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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 long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Shunt
Hemosiderin laden macrophages
20 min
LAD

2. When would arrhythmia occur after MI?
Within the first day
Sudden cardiac death
Yellow pallor macrophages
Contraction band necrosis - reperfusion injury

3. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Red border granulation tissue
4-24 hours
Prinzmetal

4. What two things cause coronary artery vasospasm?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Prinzmetal angina - cocaine
Fetal alcohol syndrome
Myxoma - benign

5. Why are cardiac enzymes elevated after an MI?
Membrane damage
IV drug users
Louder - increased systemic resistence decreases LV emptying
Pericarditits

6. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Membrane damage
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Prinzmetal stable and unstable

7. Is scar tissue or myocardium stronger?
Myocardium
Dense layer of elastic and fibrotic tissue in the endocardium - children
Minimizes ischemia
LV dilation and eccentric hypertrophy

8. What causes acute endocarditis?
Volume overload and LHF
Large vegetations of S aureus
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Coronary artery vasospasm

9. What is the most common cause of death during the acute phase of rheumatic fever?
Maternal diabetes
Dilation of all four chambers of the heart
VSD
Myocarditis

10. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
SLE
Coronary artery vasospasm
Adult coarctation of the aorta

11. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Prinzmetal angina - cocaine
Breast and lung carcinoma - melanoma - lymphoma
4-6 hours - 24 hours - 72 hours
Contraction band necrosis

12. Which artery is most often occluded in an MI?
3-8 wks
LAD
Myocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

13. What type of shunt does truncus arteriosus cause?
Cardiac tamponade
PDA
Infantile coarctation of the aorta
R-->L

14. What effect does dilated cardiomyopathy have on the heart?
Bacterial endocarditis
R-->L
ST- segment depression
Systolic dysfx leading to biventricular CHF

15. What gross and microscopic changes occur 4-7 days after an MI?
Dilation of all four chambers of the heart
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Yellow pallor macrophages
Infectious endocarditis

16. What characterizes acute rheumatic fever endocarditiis?
NG or Ca channel blocker
Mid - systolic click followed by regurgitation murmur
Small vegetations along the line of closure
Membrane damage

17. Sudden death in a young athlete.
Granulation tissue
Small - nondestructive vegetations (subacute endocarditis)
Hypertrophic cardiomyopathy
Loss of LV fx

18. How do beta blockers tx MI?
Loeffler syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia
Months out fibrosis
Small - nondestructive vegetations (subacute endocarditis)

19. How does adult coarctation of the aorta present?
Mid - systolic click followed by regurgitation murmur
Infectious
Sterile vegetations on surface and undersurface on mitral valve
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

20. What type of collagen is involved in fibrosis?
Gelatinous - abundant ground substance
Tricuspid
Thickening of chrodae tendinae and cusps - mitral stenosis
Type I

21. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Restrictive cardiomyopathy
Loeffler syndrome
Acute inflammation
Myofiber hypertrophy with disarray

22. What is Loeffler syndrome?
Breast and lung carcinoma - melanoma - lymphoma
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
RCA

23. What is the main cause of MV regurg? What are other causes?
Trisomy 21
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Transposition of the great vessels
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

24. What compensatory mechanism do tetralogy of fallot pts learn?
PDA
Squat in response to cyanotic spell
Loss of fx
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

25. What genetic conditions predispose a pt to mitral valve prolapse?
Congestive heart failure
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Ehlers - Danlow and Marfan syndrome
Infectious

26. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Sterile vegetations on surface and undersurface on mitral valve
Preductal - post aortic arch
PDA

27. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Increased blood in right heart delays closure of P valve
Mid - systolic click followed by regurgitation murmur
Tender lesions on fingers or toes.

28. What heart sound manifest with an ASD?
Contraction band necrosis
Wear and tear
Split S2 on auscultation
Open blocked vessels

29. What are the sx of PDA at birth?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
1%
Asymptomatic
Pump failure

30. What areas of the heart does the LAD supply?
Myocarditis
ASD - R-->L
Anterior wall of LV and anterior septum
Right to left

31. What is the etiology of S viridans endocarditis?
Reactive histiocyte with caterpillar nucleus
Elevated ASO anti - DNase B titers
Infectious endocarditis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

32. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
PDA
Minimizes ischemia
LHF

33. What is endocardial fibroelastosis? In what population is it found?
Stable and unstable prinzmetal
Dense layer of elastic and fibrotic tissue in the endocardium - children
Positive blood cultures anemia of chronic disease
S viridans

34. What does chronic ischemic heart disease progress to?
Aschoff bodies
Valve replacement
CHF
Mid - systolic click followed by regurgitation murmur

35. How do you tx prinzmetal angina?
Myocarditis
NG or Ca channel blocker
Stretched muscle loses contractility
Metastasis

36. What are the causes of restrictive cardiomyopathy in adults?
Spontaneous
Endocardial fibroelastosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Colon cancer

37. What does granulation tissue contain?
2-3 weeks
Plump fibroblasts - collagen - blood vessels
4-7 days macrophage infiltration
Prinzmetal angina - cocaine

38. What does rupture of the LV free wall cause?
Cardiac tamponade
Chest pain <20 min brought on by exertion or emotional stress
Nitroglycerin
Day 1-7

39. What effect does mitral stenosis have on the heart chambers?
Aortic regurg
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LA dilation
Loss of fx

40. How does dilated cardiomyopathy cause LHF?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Stretched muscle loses contractility
Ehlers - Danlow and Marfan syndrome
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

41. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Myocarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
RCA
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

42. What is the most common form of cardiomyopathy?
Mitral regurgitation due to vegetations
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Anitschow cell
Dilated

43. What does rupture of the IV septum cause?
S aureus
Shunt
Subendocardial
PDA

44. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
1-3 days out
4-7 days macrophage infiltration
Nonbacterial thrombotic endocarditis (marantic endocarditis)
4-7 days

45. How does contraction band necrosis occur?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Endocardial fibroelastosis
Coronary artery vasospasm - emboli - vasculitis

46. What structures are susceptible to rupture post MI?
Infectious endocarditis
Mitral valve prolapse
Papillary muscle - free wall - IV septum
L->R

47. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Pancarditis
Aschoff bodies
Ostium primum
2-4 hours - 24 hours - 7-10 days

48. What gross and microscopic changes occur months after an MI?
Hypertophy of RV atrophy of LV
3-8 wks
White scar fibrosis
Anitschow cell

49. What is the characteristic murmur of aortic stenosis?
R-->L
Systolic ejection click followed by crescendo - decrescendo murmur
Erythematous nontender lesions on palms and soles.
Turner syndrome

50. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
>70%
Transesophageal echo
Minimizes ischemia