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Cardiac

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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 two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Doxorubicin - cocaine
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Eisenmenger syndrome

2. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Right to left
Split S2 on auscultation
Surgical closure small defects may close spontaneously

3. What type of ischemia does stable angina cause?
Chronic ischemic heart disease
Subendocardial
Cardiogenic shock - CHF - arrhythmia
Mitral regurg

4. What does rupture of a papillary muscle cause?
Dilated
AD mutation in sarcomere proteins
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral insufficiency

5. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Ischemic heart disease
S viridans
Reperfusion injury

6. What is the most common tumor of the heart?
Metastasis
Small - nondestructive vegetations (subacute endocarditis)
RHF
ACE inhibitor

7. When does the heart have a yellow pallor post MI?
Coexisting mitral stenosis and fusion of commisures exist
Day 1-7
1-3 days
Sterile vegetations on surface and undersurface on mitral valve

8. How does restrictive cardiomyopathy present?
Congestive heart failure
Small - nondestructive vegetations (subacute endocarditis)
1-3 days out
Backward LHF pulm htn and RHF - afib and associated mural thombis

9. How does hypertension cause LHF?

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10. What imaging test is useful for detecting lesions on valves?
Inability to maintain systemic pressure w/lack of O2 to vital organs
LAD
Transesophageal echo
Aneurysm - mural thrombus - Dressler syndrome

11. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Tricuspid
Dense layer of elastic and fibrotic tissue in the endocardium - children
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

12. Is scar tissue or myocardium stronger?
Dark discoloration coagulative necrosis
Myocardium
Dilated
Chronic ischemic heart disease

13. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Posterior wall of LV - posterior septum - papillary muscles
Eisenmenger syndrome
Small - nondestructive vegetations (subacute endocarditis)

14. What causes wear and tear aortic stenosis?
Mitral valve prolapse
>70%
White scar fibrosis
Fibrosis and dystrophic calcification

15. What are the causes of LHF?
Doxorubicin - cocaine
Subendocardial
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Holosystolic machine like murmur

16. What are the major criteria of the Jones criteria?
Prophylactic abx during dental procedures
Loss of LV fx
Large - destructive vegetations
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

17. What is an Aschoff body?
Mitral mitral+aortic
Mitral regurg
Boot shaped heart
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

18. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Erythematous nontender lesions on palms and soles.
Elevated ASO anti - DNase B titers
Ostium secundum (90%)

19. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Months out fibrosis
Harmartoma
Aortic regurg

20. What causes microangiopathic hemolytic anemia in aortic stenosis?
ST- segment elevation
Eisenmenger syndrome
RBC damaged while crossing the calcified valve causing schistocytes
Type I

21. What congenital heart defect does indomethacin tx?
PDA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Reversible

22. When is an MI pt at greatest risk for cardiogenic shock?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Sterile vegetations on surface and undersurface on mitral valve
First 4 hours
Indomethacin - decreases PGE

23. What is the foundation of a scar?
Granulation tissue
Hypercoagulable state or underlying adenocarcinoma
Mitral stenosis
Chronic ischemic heart disease

24. When does the heart have dark discoloration post MI?
Decrease preload -->lowers myocardial stress
When a bacterial protein resembles a protein in human tissue
Rhabdomyoma
4-24 hours

25. What is the most common cause of RHF? What are others?
Minimizes ischemia
Right side - serotonin and other secretory products detoxified in the lung
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
>70%

26. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Contraction band necrosis - reperfusion injury
Blood vessels coming in from normal tissue
Split S2 on auscultation

27. When is an MI patent at highest risk for fibrionous pericarditis?
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
Acute inflammation
Pulsating nail bed
1-3 days out

28. What are the sx of pericardiits?
Friction rub and chest pain
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Right side - serotonin and other secretory products detoxified in the lung
Spontaneous

29. What is the most common congenital heart defect?
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
Type I
Spontaneous
VSD

30. What areas of the heart does the LAD supply?
Mitral valve prolapse
Anterior wall of LV and anterior septum
4-7 days
Left -->right

31. What is the 1day-1wk -1mo mneumonic for MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Nitroglycerin
Months out fibrosis

32. What are the complications that occur months after an MI?
Months out fibrosis
2-4 hours - 24 hours - 7-10 days
Aneurysm - mural thrombus - Dressler syndrome
Loss of LV fx

33. What murmur ccan be heard in PDA?
First 4 hours
Holosystolic machine like murmur
Subendocardial
Ostium primum

34. What is diastolic dysfx?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Infantile coarctation of the aorta PDA
Inability to fill ventricles
Mitral insufficiency

35. What maintains patency of the PDA?
PGE
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Dressler syndrome
Endocardial fibroelastosis

36. What is the tx for LHF?
Dark discoloration coagulative necrosis
Erythematous nontender lesions on palms and soles.
ACE inhibitor
R-->L

37. Why would cardiac enzymes continue to increase after the initial MI?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
RCA
Ventricles cannot pump
Reperfusion injury

38. What are the sx of aortic regurg?
Inability to fill ventricles
Low voltage EKG w/diminished QRS amplitude
Squat in response to cyanotic spell
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

39. What conditions can cause nonbacterial thrombotic endocarditis?
Hemosiderin laden macrophages
Circumflex
Hypercoagulable state or underlying adenocarcinoma
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

40. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Pericardial effusion due to pericardial involvement
Nonspecific - eg fever and elevated ESR

41. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
AD mutation in sarcomere proteins
Systolic dysfx leading to biventricular CHF
Loss of LV fx

42. What are the HACEK organisms? With what condition are they associated?
Aneurysm - mural thrombus - Dressler syndrome
Infantile coarctation of the aorta
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

43. What type of ASD is associated w/Down syndrome?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
LV dilation and eccentric hypertrophy
Ostium primum
Decrease in blood flow to an organ

44. What type of tumor is a rhabdomyoma?
Atria and RV
Pts w/previously damaged valves
Elevated ASO anti - DNase B titers
Harmartoma

45. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Transposition of the great vessels
Squatting - expiration
Stable and unstable prinzmetal
Yellow pallor macrophages

46. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
R-->L
Reversible
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

47. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Squatting - increased systemic resistence decreases LV emptying
S epidermidis
Rhadbomyoma - benign
Months out fibrosis

48. What is systolic dysfx?
2-3%
Backward LHF pulm htn and RHF - afib and associated mural thombis
Ventricles cannot pump
Migratory polyarthritis

49. What is Dressler syndrome? When does it occur?
RHF
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Autoimmune pericarditis 6-8 wks post MI
LV dilation and eccentric hypertrophy

50. How do you prevent S viridans endocarditis?
Cardiac tamponade
Holosystolic blowing murmur
Months out fibrosis
Prophylactic abx during dental procedures