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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 makes the MV prolapse murmur louder? Why?
Preductal - post aortic arch
Ventricles cannot pump
Squatting - increased systemic resistence decreases LV emptying
Spontaneous

2. What are heart failure cells?
Coxsackie A or B
Hemosiderin laden macrophages
L->R
CHF

3. How does stable angina present?
Atherosclerosis of coronary arteries
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Chest pain <20 min brought on by exertion or emotional stress
Valve replacement AFTER the onset of complications

4. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Cardiogenic shock - CHF - arrhythmia
4-7 days macrophage infiltration
Left -->right

5. What side of the heart do carcinoid tumors affect? Why?
L->R
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Right side - serotonin and other secretory products detoxified in the lung
R-->L

6. What causes prinzmetal angina?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Infantile coarctation of the aorta
Coronary artery vasospasm
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

7. What are Osler nodes?
Stable angina
Tender lesions on fingers or toes.
Myocarditis
Plump fibroblasts - collagen - blood vessels

8. What structures are susceptible to rupture post MI?
Breast and lung carcinoma - melanoma - lymphoma
Sterile vegetations on mitral valve along lines of closure
Papillary muscle - free wall - IV septum
Myxoma - benign

9. What are the causes of restrictive cardiomyopathy in adults?
PDA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dilated
Decrease preload -->lowers myocardial stress

10. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Coxsackie A or B
Rhadbomyoma - benign
Infantile coarctation of the aorta

11. What are the sx of aortic regurg?
Holosystolic machine like murmur
Asymptomatic
Plump fibroblasts - collagen - blood vessels
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

12. Which vasculitis can cause MI?
Aortic stenosis
Libman - Sacks endocarditis
Cardiogenic shock - CHF - arrhythmia
Kawasaki disease

13. What are the clinical features of endocarditis? What causes each feature?
4-6 hours - 24 hours - 72 hours
Reperfusion injury
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
Stable and unstable prinzmetal

14. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Coxsackie A or B
Regurg vs stenosis
45%

15. What gross and microscopic changes occur 1-3 days after an MI?
Coexisting mitral stenosis and fusion of commisures exist
Acute inflammation
Mitral mitral+aortic
Yellow pallor neutrophils

16. What is the only Jones criteria that doesn't resolve with time?
Left -->right
Months out fibrosis
Pancarditis
Decreases LV dilation by decreasing volume

17. When does the heart have dark discoloration post MI?
Transposition of the great vessels
Anitschow cell
4-24 hours
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

18. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Sterile vegetations on surface and undersurface on mitral valve
Mitral insufficiency
Libman - Sacks endocarditis

19. What endocarditis is commonly found in patients with colon cancer?
Ventricle
Streptococcus bovis/
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Opening snap followed by diastolic rumble

20. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Louder - increased systemic resistence decreases LV emptying
Infectious
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

21. What creates the immune reaction in acute rhuematic fever?

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22. When is an MI pt at greatest risk for cardiogenic shock?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
First 4 hours
SLE
Infectious endocarditis - arrythmias - severe mitral regurg no

23. What causes a mid - systolic click followed by a regurgitation murmur?
4-7 days macrophage infiltration
Prinzmetal angina
Mitral valve prolapse
Increased hydrostatic pressure

24. What is the tx for VSD?
Streptococcus viridans
Surgical closure small defects may close spontaneously
Tricuspid
Concentric LV hypertophy

25. What is cardiogenic shock?
Pump failure
Inability to maintain systemic pressure w/lack of O2 to vital organs
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
1%

26. How do you tx prinzmetal angina?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Minimizes ischemia
Elevated ASO anti - DNase B titers
NG or Ca channel blocker

27. Erythematous nontender lesions on palms and soles.
Cardiogenic shock - CHF - arrhythmia
1-3 days out
Squatting - increased systemic resistence decreases LV emptying
Janeway lesions

28. What is the effect of mitral regurg on the heart?
Libman - Sacks endocarditis
Trisomy 21
Volume overload and LHF
Pts w/previously damaged valves

29. What effect does mitral stenosis have on the heart chambers?
3-8 wks
LA dilation
45%
Anterior wall of LV and anterior septum

30. Vegetations on surface and undersurface of mitral valve.
Congested central veins
Erythematous nontender lesions on palms and soles.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Libman - Sacks endocarditis

31. How does dilated cardiomyopathy cause LHF?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Ventricle
Coexisting mitral stenosis and fusion of commisures exist
Stretched muscle loses contractility

32. What is the most comon cause of aortic regurg? What are the other causes?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
2-3 weeks
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

33. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Colon cancer
Nonbacterial thrombotic endocarditis (marantic endocarditis)
IV drug users

34. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Valve scarring that arises as a consequence of rheumatic fever
Low voltage EKG w/diminished QRS amplitude
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Colon cancer

35. What effect does aortic regurg have on the pulse pressure? Why?
Left -->right
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Nitroglycerin
Fibrosis and dystrophic calcification

36. What conditions can cause nonbacterial thrombotic endocarditis?
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
Hypercoagulable state or underlying adenocarcinoma
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

37. What is the characteristic murmurr of mitral stenosis?
Libman - Sacks endocarditis
Opening snap followed by diastolic rumble
Hemosiderin laden macrophages
RCA

38. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Coronary artery vasospasm
Mitral regurg
Nitroglycerin

39. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Stable angina
Adult coarctation of the aorta
PDA

40. What congenital heart defect presents later in life with lower extremity cyanosis?
Congestive heart failure
PDA
2-4 hours - 24 hours - 7-10 days
Rhabdomyoma

41. Are most congenital heart defects spontaneous or inherited?
Preductal - post aortic arch
Spontaneous
Mitral mitral+aortic
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

42. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Positive blood cultures anemia of chronic disease
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RHF

43. What causes mitral valve prolapse?
Myxoid degeneration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
RCA
Membrane damage

44. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Posterior wall of LV - posterior septum - papillary muscles
20 min

45. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
AD mutation in sarcomere proteins
Right -->left
Slow HR - decreasing O2 demand and risk for arrhythmia
Aschoff bodies

46. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Decreases LV dilation by decreasing volume
Anitschow cell
Contraction band necrosis - reperfusion injury

47. What type of shunt does truncus arteriosus cause?
Harmartoma
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
R-->L
Valve scarring that arises as a consequence of rheumatic fever

48. What is the main cause of MV regurg? What are other causes?
Large - destructive vegetations
Maternal diabetes
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
2-3 weeks

49. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Mitral mitral+aortic
Doxorubicin - cocaine
Squatting - increased systemic resistence decreases LV emptying

50. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Tuberous sclerosis
Split S2 on auscultation
Adult coarctation of the aorta
45%