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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 congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Heart transplant
Restrictive cardiomyopathy
Chest pain <20 min brought on by exertion or emotional stress

2. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
2-4 hours - 24 hours - 7-10 days
Type I
Adult coarctation of the aorta

3. What causes mitral valve prolapse?
Bacterial endocarditis
Harmartoma
Slow HR - decreasing O2 demand and risk for arrhythmia
Myxoid degeneration

4. What is systolic dysfx?
ASD - R-->L
Ventricles cannot pump
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Red border granulation tissue

5. What type of tumor is a rhabdomyoma?
Harmartoma
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Valve replacement AFTER the onset of complications
Troponin I

6. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Cardiac tamponade
Holosystolic blowing murmur
Red border granulation tissue
Anitschow cell

7. What does rupture of the LV free wall cause?
Myofiber hypertrophy with disarray
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Cardiac tamponade
Harmartoma

8. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Rupture of free wall - IV septum - or papillary muscle
4-7 days
Stable angina
CK- MB

9. What causes a mid - systolic click followed by a regurgitation murmur?
Type I
Cardiogenic shock - CHF - arrhythmia
Mitral valve prolapse
PDA

10. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
1-3 days out
R-->L
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Reperfusion injury

11. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Turner syndrome
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
Ventricles cannot pump

12. In which chamber of the heart are cardiac myxomas found?
Large - destructive vegetations
LA
Streptococcus bovis/
4-24 hours

13. EKG for stable angina?
R-->L
Libman - Sacks endocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
ST- segment depression

14. What causes endocarditis of prosthetic valves?
Chronic rheumatic heart disease
S epidermidis
Kawasaki disease
Ostium secundum (90%)

15. When do neutrophils infiltrate the myocardium post MI?
1-3 days
R-->L
Group A beta - hemolytic streptococci
Sterile vegetations on surface and undersurface on mitral valve

16. What is migratory polyarthritis?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
ST- segment depression

17. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Loeffler syndrome
Ventricles cannot pump
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nonbacterial thrombotic endocarditis (marantic endocarditis)

18. What is the effect of mitral regurg on the heart?
Reversible
Nitroglycerin
Intercostal arteries enlarged due to collateral circulation
Volume overload and LHF

19. In which chamber of the heart are rhabdomyomas found?
1-3 days
Pump failure
Ventricle
RCA

20. What areas of the heart does the RCA supply?
Eisenmenger syndrome
Posterior wall of LV - posterior septum - papillary muscles
Ehlers - Danlow and Marfan syndrome
4-7 days

21. What is a water - hammer pulse?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Myocarditis
Bounding pulse
Large - destructive vegetations

22. What gross and microscopic changes occur months after an MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
White scar fibrosis
Dilated
Ventricles cannot pump

23. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
4-24 hours
Aortic regurg
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Prinzmetal angina

24. What type of vegetations form in nonbacterial thrombotic endocarditis?
Coronary artery vasospasm
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Sterile vegetations on mitral valve along lines of closure
Infantile coarctation of the aorta

25. What does chronic ischemic heart disease progress to?
CHF
Right -->left
Split S2 on auscultation
Migratory polyarthritis

26. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Squatting - expiration
Valve replacement once LV dysfx develops
Type I

27. What is the most common type of endocarditis?
Contraction band necrosis - reperfusion injury
Months out fibrosis
Infectious
Coronary artery vasospasm - emboli - vasculitis

28. At what point in development do congenital heart defects arise?
Indomethacin - decreases PGE
Valve scarring that arises as a consequence of rheumatic fever
Aortic regurg
3-8 wks

29. What causes heart failure cells?
Heart can't fill
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
2-3%
Hypertrophic cardiomyopathy

30. How does O2 tx MI?
Reperfusion injury
Mitral mitral+aortic
Minimizes ischemia
L->R

31. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
LAD
Endocardial fibroelastosis
Pulsating nail bed

32. What is the most common cause of mitral stenosis?
Eisenmenger syndrome
Reversible
Chronic rheumatic heart disease
Stable angina

33. When does the heart have a yellow pallor post MI?
Large - destructive vegetations
Day 1-7
Rhadbomyoma - benign
Friction rub and chest pain

34. What is the tx for aortic stenosis?
Asymptomatic
Valve replacement AFTER the onset of complications
Fetal alcohol syndrome
SLE

35. What is typically the mechanims of sudden cardiac death?
Months out fibrosis
Stable angina
Inability to maintain systemic pressure w/lack of O2 to vital organs
Ventricular arrhythmia

36. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
RHF
Louder - increased systemic resistence decreases LV emptying
Systolic dysfx leading to biventricular CHF

37. What type of shunt does transposition of the great vessels cause?
R-->L
RCA
Mitral stenosis
RBC damaged while crossing the calcified valve causing schistocytes

38. With what congenital heart defect is ADULT coarctation of the aorta associated?
Spontaneous
Bicuspid aortic valve
Positive blood cultures anemia of chronic disease
Inability to fill ventricles

39. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Reactive histiocyte with caterpillar nucleus
Aortic regurg
PDA
Spontaneous

40. What are the sx of hypertrophic cardiomyopathy?
Rhabdomyoma
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
S viridans

41. What are the clinical features of endocarditis? What causes each feature?
Prinzmetal angina
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Pancarditis
Right -->left

42. What are the HACEK organisms? With what condition are they associated?
Cardiogenic shock - CHF - arrhythmia
Pancarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Decreases LV dilation by decreasing volume

43. Infects predamaged valves after transient bacteremia?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
S viridans
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

44. What complication occurs 1-3 days post MI?
Sterile vegetations on mitral valve along lines of closure
Fibrinous pericarditis
RCA
Dilated

45. What causes acute endocarditis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Prinzmetal
Day 1-7
Large vegetations of S aureus

46. What effect does mitral stenosis have on the heart chambers?
Prinzmetal
Group A beta - hemolytic streptococci
LA dilation
LV dilation and eccentric hypertrophy

47. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Mid - systolic click followed by regurgitation murmur
Loeffler syndrome
Red border granulation tissue
Janeway lesions

48. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Infectious
Hypertrophic cardiomyopathy
Months out fibrosis
4-7 days macrophage infiltration

49. With what disease is Libman - Sacks endocarditis associated?
Rhabdomyoma
SLE
Congestive heart failure
1-3 days out

50. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Elevated ASO anti - DNase B titers
Squatting - increased systemic resistence decreases LV emptying
VSD