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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 vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Right -->left
Shunt - PGE to maintain PDA until surgical repair can be performed
Infectious endocarditis

2. Pericarditis 6-8 wks post MI.
Coronary artery vasospasm
Dressler syndrome
Migratory polyarthritis
Hemosiderin laden macrophages

3. How does hypertension cause LHF?

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4. What is molecular mimicry?
Contraction band necrosis
Cardiac tamponade
When a bacterial protein resembles a protein in human tissue
Mitral regurg

5. How does aortic regurg affect the heart chambers?
PDA
20 min
LV dilation and eccentric hypertrophy
Small - nondestructive vegetations (subacute endocarditis)

6. How does asprin/heparin tx MI?
Limits thrombosis
S epidermidis
Small - nondestructive vegetations (subacute endocarditis)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

7. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Positive blood cultures anemia of chronic disease
Wear and tear
Doxorubicin - cocaine

8. What causes endocarditis of prosthetic valves?
Pericarditits
S epidermidis
Systemic venous congestion
Myocardium

9. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Dilation of all four chambers of the heart
2-4 hours - 24 hours - 7-10 days
Systolic dysfx leading to biventricular CHF

10. What is the most common cause of aortic stenosis?
Anitschow cell
When a bacterial protein resembles a protein in human tissue
Backward LHF pulm htn and RHF - afib and associated mural thombis
Wear and tear

11. In transposition of the great vessels - What is required for survival? How is this achieved?
Positive blood cultures anemia of chronic disease
S aureus
Concentric LV hypertophy
Shunt - PGE to maintain PDA until surgical repair can be performed

12. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
LAD
Concentric LV hypertophy
Tender lesions on fingers or toes.

13. What are heart failure cells?
Hemosiderin laden macrophages
Dense layer of elastic and fibrotic tissue in the endocardium - children
Mitral and tricuspid regurg - arrhythmia
Elevated ASO anti - DNase B titers

14. In which pts does S viridans cause endocarditits?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
LA dilation
Red border granulation tissue
Pts w/previously damaged valves

15. What causes the nutmeg color in nutmeg liver?
Decreased forward perfusion pulmonary congestion
Janeway lesions
Intercostal arteries enlarged due to collateral circulation
Congested central veins

16. What does rupture of the LV free wall cause?
Restrictive cardiomyopathy
Maternal diabetes
Cardiac tamponade
Autoimmune pericarditis 6-8 wks post MI

17. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Prinzmetal angina
Small vegetations along the line of closure
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rhadbomyoma - benign

18. What complications occur 4-7 days post MI?
L->R
Reversible
Granulation tissue
Rupture of free wall - IV septum - or papillary muscle

19. What type of shunt does transposition of the great vessels cause?
Months out fibrosis
White scar fibrosis
Acute inflammation
R-->L

20. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Opening snap followed by diastolic rumble
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

21. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Eisenmenger syndrome
SLE
Prinzmetal angina
Dilation of all four chambers of the heart

22. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Loeffler syndrome
Maternal diabetes
Louder - increased systemic resistence decreases LV emptying
Sterile vegetations on surface and undersurface on mitral valve

23. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Spontaneous
Cardiac tamponade
Bicuspid aortic valve

24. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Anitschow cell
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Group A beta - hemolytic streptococci

25. What gross and microscopic changes occur 4-7 days after an MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Dressler syndrome
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Yellow pallor macrophages

26. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Myocardium
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

27. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Regurg vs stenosis
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea
Adult coarctation of the aorta
Opening snap followed by diastolic rumble

28. What structures are susceptible to rupture post MI?
Yellow pallor macrophages
Papillary muscle - free wall - IV septum
Prinzmetal
Coexisting mitral stenosis and fusion of commisures exist

29. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
Regurg vs stenosis
Louder - increased systemic resistence decreases LV emptying
Decreases LV dilation by decreasing volume

30. Which coronary artery supplies the anterior wall and anterior septum?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
LAD
Bacterial endocarditis
Holosystolic blowing murmur

31. How does ischemia cause LHF?
RHF
Bicuspid aortic valve
S epidermidis
Loss of fx

32. How does subendocardial MI/ischemia present on EKG?
Ventricle
ST- segment depression
Annular - non pruritic rash w/erythematous borders trunks and limbs
Right to left

33. What causes an early - blowing diastolic murmur?
Anitschow cell
Aortic regurg
Atria and RV
ASD - R-->L

34. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Sterile vegetations on surface and undersurface on mitral valve
Shunt - PGE to maintain PDA until surgical repair can be performed
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

35. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Myxoma - benign
PDA
Bacterial endocarditis
Split S2 on auscultation

36. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Months out fibrosis
Stretched muscle loses contractility
Tender lesions on fingers or toes.

37. What is the main cause of MV regurg? What are other causes?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Mitral regurg
Decrease preload -->lowers myocardial stress
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

38. What effect does aortic regurg have on the pulse pressure? Why?
2-4 hours - 24 hours - 7-10 days
Valve replacement
Tetralogy of fallot
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

39. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Dilated
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Slow HR - decreasing O2 demand and risk for arrhythmia

40. What is the basic principle of CHF?
Preductal - post aortic arch
Pump failure
Fetal alcohol syndrome
Loss of fx

41. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Dilation of all four chambers of the heart
Surgical closure small defects may close spontaneously
4-7 days macrophage infiltration
Boot shaped heart

42. Why are cardiac enzymes elevated after an MI?
Hemosiderin laden macrophages
White scar fibrosis
Sterile vegetations on mitral valve along lines of closure
Membrane damage

43. What is the cause of the red border around granulation tissue?
AD mutation in sarcomere proteins
3-8 wks
Blood vessels coming in from normal tissue
Mitral stenosis

44. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Fibrosis and dystrophic calcification
Rupture of free wall - IV septum - or papillary muscle
SLE

45. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Hypertophy of RV atrophy of LV
Prinzmetal stable and unstable
Prinzmetal angina

46. When do neutrophils infiltrate the myocardium post MI?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Prinzmetal angina - cocaine
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
1-3 days

47. Dense layer of elastic and fibrotic tissue in the endocardium.
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Hypercoagulable state or underlying adenocarcinoma
Endocardial fibroelastosis
Libman - Sacks endocarditis

48. What is the effect of mitral regurg on the heart?
S aureus
Intercostal arteries enlarged due to collateral circulation
45%
Volume overload and LHF

49. What areas of the heart does the LAD supply?
Gelatinous - abundant ground substance
Sudden cardiac death
Anterior wall of LV and anterior septum
Within the first day

50. What is typically the mechanims of sudden cardiac death?
Asymptomatic
Ventricular arrhythmia
Hypercoagulable state or underlying adenocarcinoma
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy