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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 always follows necrosis?
Large vegetations of S aureus
Prinzmetal
Acute inflammation
Mitral regurg

2. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
1%
Doxorubicin - cocaine
Myocarditis

3. What two things cause coronary artery vasospasm?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Infantile coarctation of the aorta
S aureus
Prinzmetal angina - cocaine

4. What is molecular mimicry?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
When a bacterial protein resembles a protein in human tissue
Anterior wall of LV and anterior septum
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

5. At what point in development do congenital heart defects arise?
3-8 wks
Pump failure
Membrane damage
PDA

6. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Shunt
RHF
SLE
Janeway lesions

7. When is an MI patent at highest risk for fibrionous pericarditis?
Large - destructive vegetations
1-3 days out
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Day 1-7

8. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Valve scarring that arises as a consequence of rheumatic fever
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
VSD

9. How does contraction band necrosis occur?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ischemic heart disease
PDA

10. How does aortic regurg affect the heart chambers?
MI
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
LV dilation and eccentric hypertrophy
Low voltage EKG w/diminished QRS amplitude

11. What type of ischemia does stable angina cause?
Right -->left
First 4 hours
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Subendocardial

12. What are the complications of aortic stenosis?
Subendocardial
Infectious
Pericarditits
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

13. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Breast and lung carcinoma - melanoma - lymphoma
Stable and unstable prinzmetal
Prinzmetal angina
Mitral regurg

14. What makes the MV prolapse murmur louder? Why?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Troponin I
Infectious endocarditis
Squatting - increased systemic resistence decreases LV emptying

15. In which chamber of the heart are rhabdomyomas found?
Ventricle
Valve replacement
Pericardial effusion due to pericardial involvement
Decrease preload -->lowers myocardial stress

16. Myofiber hypertrophy with disarray.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Congenital rubella
Pancarditis
Hypertrophic cardiomyopathy

17. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Plump fibroblasts - collagen - blood vessels
Cyanosis - RV hypertrophy - polycythemia - clubbing
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

18. What are the four defects in tetralogy of fallot?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Months out fibrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Loss of fx

19. What is eythema marginatum? What parts of the body does it commonly involve?
Reactive histiocyte with caterpillar nucleus
Annular - non pruritic rash w/erythematous borders trunks and limbs
S aureus
Metastasis

20. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Rupture of free wall - IV septum - or papillary muscle
Atherosclerosis of coronary arteries

21. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Annular - non pruritic rash w/erythematous borders trunks and limbs
Infectious
Heart can't fill

22. What is endocardial fibroelastosis? In what population is it found?
Colon cancer
Dense layer of elastic and fibrotic tissue in the endocardium - children
RCA
Rhadbomyoma - benign

23. What is the JOneS mneumonic?
Hypertrophic cardiomyopathy
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
Chest pain <20 min brought on by exertion or emotional stress
Pancarditis

24. What is the most common cause of infectious endocarditis?
Intercostal arteries enlarged due to collateral circulation
Ventricle
Streptococcus viridans
Chronic rheumatic heart disease

25. How does MI cause LHF?
Loss of LV fx
Indomethacin - decreases PGE
Positive blood cultures anemia of chronic disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

26. What is the most common cause of RHF? What are others?
Breast and lung carcinoma - melanoma - lymphoma
Myocarditis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
PDA

27. What is systolic dysfx?
>60 years - bicuspid aortic valve
Type I
Mitral regurg
Ventricles cannot pump

28. How long after pharyngitis does acute rheumatic fever occur?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Dense layer of elastic and fibrotic tissue in the endocardium - children
2-3 weeks
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

29. What type of endocarditis is associated with SLE?
Large - destructive vegetations
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
RBC damaged while crossing the calcified valve causing schistocytes
Libman - Sacks endocarditis

30. What genetic conditions predispose a pt to mitral valve prolapse?
Rhabdomyoma
Ehlers - Danlow and Marfan syndrome
S epidermidis
Mitral mitral+aortic

31. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Aschoff bodies
Aortic stenosis
Within the first day

32. What increases the risk for chronic rheumatic heart disease?
Myocarditis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Blood vessels coming in from normal tissue
2-4 hours - 24 hours - 7-10 days

33. What causes the nutmeg color in nutmeg liver?
RCA
Coxsackie A or B
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Congested central veins

34. What causes a mid - systolic click followed by a regurgitation murmur?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Squatting - increased systemic resistence decreases LV emptying
Within the first day
Mitral valve prolapse

35. What is the cause of restrictive cardiomyopathy in children?
Myocarditis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
LAD
Endocardial fibroelastosis (rare)

36. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Congested central veins
Systolic ejection click followed by crescendo - decrescendo murmur
Boot shaped heart

37. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Low voltage EKG w/diminished QRS amplitude
MI
Ventricle

38. What is the basic principle of CHF?
Pump failure
Myxoid degeneration
PDA
PDA

39. Which angina(s) show ST elevation on EKG? ST depression?
CHF
Prinzmetal stable and unstable
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
LAD

40. What are the sx of cardiac myxoma?
Decreases LV dilation by decreasing volume
PDA
Hypertrophic cardiomyopathy
Pedunculated mass in the LA that causes syncope due to obstruction of MV

41. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Squat in response to cyanotic spell
Prophylactic abx during dental procedures
4-7 days

42. What increases the volume of mitral regurg murmur?
Asymptomatic
Plump fibroblasts - collagen - blood vessels
Squatting - expiration
Surgical closure small defects may close spontaneously

43. Erythematous nontender lesions on palms and soles.
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Janeway lesions
Blood vessels coming in from normal tissue
1%

44. What type of vegetations does Strep viridans cause?
Subendocardial
Nitroglycerin
3-8 wks
Small - nondestructive vegetations (subacute endocarditis)

45. Why are cardiac enzymes elevated after an MI?
Stable angina
S viridans
Membrane damage
Right to left

46. What causes notching of the ribs in adult coarctation of the aorta?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Migratory polyarthritis
Months out fibrosis
Intercostal arteries enlarged due to collateral circulation

47. What are the complications of mitral stenosis?
2-3 weeks
Yellow pallor macrophages
Right -->left
Backward LHF pulm htn and RHF - afib and associated mural thombis

48. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
2-4 hours - 24 hours - 7-10 days
Atherosclerosis of coronary arteries
ASD - R-->L
S aureus

49. What causes the split S2 in ASD?
Infantile coarctation of the aorta
Small vegetations along the line of closure
S viridans
Increased blood in right heart delays closure of P valve

50. When do CK- MB levels rise - peak - and return to normal?
Minimizes ischemia
Bacterial endocarditis
4-6 hours - 24 hours - 72 hours
Myocarditis in acute rheumatic heart fever