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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. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Valve replacement AFTER the onset of complications
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Ischemic heart disease

2. What is the most common tumor of the heart?
Nitroglycerin
Metastasis
Coxsackie A or B
Transposition of the great vessels

3. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Concentric LV hypertophy
Ehlers - Danlow and Marfan syndrome
4-7 days macrophage infiltration

4. What does nonbacterial thrombotic endocarditis cause?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mitral regurg
Ventricles cannot pump
Nonbacterial thrombotic endocarditis (marantic endocarditis)

5. How does contraction band necrosis occur?
Pericarditits
Posterior wall of LV - posterior septum - papillary muscles
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral regurg

6. What causes mitral valve prolapse?
Myxoid degeneration
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Right side - serotonin and other secretory products detoxified in the lung
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

7. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Harmartoma
MI
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

8. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Chronic rheumatic heart disease
PDA
Spontaneous
Nitroglycerin

9. Lower extremity cyanosis in infants? In adults?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Bacterial endocarditis
Anterior wall of LV and anterior septum
Infantile coarctation of the aorta PDA

10. With what disease is infantile coarctation of the aorta associated?
S aureus
Turner syndrome
Small - nondestructive vegetations (subacute endocarditis)
Myofiber hypertrophy with disarray

11. What are the forward and backward sx of LHF?
LA dilation
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
Breast and lung carcinoma - melanoma - lymphoma
Louder - increased systemic resistence decreases LV emptying

12. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Bacterial endocarditis
Boot shaped heart
Posterior wall of LV - posterior septum - papillary muscles

13. Which angina is relieved by Ca channel blockers?
Bicuspid aortic valve
Prinzmetal
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Yellow pallor macrophages

14. What does a biopsy of hypertrophic cardiomyopathy look like?
PDA
Myofiber hypertrophy with disarray
PGE
Rhadbomyoma - benign

15. What is the most common type of endocarditis?
PDA
Chronic rheumatic heart disease
Small - nondestructive vegetations (subacute endocarditis)
Infectious

16. What is the most common type of ASD? What %?
Aneurysm - mural thrombus - Dressler syndrome
Systolic dysfx leading to biventricular CHF
Ostium secundum (90%)
Granulation tissue

17. When does the heart have dark discoloration post MI?
ACE inhibitor
Chronic rheumatic heart disease
Prinzmetal stable and unstable
4-24 hours

18. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Concentric LV hypertophy
LAD
20 min

19. When is an MI pt at greatest risk for cardiogenic shock?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Myocarditis
Transesophageal echo
First 4 hours

20. When would arrhythmia occur after MI?
Within the first day
Contraction band necrosis
Mitral valve prolapse
Coronary artery vasospasm

21. 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
Prinzmetal angina - cocaine
Trisomy 21
LV dilation and eccentric hypertrophy

22. What is the basic principle of CHF?
Reversible
Myocardium
Pump failure
SLE

23. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Restrictive cardiomyopathy
Janeway lesions
Prinzmetal

24. What is the rate of congenital heart defects?
Bacterial endocarditis
Tricuspid
Systolic ejection click followed by crescendo - decrescendo murmur
1%

25. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Infectious endocarditis - arrythmias - severe mitral regurg no
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

26. What causes microangiopathic hemolytic anemia in aortic stenosis?
Mitral valve prolapse
Prophylactic abx during dental procedures
RBC damaged while crossing the calcified valve causing schistocytes
RCA

27. What is the tx for VSD?
Surgical closure small defects may close spontaneously
>70%
Increased hydrostatic pressure
Dark discoloration coagulative necrosis

28. When do macrophagess infiltrate the myocardium post MI?
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
Inability to maintain systemic pressure w/lack of O2 to vital organs
Left -->right
4-7 days

29. How does Eisenmeger syndrome occur?
45%
1%
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
Months out fibrosis

30. What type of shunt results in cyanosis at birth?
Rupture of free wall - IV septum - or papillary muscle
SLE
Prinzmetal angina - cocaine
Right to left

31. What are the complications of mitral stenosis?
Increased hydrostatic pressure
Right to left
4-7 days
Backward LHF pulm htn and RHF - afib and associated mural thombis

32. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Paradoxical emboli
Contraction band necrosis - reperfusion injury
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

33. What are the clinical features of endocarditis? What causes each feature?
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
Within the first day
Chest pain <20 min brought on by exertion or emotional stress
Decrease preload -->lowers myocardial stress

34. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Dark discoloration coagulative necrosis
Contraction band necrosis
LA dilation

35. What is the classic EKG finding of restrictive cardiomyopathy?
Janeway lesions
Low voltage EKG w/diminished QRS amplitude
Months out fibrosis
Myocardium

36. What gross and microscopic changes occur 4-24 hours after an MI?
Wear and tear
Dark discoloration coagulative necrosis
Right side - serotonin and other secretory products detoxified in the lung
Dilated

37. What is the most common cause of RHF? What are others?
Valve scarring that arises as a consequence of rheumatic fever
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Kawasaki disease
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

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

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39. What is the most common cause of endocarditis in IV drug users?
Streptococcus viridans
PDA
S aureus
Infectious

40. What is the main cause of MV regurg? What are other causes?
Low voltage EKG w/diminished QRS amplitude
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
RCA

41. In which pts does S viridans cause endocarditits?
R-->L
Pts w/previously damaged valves
Chest pain <20 min brought on by exertion or emotional stress
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

42. What type of collagen is involved in fibrosis?
Type I
Right to left
Preductal - post aortic arch
Holosystolic blowing murmur

43. What causes angina and syncope in aortic stenosis?

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44. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
3-8 wks
ST- segment depression
Adult coarctation of the aorta
Limits thrombosis

45. What is the effect of mitral regurg on the heart?
Aneurysm - mural thrombus - Dressler syndrome
Anterior wall of LV and anterior septum
Volume overload and LHF
Mid - systolic click followed by regurgitation murmur

46. What is the 1day-1wk -1mo mneumonic for MI?
PDA
S epidermidis
LA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

47. What is the only Jones criteria that doesn't resolve with time?
Ischemic heart disease
Pancarditis
Anitschow cell
First 4 hours

48. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Migratory polyarthritis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Chronic rheumatic heart disease

49. Which chambers of the heart are generally spared in an MI?
Months out fibrosis
Sudden cardiac death
Atria and RV
Months out fibrosis

50. What is endocardial fibroelastosis? In what population is it found?
RCA
Months out fibrosis
SLE
Dense layer of elastic and fibrotic tissue in the endocardium - children