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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 type of collagen is involved in fibrosis?
Coexisting mitral stenosis and fusion of commisures exist
Type I
RCA
Hypertophy of RV atrophy of LV

2. How do ACE inhibitors tx MI?
Infantile coarctation of the aorta PDA
Decreases LV dilation by decreasing volume
LAD
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

3. What typically causes hypertrophic cardiomyopathy?
Janeway lesions
Pulsating nail bed
Systolic ejection click followed by crescendo - decrescendo murmur
AD mutation in sarcomere proteins

4. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Transesophageal echo
LA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

5. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Within the first day
Bacterial endocarditis
Mitral and tricuspid regurg - arrhythmia
Fibrosis and dystrophic calcification

6. What are other (not atherosclerotic) causes of MI?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Large vegetations of S aureus
Reperfusion injury
Coronary artery vasospasm - emboli - vasculitis

7. What is the most common cause of dilated cardiomyopathy? What are other causes?
Inability to fill ventricles
Mitral mitral+aortic
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
SLE

8. What gross and microscopic changes occur months after an MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Blood vessels coming in from normal tissue
White scar fibrosis

9. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
Congestive heart failure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pump failure

10. What is the most common tumor of the heart?
4-24 hours
Metastasis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Prinzmetal

11. What shunt does tetralogy of fallot produce?
Mitral valve prolapse
Decrease preload -->lowers myocardial stress
Right -->left
Right side - serotonin and other secretory products detoxified in the lung

12. What are the tx for MI?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Paradoxical emboli
3-8 wks

13. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Rupture of free wall - IV septum - or papillary muscle
1%
Right -->left

14. What is the most common valve infected by S aureus?
Chronic rheumatic heart disease
Coronary artery vasospasm
RBC damaged while crossing the calcified valve causing schistocytes
Tricuspid

15. Infects predamaged valves after transient bacteremia?
Dark discoloration coagulative necrosis
S viridans
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Mid - systolic click followed by regurgitation murmur

16. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Prophylactic abx during dental procedures
ASD - R-->L
Mitral mitral+aortic

17. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Valve replacement
Rhadbomyoma - benign
NG or Ca channel blocker
Coexisting mitral stenosis and fusion of commisures exist

18. What are the sx of right - to - left shunt?
Mitral valve prolapse
Dark discoloration coagulative necrosis
Transposition of the great vessels
Cyanosis - RV hypertrophy - polycythemia - clubbing

19. What is typically the mechanims of sudden cardiac death?
Holosystolic machine like murmur
Ventricular arrhythmia
ST- segment depression
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

20. Turner syndrome is associated with which congenital heart defect?
Troponin I
Infantile coarctation of the aorta
Myocarditis
Myxoma - benign

21. Lower extremity cyanosis in infants? In adults?
4-6 hours - 24 hours - 72 hours
Infantile coarctation of the aorta PDA
Backward LHF pulm htn and RHF - afib and associated mural thombis
Holosystolic machine like murmur

22. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myocarditis
Contraction band necrosis - reperfusion injury

23. What is the most common type of endocarditis?
Infectious
Wear and tear
MI
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

24. What are the clinical features of LHF due to?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Decreased forward perfusion pulmonary congestion
Circumflex
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

25. What gross and microscopic changes occur 4-24 hours after an MI?
Tricuspid
Bacterial endocarditis
Dark discoloration coagulative necrosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

26. What is the gross and microscopic appearance of cardiac myxomas?
Squatting - increased systemic resistence decreases LV emptying
Gelatinous - abundant ground substance
Mitral valve prolapse
When a bacterial protein resembles a protein in human tissue

27. What are the two effects of ATII?
Metastasis
Ischemic heart disease
Squat in response to cyanotic spell
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

28. With what condition are rhabdomyomas associated?
Fibrosis and dystrophic calcification
Tetralogy of fallot
Stable angina
Tuberous sclerosis

29. Low voltage EKG w/diminished QRS amplitude.
Tuberous sclerosis
LAD
2-4 hours - 24 hours - 7-10 days
Restrictive cardiomyopathy

30. With what congenital heart defect is ADULT coarctation of the aorta associated?
Systolic dysfx leading to biventricular CHF
Small - nondestructive vegetations (subacute endocarditis)
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Bicuspid aortic valve

31. When would arrhythmia occur after MI?
LA
Within the first day
Backward LHF pulm htn and RHF - afib and associated mural thombis
White scar fibrosis

32. What does rupture of a papillary muscle cause?
Sudden cardiac death
Endocarditis of prosthetic valves
Stable and unstable prinzmetal
Mitral insufficiency

33. What causes notching of the ribs in adult coarctation of the aorta?
S aureus
Intercostal arteries enlarged due to collateral circulation
LA dilation
Minimizes ischemia

34. What genetic conditions predispose a pt to mitral valve prolapse?
White scar fibrosis
Ehlers - Danlow and Marfan syndrome
Rhabdomyoma
Fetal alcohol syndrome

35. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Atria and RV
Paradoxical emboli
Low voltage EKG w/diminished QRS amplitude

36. Which angina is relieved by Ca channel blockers?
Valve scarring that arises as a consequence of rheumatic fever
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Prinzmetal
Bicuspid aortic valve

37. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
PDA
Fibrosis and dystrophic calcification
Rhadbomyoma - benign

38. In which chamber of the heart are cardiac myxomas found?
LA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Autoimmune pericarditis 6-8 wks post MI
Cyanosis - RV hypertrophy - polycythemia - clubbing

39. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1-3 days
Shunt - PGE to maintain PDA until surgical repair can be performed

40. What is the etiology of S viridans endocarditis?
Bacterial endocarditis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Right to left
Eisenmenger syndrome

41. What effect does chronic rheumatic heart disease have the mitral valve?
R-->L
Thickening of chrodae tendinae and cusps - mitral stenosis
Coexisting mitral stenosis and fusion of commisures exist
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

42. How does ischemia cause LHF?
Loss of fx
S epidermidis
Day 1-7
Harmartoma

43. What type of shunt does a VSD cause?
L->R
Transesophageal echo
RHF
Restrictive cardiomyopathy

44. What congenital heart defect does indomethacin tx?
Large - destructive vegetations
When a bacterial protein resembles a protein in human tissue
Myxoma - benign
PDA

45. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Spontaneous
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Concentric LV hypertophy

46. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Adult coarctation of the aorta
>60 years - bicuspid aortic valve
Mitral regurg

47. What causes wear and tear aortic stenosis?
Preductal - post aortic arch
Fibrosis and dystrophic calcification
Volume overload and LHF
Rupture of free wall - IV septum - or papillary muscle

48. What does granulation tissue contain?
Right to left
Minimizes ischemia
Plump fibroblasts - collagen - blood vessels
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

49. What are the Jones criteria?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Squatting - expiration
Holosystolic machine like murmur
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

50. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
4-7 days
Coxsackie A or B
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy