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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. How does transmural MI/ischemia present on EKG?
Decreased forward perfusion pulmonary congestion
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Congestive heart failure
ST- segment elevation

2. Why are cardiac enzymes elevated after an MI?
Cardiac tamponade
CK- MB
Cardiogenic shock - CHF - arrhythmia
Membrane damage

3. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Group A beta - hemolytic streptococci
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Dilation of all four chambers of the heart

4. What imaging test is useful for detecting lesions on valves?
Holosystolic machine like murmur
Transesophageal echo
Squatting - expiration
Pts w/previously damaged valves

5. What causes prinzmetal angina?
Months out fibrosis
Coronary artery vasospasm
MI
RCA

6. What coronary arterysupplies the lateral wall of the LV?
Minimizes ischemia
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Circumflex
3-8 wks

7. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Reversible
Fetal alcohol syndrome
Aortic regurg

8. How long after pharyngitis does acute rheumatic fever occur?
Myocarditis in acute rheumatic heart fever
2-3 weeks
Degree of pulmonary artery stenosis
Dilated

9. What type of shunt does ASD cause?
Left -->right
Small - nondestructive vegetations (subacute endocarditis)
ASD - R-->L
Pulsating nail bed

10. What type of shunt does transposition of the great vessels cause?
Holosystolic machine like murmur
R-->L
Hypertophy of RV atrophy of LV
Aortic stenosis

11. What is the most common congenital heart defect?
Increased hydrostatic pressure
LHF
Stretched muscle loses contractility
VSD

12. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Holosystolic machine like murmur
Ehlers - Danlow and Marfan syndrome
Coexisting mitral stenosis and fusion of commisures exist

13. When is an MI pt at greatest risk for cardiogenic shock?
Yellow pallor neutrophils
4-7 days
First 4 hours
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

14. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
CK- MB
Intercostal arteries enlarged due to collateral circulation
Pump failure

15. What is the most common cause of infectious endocarditis?
Myocarditis in acute rheumatic heart fever
Streptococcus viridans
Ischemic heart disease
Type I

16. What is dilated cardiomyopathy?
Pulsating nail bed
Chronic ischemic heart disease
Dilation of all four chambers of the heart
Fetal alcohol syndrome

17. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Split S2 on auscultation
Valve scarring that arises as a consequence of rheumatic fever
Bounding pulse

18. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Streptococcus viridans
RBC damaged while crossing the calcified valve causing schistocytes
Decreased forward perfusion pulmonary congestion

19. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Red border granulation tissue
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Infectious endocarditis
Bacterial endocarditis

20. What are the two effects of ATII?
4-6 hours - 24 hours - 72 hours
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Backward LHF pulm htn and RHF - afib and associated mural thombis
Gelatinous - abundant ground substance

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

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22. What is an Anitschow cell?
CHF
Dressler syndrome
Reactive histiocyte with caterpillar nucleus
Systolic dysfx leading to biventricular CHF

23. What two things cause coronary artery vasospasm?
Left -->right
PDA
Inability to maintain systemic pressure w/lack of O2 to vital organs
Prinzmetal angina - cocaine

24. What does nonbacterial thrombotic endocarditis cause?
Janeway lesions
Mitral regurg
Right -->left
Nonspecific - eg fever and elevated ESR

25. With what disease is transposition of the great vessels associated?
Sterile vegetations on surface and undersurface on mitral valve
Maternal diabetes
IV drug users
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

26. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
LV dilation and eccentric hypertrophy
Louder - increased systemic resistence decreases LV emptying
Increased blood in right heart delays closure of P valve
ASD - R-->L

27. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Mitral and tricuspid regurg - arrhythmia
Right side - serotonin and other secretory products detoxified in the lung
Prinzmetal angina
Transposition of the great vessels

28. Which angina is relieved by Ca channel blockers?
Months out fibrosis
Limits thrombosis
Prinzmetal
RCA

29. What is the cause of the red border around granulation tissue?
Squatting - increased systemic resistence decreases LV emptying
Inability to fill ventricles
Blood vessels coming in from normal tissue
PDA

30. At what point in development do congenital heart defects arise?
Infantile coarctation of the aorta PDA
LA dilation
Annular - non pruritic rash w/erythematous borders trunks and limbs
3-8 wks

31. What are complications of dilated cardiomyopathy?
Fetal alcohol syndrome
Mitral and tricuspid regurg - arrhythmia
Osler nodes (ouch - ouch Osler)
Plump fibroblasts - collagen - blood vessels

32. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Streptococcus viridans
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Ventricles cannot pump

33. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
PGE
Janeway lesions

34. What is the most common cause of RHF? What are others?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Prophylactic abx during dental procedures
LAD

35. What maintains patency of the PDA?
PGE
Cardiogenic shock - CHF - arrhythmia
Atria and RV
Reversible

36. What disesase has Aschoff bodies?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Myocarditis in acute rheumatic heart fever
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Pancarditis

37. What is the tx for VSD?
Trisomy 21
Reversible
Surgical closure small defects may close spontaneously
Decrease in blood flow to an organ

38. Pericarditis 6-8 wks post MI.
Aortic regurg
Anterior wall of LV and anterior septum
Dressler syndrome
Concentric LV hypertophy

39. What areas of the heart does the RCA supply?
RCA
PDA
ST- segment depression
Posterior wall of LV - posterior septum - papillary muscles

40. Dilated cardiomyopathy is a late complication of what illness?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Infantile coarctation of the aorta
Myocarditis
Plump fibroblasts - collagen - blood vessels

41. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Preductal - post aortic arch
Prinzmetal stable and unstable
Granulation tissue

42. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
MI
Stable and unstable prinzmetal
Aneurysm - mural thrombus - Dressler syndrome

43. What is the murmur of mitral regurg?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Months out fibrosis
Circumflex
Holosystolic blowing murmur

44. What iis the tx for aortic regurg?
Large vegetations of S aureus
Valve replacement once LV dysfx develops
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)

45. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Ventricles cannot pump
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RCA
Slow HR - decreasing O2 demand and risk for arrhythmia

46. What is the most common tumor of the heart?
Mitral regurg
Aneurysm - mural thrombus - Dressler syndrome
Metastasis
Limits thrombosis

47. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Hypertophy of RV atrophy of LV
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Valve replacement AFTER the onset of complications

48. What compensatory mechanism do tetralogy of fallot pts learn?
Loss of LV fx
Squat in response to cyanotic spell
VSD
Large - destructive vegetations

49. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Bounding pulse
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
RBC damaged while crossing the calcified valve causing schistocytes

50. With what condition are rhabdomyomas associated?
Fibrinous pericarditis
Cardiac tamponade
Tuberous sclerosis
Open blocked vessels