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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. Holosystolic blowing murmur that increases w/expiration?
Mitral valve prolapse
Mitral regurg
Fetal alcohol syndrome
>60 years - bicuspid aortic valve

2. What causes endocarditis of prosthetic valves?
S epidermidis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Migratory polyarthritis

3. When would arrhythmia occur after MI?
LA
Nonspecific - eg fever and elevated ESR
Within the first day
Janeway lesions

4. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Libman - Sacks endocarditis
Months out fibrosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

5. What causes mitral valve prolapse?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Maternal diabetes
Myxoid degeneration
VSD

6. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Cardiac tamponade
Streptococcus viridans
Louder - increased systemic resistence decreases LV emptying
Acute inflammation

7. What causes microangiopathic hemolytic anemia in aortic stenosis?
Bacterial endocarditis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reactive histiocyte with caterpillar nucleus
RBC damaged while crossing the calcified valve causing schistocytes

8. What are other (not atherosclerotic) causes of MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Metastasis
Coronary artery vasospasm - emboli - vasculitis
Streptococcus viridans

9. What congenital heart defect is associated with fetal alcohol syndrome?
Prinzmetal angina
Yellow pallor macrophages
VSD
ACE inhibitor

10. What is the etiology of S viridans endocarditis?
Limits thrombosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Split S2 on auscultation
Positive blood cultures anemia of chronic disease

11. What complications occur 4-7 days post MI?
RBC damaged while crossing the calcified valve causing schistocytes
Within the first day
Cardiac tamponade
Rupture of free wall - IV septum - or papillary muscle

12. What gross and microscopic changes occur 1-3 days after an MI?
Concentric LV hypertophy
Large vegetations of S aureus
Opening snap followed by diastolic rumble
Yellow pallor neutrophils

13. What makes the MV prolapse murmur louder? Why?
Regurg vs stenosis
Squatting - increased systemic resistence decreases LV emptying
Small - nondestructive vegetations (subacute endocarditis)
Red border granulation tissue

14. What drug relieves stable angina?
Dressler syndrome
Nitroglycerin
Tricuspid
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

15. What is the murmur of mitral regurg?
Congestive heart failure
Indomethacin - decreases PGE
Nitroglycerin
Holosystolic blowing murmur

16. What is the characteristic finding on CXR in tetralogy of fallot?
Mitral stenosis
VSD
Hypertrophic cardiomyopathy
Boot shaped heart

17. What does rupture of the LV free wall cause?
Coronary artery vasospasm
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
2-4 hours - 24 hours - 7-10 days
Cardiac tamponade

18. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Shunt
Adult coarctation of the aorta
Doxorubicin - cocaine

19. What type of valvular vegetations does S aureus cause?
Regurg vs stenosis
Large - destructive vegetations
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Eisenmenger syndrome

20. What type of tumor is a rhabdomyoma?
CHF
Troponin I
Autoimmune pericarditis 6-8 wks post MI
Harmartoma

21. What is the tx for VSD?
Tetralogy of fallot
Valve scarring that arises as a consequence of rheumatic fever
Nitroglycerin
Surgical closure small defects may close spontaneously

22. What does chronic ischemic heart disease progress to?
Heart transplant
CHF
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

23. Dense layer of elastic and fibrotic tissue in the endocardium.
LA dilation
Tetralogy of fallot
Cardiogenic shock - CHF - arrhythmia
Endocardial fibroelastosis

24. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
S viridans
Reperfusion injury
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

25. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
SLE
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Trisomy 21

26. What causes a mid - systolic click followed by a regurgitation murmur?
Nitroglycerin
Valve replacement
Mitral valve prolapse
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

27. What is the definition of ischemia?
Inability to fill ventricles
Decrease in blood flow to an organ
Acute inflammation
Myocarditis in acute rheumatic heart fever

28. What effect does transposition of the great vessels have on the ventricles?
Squatting - increased systemic resistence decreases LV emptying
Backward LHF pulm htn and RHF - afib and associated mural thombis
Hypertophy of RV atrophy of LV
Membrane damage

29. What does Libman - Sacks endocarditis cause?
Mitral regurg
Hypertophy of RV atrophy of LV
Inability to fill ventricles
Hemosiderin laden macrophages

30. What are heart failure cells?
Hemosiderin laden macrophages
Breast and lung carcinoma - melanoma - lymphoma
Valve replacement
>60 years - bicuspid aortic valve

31. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Anitschow cell
Months out fibrosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Coxsackie A or B

32. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
PDA
Aortic regurg
SLE
Preductal - post aortic arch

33. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
Right to left
Rhabdomyoma
Circumflex

34. Are most congenital heart defects spontaneous or inherited?
Spontaneous
Myocarditis
4-7 days macrophage infiltration
Pts w/previously damaged valves

35. How does MI cause LHF?
Loss of LV fx
Prinzmetal angina - cocaine
Fibrosis and dystrophic calcification
Plump fibroblasts - collagen - blood vessels

36. What % of MIs involve the LAD?
Mitral regurg
Congested central veins
Months out fibrosis
45%

37. What are the minor critera of the Jones criteria?
Aortic regurg
Nonspecific - eg fever and elevated ESR
Myocarditis
Aschoff bodies

38. What is the characteristic murmurr of mitral stenosis?
Mitral and tricuspid regurg - arrhythmia
Opening snap followed by diastolic rumble
Preductal - post aortic arch
Contraction band necrosis

39. In which chamber of the heart are cardiac myxomas found?
Squatting - expiration
Mitral and tricuspid regurg - arrhythmia
LA
1-3 days out

40. What gross and microscopic changes occur 4-7 days after an MI?
S aureus
4-7 days macrophage infiltration
Yellow pallor macrophages
R-->L

41. What are the major criteria of the Jones criteria?
RCA
Months out fibrosis
LAD
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

42. What are the causes of LHF?
PDA
Right to left
2-4 hours - 24 hours - 7-10 days
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

43. When do neutrophils infiltrate the myocardium post MI?
Friction rub and chest pain
Infantile coarctation of the aorta
1-3 days
Contraction band necrosis - reperfusion injury

44. At what point in development do congenital heart defects arise?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
3-8 wks
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
4-7 days

45. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Bounding pulse
MI
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Hypertrophic cardiomyopathy

46. With what disease is infantile coarctation of the aorta associated?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Turner syndrome
Prinzmetal stable and unstable
Atria and RV

47. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Pericardial effusion due to pericardial involvement
Infectious
Anitschow cell
Decreased forward perfusion pulmonary congestion

48. What is the rate of mitral valve prolapse in the US?
Troponin I
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decrease preload -->lowers myocardial stress
2-3%

49. What are the laboratory findings of bacterial endocarditis?
Transesophageal echo
Anterior wall of LV and anterior septum
Positive blood cultures anemia of chronic disease
IV drug users

50. What are the four defects in tetralogy of fallot?
Nitroglycerin
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral regurg
Nonspecific - eg fever and elevated ESR