressure
Cardiogenic shock - CHF - arrhythmia
Congested central veins
Prinzmetal

49. With what virus is PDA associated?
Chest pain <20 min brought on by exertion or emotional stress
Mitral mitral+aortic
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Congenital rubella

50. What is the cause of the red border around granulation tissue?
Loss of LV fx
Thickening of chrodae tendinae and cusps - mitral stenosis
Group A beta - hemolytic streptococci
Blood vessels coming in from normal tissue

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