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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. How does transmural MI/ischemia present on EKG?
Holosystolic machine like murmur
ST- segment elevation
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Large vegetations of S aureus

2. What valves are most commonly involved in chronic rheumatic heart disease?
Large - destructive vegetations
Mitral mitral+aortic
Left -->right
Transesophageal echo

3. What are heart failure cells?
Hemosiderin laden macrophages
Sudden cardiac death
Dense layer of elastic and fibrotic tissue in the endocardium - children
Atria and RV

4. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Chronic rheumatic heart disease
Coxsackie A or B
Aschoff bodies
LA dilation

5. What is the most common tumor of the heart?
1-3 days out
Spontaneous
Restrictive cardiomyopathy
Metastasis

6. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Months out fibrosis
Rupture of free wall - IV septum - or papillary muscle

7. Tender lesions on fingers or toes.
Aneurysm - mural thrombus - Dressler syndrome
Pericardial effusion due to pericardial involvement
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Osler nodes (ouch - ouch Osler)

8. What compensatory mechanism do tetralogy of fallot pts learn?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Concentric LV hypertophy
Squat in response to cyanotic spell

9. How does adult coarctation of the aorta present?
Sudden cardiac death
Increased blood in right heart delays closure of P valve
Shunt
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

10. What is the most common cause of dilated cardiomyopathy? What are other causes?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Pulsating nail bed
Decreased forward perfusion pulmonary congestion

11. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Infectious endocarditis - arrythmias - severe mitral regurg no
LHF
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Aortic regurg

12. With what congenital heart defect is ADULT coarctation of the aorta associated?
Cardiac tamponade
Red border granulation tissue
3-8 wks
Bicuspid aortic valve

13. Erythematous nontender lesions on palms and soles.
Valve replacement once LV dysfx develops
Janeway lesions
Shunt - PGE to maintain PDA until surgical repair can be performed
Aortic regurg

14. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Rhadbomyoma - benign
Atherosclerosis of coronary arteries
Infectious

15. Pericarditis 6-8 wks post MI.
Dressler syndrome
Mitral insufficiency
Pulsating nail bed
Endocardial fibroelastosis

16. What type of shunt dose PDA cause?
Left -->right
Membrane damage
Endocardial fibroelastosis
ASD - R-->L

17. What typically causes hypertrophic cardiomyopathy?
Infantile coarctation of the aorta PDA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
AD mutation in sarcomere proteins
4-7 days macrophage infiltration

18. What is the rate of congenital heart defects?
1%
Sterile vegetations on surface and undersurface on mitral valve
4-24 hours
LA

19. What effect does transposition of the great vessels have on the ventricles?
Right -->left
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
ST- segment depression
Hypertophy of RV atrophy of LV

20. How does O2 tx MI?
Rupture of free wall - IV septum - or papillary muscle
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Sterile vegetations on surface and undersurface on mitral valve
Minimizes ischemia

21. What are the complications that occur months after an MI?
Increased hydrostatic pressure
Chronic rheumatic heart disease
Aneurysm - mural thrombus - Dressler syndrome
Mitral regurgitation due to vegetations

22. What type of vegetations does Strep viridans cause?
Increased blood in right heart delays closure of P valve
Valve replacement
Small - nondestructive vegetations (subacute endocarditis)
Asymptomatic

23. What are the clinical features of RHF due to?
Valve replacement AFTER the onset of complications
Myocardium
Pts w/previously damaged valves
Systemic venous congestion

24. What is the most common type of ASD? What %?
Libman - Sacks endocarditis
Tricuspid
Louder - increased systemic resistence decreases LV emptying
Ostium secundum (90%)

25. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Endocardial fibroelastosis
Positive blood cultures anemia of chronic disease
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Contraction band necrosis

26. What are the causes of restrictive cardiomyopathy in adults?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Prinzmetal angina - cocaine
Aneurysm - mural thrombus - Dressler syndrome

27. What valves are involved in rhuematic endocarditis?
Osler nodes (ouch - ouch Osler)
Mitral mitral+aortic
Myocardium
Split S2 on auscultation

28. What type of ischemia does stable angina cause?
Subendocardial
Chronic rheumatic heart disease
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
Positive blood cultures anemia of chronic disease

29. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Circumflex
Fibrinous pericarditis
Systolic dysfx leading to biventricular CHF

30. What coronary arterysupplies the lateral wall of the LV?
>60 years - bicuspid aortic valve
Chronic ischemic heart disease
Circumflex
45%

31. What does a biopsy of hypertrophic cardiomyopathy look like?
Gelatinous - abundant ground substance
Reperfusion injury
Valve scarring that arises as a consequence of rheumatic fever
Myofiber hypertrophy with disarray

32. What is the tx for VSD?
RHF
Surgical closure small defects may close spontaneously
Holosystolic blowing murmur
Fetal alcohol syndrome

33. What murmur ccan be heard in PDA?
Wear and tear
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Holosystolic machine like murmur
Breast and lung carcinoma - melanoma - lymphoma

34. What is the effect of mitral regurg on the heart?
RHF
Left -->right
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Volume overload and LHF

35. Systolic ejection click followed by crescendo - decrescendo murmur.
Autoimmune pericarditis 6-8 wks post MI
Yellow pallor neutrophils
Aortic stenosis
Osler nodes (ouch - ouch Osler)

36. What causes the nutmeg color in nutmeg liver?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Heart transplant
Loeffler syndrome
Congested central veins

37. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Rupture of free wall - IV septum - or papillary muscle
PDA
Pancarditis

38. What effect does mitral stenosis have on the heart chambers?
Reperfusion injury
LAD
LA dilation
PGE

39. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Coexisting mitral stenosis and fusion of commisures exist
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
Myofiber hypertrophy with disarray

40. What effect does chronic rheumatic heart disease have the mitral valve?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Thickening of chrodae tendinae and cusps - mitral stenosis
Cardiogenic shock - CHF - arrhythmia
Stable angina

41. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Heart transplant
Shunt - PGE to maintain PDA until surgical repair can be performed
Endocarditis of prosthetic valves

42. What are the sx of PDA at birth?
Asymptomatic
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Wear and tear

43. What effect does aortic regurg have on the pulse pressure? Why?
Mitral regurg
Papillary muscle - free wall - IV septum
Streptococcus viridans
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

44. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Maternal diabetes
Blood vessels coming in from normal tissue
Myofiber hypertrophy with disarray

45. Which congenital heart defect is associated with congenital rubella?
PDA
NG or Ca channel blocker
Left -->right
Myocardium

46. How does MI cause LHF?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Loss of LV fx
Streptococcus viridans
Open blocked vessels

47. How do you prevent S viridans endocarditis?
Mitral valve prolapse
Transesophageal echo
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Prophylactic abx during dental procedures

48. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Restrictive cardiomyopathy
4-7 days
MI

49. How does aortic regurg affect the heart chambers?
2-3%
AD mutation in sarcomere proteins
Rhadbomyoma - benign
LV dilation and eccentric hypertrophy

50. What is the most comon cause of aortic regurg? What are the other causes?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Prinzmetal angina
4-7 days
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)