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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 is the most common cause of endocarditis in IV drug users?
S aureus
RCA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

2. What are other (not atherosclerotic) causes of MI?
Boot shaped heart
Coronary artery vasospasm - emboli - vasculitis
Hypertrophic cardiomyopathy
R-->L

3. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Months out fibrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
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

4. What are the sx of aortic regurg?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
4-6 hours - 24 hours - 72 hours
Coexisting mitral stenosis and fusion of commisures exist
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

5. What coronary arterysupplies the lateral wall of the LV?
Increased blood in right heart delays closure of P valve
Prophylactic abx during dental procedures
Circumflex
Reactive histiocyte with caterpillar nucleus

6. With what condition are rhabdomyomas associated?
Tuberous sclerosis
3-8 wks
Nitroglycerin
Mitral stenosis

7. At what point in development do congenital heart defects arise?
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
SLE
Libman - Sacks endocarditis
3-8 wks

8. What causes mitral valve prolapse?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Bounding pulse
Myxoid degeneration
Coexisting mitral stenosis and fusion of commisures exist

9. What does rupture of the LV free wall cause?
Valve replacement once LV dysfx develops
Coronary artery vasospasm
Cardiac tamponade
Large vegetations of S aureus

10. What causes an early - blowing diastolic murmur?
Left -->right
Myocarditis
Decreases LV dilation by decreasing volume
Aortic regurg

11. What effect does chronic rheumatic heart disease have on the aortic valve?

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12. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
R-->L
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

13. What genetic conditions predispose a pt to mitral valve prolapse?
Anterior wall of LV and anterior septum
Ehlers - Danlow and Marfan syndrome
Day 1-7
RCA

14. Is injury due angina reversible or irreversible?
Reversible
Cardiac tamponade
CHF
Cardiogenic shock - CHF - arrhythmia

15. What type of collagen is involved in fibrosis?
Type I
S viridans
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Infectious endocarditis

16. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
45%
Decrease in blood flow to an organ
Turner syndrome
Aschoff bodies

17. Which angina is relieved by Ca channel blockers?
Prinzmetal
Large vegetations of S aureus
Increased hydrostatic pressure
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

18. When does the heart have dark discoloration post MI?
Intercostal arteries enlarged due to collateral circulation
RBC damaged while crossing the calcified valve causing schistocytes
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
4-24 hours

19. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
1-3 days
Erythematous nontender lesions on palms and soles.
Boot shaped heart

20. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
20 min
PDA
Intercostal arteries enlarged due to collateral circulation

21. With what disease is transposition of the great vessels associated?
Maternal diabetes
Pts w/previously damaged valves
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Squatting - increased systemic resistence decreases LV emptying

22. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Blood vessels coming in from normal tissue
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Preductal - post aortic arch

23. When would arrhythmia occur after MI?
Myofiber hypertrophy with disarray
Prinzmetal
Tender lesions on fingers or toes.
Within the first day

24. What causes microangiopathic hemolytic anemia in aortic stenosis?
Sterile vegetations on surface and undersurface on mitral valve
RBC damaged while crossing the calcified valve causing schistocytes
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

25. What causes a mid - systolic click followed by a regurgitation murmur?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Increased blood in right heart delays closure of P valve
Mitral valve prolapse
Decrease preload -->lowers myocardial stress

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

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27. What is the characteristic murmur of aortic stenosis?
CK- MB
45%
Systolic ejection click followed by crescendo - decrescendo murmur
Increased hydrostatic pressure

28. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Prinzmetal angina
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Months out fibrosis
Rhadbomyoma - benign

29. Opening snap followed by diastolic rumble.
Boot shaped heart
PDA
Mitral stenosis
AD mutation in sarcomere proteins

30. What gross and microscopic changes occur 1-3 weeks after an MI?
Congenital rubella
Red border granulation tissue
Fibrinous pericarditis
Chest pain <20 min brought on by exertion or emotional stress

31. What is the murmur of mitral regurg?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Holosystolic blowing murmur
Anitschow cell
Gelatinous - abundant ground substance

32. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Dense layer of elastic and fibrotic tissue in the endocardium - children
Pericarditits
RHF

33. In transposition of the great vessels - What is required for survival? How is this achieved?
Intercostal arteries enlarged due to collateral circulation
Shunt - PGE to maintain PDA until surgical repair can be performed
Nonspecific - eg fever and elevated ESR
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

34. What effect does transposition of the great vessels have on the ventricles?
R-->L
Hypertophy of RV atrophy of LV
Hemosiderin laden macrophages
Stable angina

35. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Pericardial effusion due to pericardial involvement
Endocardial fibroelastosis (rare)
PDA

36. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Reperfusion injury
Bounding pulse
Valve replacement AFTER the onset of complications

37. What is an important complication of ASD?
Paradoxical emboli
Decreased forward perfusion pulmonary congestion
Streptococcus bovis/
Fibrosis and dystrophic calcification

38. How does asprin/heparin tx MI?
Small - nondestructive vegetations (subacute endocarditis)
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Limits thrombosis

39. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Coexisting mitral stenosis and fusion of commisures exist
Reactive histiocyte with caterpillar nucleus
Anitschow cell
Osler nodes (ouch - ouch Osler)

40. Vegetations on surface and undersurface of mitral valve.
Doxorubicin - cocaine
Coxsackie A or B
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Libman - Sacks endocarditis

41. What is the most common cause of RHF? What are others?
Loeffler syndrome
Tetralogy of fallot
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

42. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Sudden cardiac death
Hemosiderin laden macrophages
Subendocardial

43. What are the sx of PDA at birth?
RCA
Asymptomatic
Troponin I
Atherosclerosis of coronary arteries

44. What is the most common cause of infectious endocarditis?
Ostium primum
Streptococcus viridans
Tuberous sclerosis
Myocardium

45. What increases the volume of mitral regurg murmur?
Squatting - expiration
S aureus
Tuberous sclerosis
PDA

46. With what developmental disorder is VSD associated?
Open blocked vessels
Restrictive cardiomyopathy
Plump fibroblasts - collagen - blood vessels
Fetal alcohol syndrome

47. What is the major cause of MI?
Fibrosis and dystrophic calcification
RHF
Myocarditis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

48. What is the main cause of MV regurg? What are other causes?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Contraction band necrosis - reperfusion injury
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mitral regurg

49. 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.
L->R
Stable angina
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
Small - nondestructive vegetations (subacute endocarditis)

50. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Day 1-7
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Type I