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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. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Minimizes ischemia
Months out fibrosis
Transesophageal echo
Sterile vegetations on surface and undersurface on mitral valve

2. In which pts does S viridans cause endocarditits?
Metastasis
Myxoid degeneration
Pts w/previously damaged valves
Eisenmenger syndrome

3. Lower extremity cyanosis in infants? In adults?
IV drug users
Infantile coarctation of the aorta PDA
Infantile coarctation of the aorta
Atherosclerosis of coronary arteries

4. What type of shunt does transposition of the great vessels cause?
Large - destructive vegetations
Infantile coarctation of the aorta PDA
R-->L
Infantile coarctation of the aorta

5. What is the cause of the red border around granulation tissue?
Loss of LV fx
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Blood vessels coming in from normal tissue
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

6. What is the most common congenital heart defect?
VSD
LHF
Papillary muscle - free wall - IV septum
Hypercoagulable state or underlying adenocarcinoma

7. How does reperfusion injury occur?
>70%
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Circumflex
PDA

8. What causes the split S2 in ASD?
Paradoxical emboli
Increased blood in right heart delays closure of P valve
Fetal alcohol syndrome
Increased hydrostatic pressure

9. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Positive blood cultures anemia of chronic disease
ST- segment depression
Systolic ejection click followed by crescendo - decrescendo murmur

10. How do you prevent S viridans endocarditis?
Friction rub and chest pain
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
1-3 days out
Prophylactic abx during dental procedures

11. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Congestive heart failure
CHF
Troponin I

12. What causes notching of the ribs in adult coarctation of the aorta?
Mitral regurgitation due to vegetations
Intercostal arteries enlarged due to collateral circulation
SLE
Bounding pulse

13. Boot - shaped heart on x- ray?
Reactive histiocyte with caterpillar nucleus
Sterile vegetations on surface and undersurface on mitral valve
Tetralogy of fallot
Troponin I

14. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Backward LHF pulm htn and RHF - afib and associated mural thombis
Streptococcus viridans
Ventricles cannot pump

15. What effect does chronic rheumatic heart disease have on the aortic valve?

16. How do ACE inhibitors tx MI?
20 min
Myocardium
Decreases LV dilation by decreasing volume
Tuberous sclerosis

17. Systolic ejection click followed by crescendo - decrescendo murmur.
Hypertophy of RV atrophy of LV
Inability to fill ventricles
Mitral valve prolapse
Aortic stenosis

18. What is the only Jones criteria that doesn't resolve with time?
IV drug users
Pancarditis
Autoimmune pericarditis 6-8 wks post MI
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

19. How does ischemia cause LHF?
Loss of fx
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Sterile vegetations on surface and undersurface on mitral valve
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

20. What is the classic EKG finding of restrictive cardiomyopathy?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Low voltage EKG w/diminished QRS amplitude
Loss of fx
Prophylactic abx during dental procedures

21. What effect does aortic regurg have on the pulse pressure? Why?
MI
LA
2-3%
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

22. When do macrophagess infiltrate the myocardium post MI?
Coronary artery vasospasm
4-7 days
Janeway lesions
LAD

23. What type of valvular vegetations does S aureus cause?
Dilation of all four chambers of the heart
Prinzmetal angina
PDA
Large - destructive vegetations

24. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Ostium secundum (90%)
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Sterile vegetations on mitral valve along lines of closure
Months out fibrosis

25. With what congenital heart defect is ADULT coarctation of the aorta associated?
Endocarditis of prosthetic valves
Shunt - PGE to maintain PDA until surgical repair can be performed
Myocardium
Bicuspid aortic valve

26. Tx for PDA?
Nitroglycerin
Indomethacin - decreases PGE
Yellow pallor macrophages
L->R

27. What heart sound manifest with an ASD?
Months out fibrosis
Holosystolic machine like murmur
Split S2 on auscultation
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

28. What is a Quincke pulse?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pulsating nail bed
Tuberous sclerosis
LV dilation and eccentric hypertrophy

29. What does rupture of the LV free wall cause?
RHF
Cardiac tamponade
4-7 days
>70%

30. What are the sx of hypertrophic cardiomyopathy?
Aortic regurg
Prophylactic abx during dental procedures
White scar fibrosis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

31. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reperfusion injury
Rupture of free wall - IV septum - or papillary muscle
Mitral valve prolapse

32. What endocarditis is commonly found in patients with colon cancer?
Fibrinous pericarditis
1-3 days
Streptococcus bovis/
Hypertophy of RV atrophy of LV

33. What is the definition of ischemia?
Decrease in blood flow to an organ
Large - destructive vegetations
Group A beta - hemolytic streptococci
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

34. What causes an early - blowing diastolic murmur?
>70%
Aortic regurg
Hypertrophic cardiomyopathy
Holosystolic machine like murmur

35. What are the sx of cardiac myxoma?
Right -->left
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral regurg
Pedunculated mass in the LA that causes syncope due to obstruction of MV

36. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Hypertrophic cardiomyopathy
>60 years - bicuspid aortic valve
Myocarditis in acute rheumatic heart fever

37. Which congenital heart defect is associated with congenital rubella?
Systolic dysfx leading to biventricular CHF
PDA
Valve scarring that arises as a consequence of rheumatic fever
Loss of fx

38. How does aortic regurg affect the heart chambers?
Large vegetations of S aureus
Louder - increased systemic resistence decreases LV emptying
LV dilation and eccentric hypertrophy
Paradoxical emboli

39. What does a biopsy of hypertrophic cardiomyopathy look like?
Acute inflammation
Small - nondestructive vegetations (subacute endocarditis)
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Myofiber hypertrophy with disarray

40. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Months out fibrosis
LAD
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

41. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Coronary artery vasospasm - emboli - vasculitis
ACE inhibitor
Annular - non pruritic rash w/erythematous borders trunks and limbs

42. What type of shunt dose PDA cause?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Left -->right

43. What is the most common type of ASD? What %?
3-8 wks
PDA
Nitroglycerin
Ostium secundum (90%)

44. Which vasculitis can cause MI?
Myocarditis in acute rheumatic heart fever
Kawasaki disease
Myocarditis
Mitral mitral+aortic

45. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Months out fibrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral valve prolapse

46. What is the characteristic murmurr of mitral stenosis?
Coronary artery vasospasm
Infantile coarctation of the aorta
Contraction band necrosis - reperfusion injury
Opening snap followed by diastolic rumble

47. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Myocarditis
Mitral regurg
Nonbacterial thrombotic endocarditis (marantic endocarditis)

48. What are the major criteria of the Jones criteria?
Right side - serotonin and other secretory products detoxified in the lung
Systolic dysfx leading to biventricular CHF
Cardiac tamponade
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

49. What vavular defect results from acute rheumatic fever?
Pump failure
Mitral regurgitation due to vegetations
Bounding pulse
Rhadbomyoma - benign

50. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Heart can't fill
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
Type I
Nonbacterial thrombotic endocarditis (marantic endocarditis)