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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 disesase has Aschoff bodies?
Mitral regurg
CK- MB
Myocarditis in acute rheumatic heart fever
Cardiogenic shock - CHF - arrhythmia

2. What are the forward and backward sx of LHF?
Type I
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
Hypertophy of RV atrophy of LV
Ostium primum

3. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Pts w/previously damaged valves
Transposition of the great vessels
Sterile vegetations on mitral valve along lines of closure
Nonbacterial thrombotic endocarditis (marantic endocarditis)

4. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Migratory polyarthritis
Breast and lung carcinoma - melanoma - lymphoma
Kawasaki disease

5. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
CHF
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
LV dilation and eccentric hypertrophy

6. When does the heart have a yellow pallor post MI?
Day 1-7
Papillary muscle - free wall - IV septum
Trisomy 21
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

7. Where is the coarctation in infantile coarctation of the aorta?
Squatting - increased systemic resistence decreases LV emptying
Preductal - post aortic arch
Contraction band necrosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

8. What is the most common cause of endocarditis in IV drug users?
Shunt - PGE to maintain PDA until surgical repair can be performed
S aureus
Inability to maintain systemic pressure w/lack of O2 to vital organs
Increased blood in right heart delays closure of P valve

9. What heart sound manifest with an ASD?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
4-7 days macrophage infiltration
Split S2 on auscultation
Hypertrophic cardiomyopathy

10. What is the most common form of cardiomyopathy?
SLE
Dilated
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Pump failure

11. How does Eisenmeger syndrome occur?
RBC damaged while crossing the calcified valve causing schistocytes
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
Day 1-7
Turner syndrome

12. What conditions can cause nonbacterial thrombotic endocarditis?
Mitral mitral+aortic
Dilated
CK- MB
Hypercoagulable state or underlying adenocarcinoma

13. What are heart failure cells?
Heart transplant
Subendocardial
Hemosiderin laden macrophages
Concentric LV hypertophy

14. What are the sx of cardiac myxoma?
Valve replacement AFTER the onset of complications
Pedunculated mass in the LA that causes syncope due to obstruction of MV
VSD
S viridans

15. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Dressler syndrome
LA
Months out fibrosis

16. Which vasculitis can cause MI?
Kawasaki disease
Myocarditis in acute rheumatic heart fever
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Harmartoma

17. What genetic conditions predispose a pt to mitral valve prolapse?
Reperfusion injury
Louder - increased systemic resistence decreases LV emptying
Ehlers - Danlow and Marfan syndrome
Friction rub and chest pain

18. What is the most common congenital heart defect?
Elevated ASO anti - DNase B titers
Systolic ejection click followed by crescendo - decrescendo murmur
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
VSD

19. What are the complications of aortic stenosis?
>70%
Stable and unstable prinzmetal
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
4-7 days

20. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Louder - increased systemic resistence decreases LV emptying
LV dilation and eccentric hypertrophy

21. Dilated cardiomyopathy is a late complication of what illness?
Yellow pallor macrophages
Colon cancer
Myocarditis
Mitral insufficiency

22. What is diastolic dysfx?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Inability to fill ventricles
Opening snap followed by diastolic rumble
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

23. What type of ischemia does stable angina cause?
Subendocardial
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Loeffler syndrome
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

24. What is the cause of restrictive cardiomyopathy in children?
Concentric LV hypertophy
PDA
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
Endocardial fibroelastosis (rare)

25. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Membrane damage
Gelatinous - abundant ground substance
Erythematous nontender lesions on palms and soles.

26. What is an Anitschow cell?
Myxoma - benign
Prinzmetal
Reactive histiocyte with caterpillar nucleus
Atria and RV

27. What increases the volume of mitral regurg murmur?
Sudden cardiac death
Atherosclerosis of coronary arteries
Myocarditis in acute rheumatic heart fever
Squatting - expiration

28. What are the clinical features of RHF?
Large vegetations of S aureus
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Kawasaki disease
Acute inflammation

29. Systolic ejection click followed by crescendo - decrescendo murmur.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Day 1-7
Ventricles cannot pump
Aortic stenosis

30. How does transmural MI/ischemia present on EKG?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Yellow pallor neutrophils
S epidermidis
ST- segment elevation

31. How does contraction band necrosis occur?
Cardiogenic shock - CHF - arrhythmia
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Migratory polyarthritis

32. How long after pharyngitis does acute rheumatic fever occur?
Infectious
Transesophageal echo
2-3 weeks
Ventricles cannot pump

33. How does asprin/heparin tx MI?
Limits thrombosis
4-24 hours
Prinzmetal angina
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

34. What gross and microscopic changes occur 1-3 weeks after an MI?
Posterior wall of LV - posterior septum - papillary muscles
Boot shaped heart
Red border granulation tissue
Trisomy 21

35. How does aortic regurg affect the heart chambers?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Ehlers - Danlow and Marfan syndrome
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
LV dilation and eccentric hypertrophy

36. What is dilated cardiomyopathy?
Breast and lung carcinoma - melanoma - lymphoma
Dilation of all four chambers of the heart
Streptococcus viridans
45%

37. What is the basic principle of CHF?
Pump failure
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
4-24 hours
PGE

38. What coronary artery supplies the mitral valve papillary muscles?
Mitral valve prolapse
Transposition of the great vessels
RCA
Aortic regurg

39. Which angina(s) show ST elevation on EKG? ST depression?
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
Surgical closure small defects may close spontaneously
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
Prinzmetal stable and unstable

40. What is typically the mechanims of sudden cardiac death?
CK- MB
Ventricular arrhythmia
ST- segment depression
SLE

41. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Ischemic heart disease
Heart can't fill
Sudden cardiac death
Split S2 on auscultation

42. What causes angina and syncope in aortic stenosis?

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43. What characterizes acute rheumatic fever endocarditiis?
Squatting - increased systemic resistence decreases LV emptying
Stable angina
Small vegetations along the line of closure
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

44. When do neutrophils infiltrate the myocardium post MI?
Regurg vs stenosis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
1-3 days
Mitral regurgitation due to vegetations

45. What is a common complication of cardiac metastasis?
Aschoff bodies
Asymptomatic
R-->L
Pericardial effusion due to pericardial involvement

46. What tests show prior group A beta - hemolytic strep infection?
Inability to maintain systemic pressure w/lack of O2 to vital organs
VSD
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
Elevated ASO anti - DNase B titers

47. What type of shunt does a VSD cause?
Subendocardial
Small - nondestructive vegetations (subacute endocarditis)
L->R
S aureus

48. What causes mitral valve prolapse?
Coexisting mitral stenosis and fusion of commisures exist
Subendocardial
Myxoid degeneration
Libman - Sacks endocarditis

49. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Endocardial fibroelastosis
Reactive histiocyte with caterpillar nucleus
Hypercoagulable state or underlying adenocarcinoma

50. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Low voltage EKG w/diminished QRS amplitude
Ehlers - Danlow and Marfan syndrome
Mitral regurg