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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 are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Prinzmetal angina - cocaine
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
RBC damaged while crossing the calcified valve causing schistocytes

2. What are heart failure cells?
Bounding pulse
Coexisting mitral stenosis and fusion of commisures exist
Pancarditis
Hemosiderin laden macrophages

3. What is the tx for VSD?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Cyanosis - RV hypertrophy - polycythemia - clubbing
Surgical closure small defects may close spontaneously
Large vegetations of S aureus

4. What type of ischemia does stable angina cause?
Subendocardial
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Adult coarctation of the aorta
ASD - R-->L

5. What type of vegetations are associated with Libman - Sacks endocarditis?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Dressler syndrome
Sterile vegetations on surface and undersurface on mitral valve
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

6. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Contraction band necrosis
Janeway lesions
Hypercoagulable state or underlying adenocarcinoma

7. What effect does mitral stenosis have on the heart chambers?
Chronic ischemic heart disease
Inability to maintain systemic pressure w/lack of O2 to vital organs
LA dilation
LA

8. What are the sx of right - to - left shunt?
Indomethacin - decreases PGE
Systolic dysfx leading to biventricular CHF
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Cyanosis - RV hypertrophy - polycythemia - clubbing

9. What type of ASD is associated w/Down syndrome?
Slow HR - decreasing O2 demand and risk for arrhythmia
Stretched muscle loses contractility
Ostium primum
Open blocked vessels

10. When does the heart have a yellow pallor post MI?
Day 1-7
Pancarditis
L->R
4-24 hours

11. What are the forward and backward sx of LHF?
Mitral regurg
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
Spontaneous
Inability to fill ventricles

12. How does fibrinolysis/angioplasty tx MI?
Spontaneous
Nitroglycerin
Open blocked vessels
Hemosiderin laden macrophages

13. How do you tx prinzmetal angina?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
VSD
NG or Ca channel blocker
White scar fibrosis

14. What effect does dilated cardiomyopathy have on the heart?
4-6 hours - 24 hours - 72 hours
Systolic dysfx leading to biventricular CHF
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
Pump failure

15. L- to - R shunt switching to R- to - L shunt.
Loss of fx
Eisenmenger syndrome
L->R
Nonbacterial thrombotic endocarditis (marantic endocarditis)

16. What makes the MV prolapse murmur louder? Why?
Boot shaped heart
Squatting - increased systemic resistence decreases LV emptying
Mitral mitral+aortic
Ehlers - Danlow and Marfan syndrome

17. What causes the nutmeg color in nutmeg liver?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Sterile vegetations on mitral valve along lines of closure
Gelatinous - abundant ground substance
Congested central veins

18. What disesase has Aschoff bodies?
Limits thrombosis
Transposition of the great vessels
Wear and tear
Myocarditis in acute rheumatic heart fever

19. What causes unstable angina?
Autoimmune pericarditis 6-8 wks post MI
Large - destructive vegetations
Annular - non pruritic rash w/erythematous borders trunks and limbs
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

20. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Dilated
Libman - Sacks endocarditis
1-3 days out

21. What causes wear and tear aortic stenosis?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Anterior wall of LV and anterior septum
Doxorubicin - cocaine
Fibrosis and dystrophic calcification

22. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
RCA
Mitral regurg
4-7 days macrophage infiltration
LA dilation

23. Tx for PDA?
Colon cancer
Indomethacin - decreases PGE
Papillary muscle - free wall - IV septum
Asymptomatic

24. How does MI cause LHF?
Tender lesions on fingers or toes.
Streptococcus viridans
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Loss of LV fx

25. What are the sx of pericardiits?
Friction rub and chest pain
Infantile coarctation of the aorta PDA
Mitral insufficiency
Dressler syndrome

26. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
RBC damaged while crossing the calcified valve causing schistocytes
CHF
Cardiogenic shock - CHF - arrhythmia

27. What type of tumor is a rhabdomyoma?
Anitschow cell
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
3-8 wks
Harmartoma

28. What are the sx of aortic regurg?
Valve replacement
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Louder - increased systemic resistence decreases LV emptying
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

29. What does granulation tissue contain?
PDA
Sudden cardiac death
Plump fibroblasts - collagen - blood vessels
Atherosclerosis of coronary arteries

30. How do ACE inhibitors tx MI?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
LAD
Degree of pulmonary artery stenosis
Decreases LV dilation by decreasing volume

31. What complications occur within 4 hrs post MI?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Low voltage EKG w/diminished QRS amplitude
Cardiogenic shock - CHF - arrhythmia
Backward LHF pulm htn and RHF - afib and associated mural thombis

32. What areas of the heart does the LAD supply?
Mitral regurg
Transesophageal echo
Anterior wall of LV and anterior septum
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

33. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Ventricular arrhythmia
Inability to fill ventricles
Infectious endocarditis

34. What bug causes acute rheumatic fever?
1%
Group A beta - hemolytic streptococci
Mitral regurg
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

35. What effect does aortic regurg have on the pulse pressure? Why?
Indomethacin - decreases PGE
VSD
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Congenital rubella

36. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Cardiogenic shock - CHF - arrhythmia
Stable and unstable prinzmetal
Open blocked vessels

37. What coronary artery supplies the mitral valve papillary muscles?
RCA
PDA
Shunt
Membrane damage

38. Infects predamaged valves after transient bacteremia?
S viridans
>70%
Prinzmetal
Stretched muscle loses contractility

39. What is the main cause of MV regurg? What are other causes?
Minimizes ischemia
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mitral regurg
Nonspecific - eg fever and elevated ESR

40. Why are cardiac enzymes elevated after an MI?
Preductal - post aortic arch
4-24 hours
Membrane damage
Libman - Sacks endocarditis

41. What type of shunt dose PDA cause?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Left -->right
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

42. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Rhadbomyoma - benign
Ehlers - Danlow and Marfan syndrome
Migratory polyarthritis
Sterile vegetations on surface and undersurface on mitral valve

43. When do CK- MB levels rise - peak - and return to normal?
Harmartoma
4-6 hours - 24 hours - 72 hours
Infectious endocarditis - arrythmias - severe mitral regurg no
Yellow pallor macrophages

44. What is a water - hammer pulse?
Bounding pulse
Nitroglycerin
Chest pain <20 min brought on by exertion or emotional stress
Holosystolic blowing murmur

45. What is the most common cause of infectious endocarditis?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Streptococcus viridans
Sterile vegetations on surface and undersurface on mitral valve
Coexisting mitral stenosis and fusion of commisures exist

46. What is the etiology of S viridans endocarditis?
ACE inhibitor
Prinzmetal stable and unstable
Regurg vs stenosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

47. What is systolic dysfx?
Ventricles cannot pump
Red border granulation tissue
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Maternal diabetes

48. What does nonbacterial thrombotic endocarditis cause?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Mitral regurg
Thickening of chrodae tendinae and cusps - mitral stenosis
LAD

49. With what virus is PDA associated?
Colon cancer
Congenital rubella
Valve replacement once LV dysfx develops
Cyanosis - RV hypertrophy - polycythemia - clubbing

50. What is the most common cause of aortic stenosis?
Coxsackie A or B
Wear and tear
Myocarditis
Shunt