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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. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Large - destructive vegetations
Valve scarring that arises as a consequence of rheumatic fever
Maternal diabetes

2. What is the characteristic murmur of aortic stenosis?
Kawasaki disease
First 4 hours
Systolic ejection click followed by crescendo - decrescendo murmur
RBC damaged while crossing the calcified valve causing schistocytes

3. What is an Aschoff body?
Osler nodes (ouch - ouch Osler)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Kawasaki disease

4. What is the most common cause of mitral stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Preductal - post aortic arch
Atherosclerosis of coronary arteries
Chronic rheumatic heart disease

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

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6. What does rupture of the LV free wall cause?
Type I
Split S2 on auscultation
Cardiac tamponade
Valve replacement once LV dysfx develops

7. With what disease is transposition of the great vessels associated?
Mitral mitral+aortic
Maternal diabetes
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

8. What shunt does tetralogy of fallot produce?
Infectious endocarditis - arrythmias - severe mitral regurg no
Limits thrombosis
Reactive histiocyte with caterpillar nucleus
Right -->left

9. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
RCA
20 min
Positive blood cultures anemia of chronic disease

10. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
S epidermidis
Anitschow cell
Months out fibrosis

11. In which chamber of the heart are cardiac myxomas found?
Bacterial endocarditis
Valve replacement AFTER the onset of complications
Decreased forward perfusion pulmonary congestion
LA

12. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Stretched muscle loses contractility
Large vegetations of S aureus
Rhadbomyoma - benign
2-3 weeks

13. When does the heart have dark discoloration post MI?
Small vegetations along the line of closure
Preductal - post aortic arch
Stretched muscle loses contractility
4-24 hours

14. Low voltage EKG w/diminished QRS amplitude.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Restrictive cardiomyopathy
Shunt - PGE to maintain PDA until surgical repair can be performed
Hypertrophic cardiomyopathy

15. How does ischemia cause LHF?
Loss of fx
Circumflex
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
2-3%

16. How does transmural MI/ischemia present on EKG?
Prophylactic abx during dental procedures
ST- segment elevation
Mitral regurgitation due to vegetations
Coronary artery vasospasm - emboli - vasculitis

17. What type of vegetations form in nonbacterial thrombotic endocarditis?
Harmartoma
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Sterile vegetations on mitral valve along lines of closure
Right side - serotonin and other secretory products detoxified in the lung

18. What tests show prior group A beta - hemolytic strep infection?
Fibrinous pericarditis
Opening snap followed by diastolic rumble
Reperfusion injury
Elevated ASO anti - DNase B titers

19. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Right -->left
Stable angina
Yellow pallor macrophages
Annular - non pruritic rash w/erythematous borders trunks and limbs

20. What are the sx of pericardiits?
Friction rub and chest pain
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
Endocardial fibroelastosis (rare)
Limits thrombosis

21. How does subendocardial MI/ischemia present on EKG?
1-3 days
Myxoma - benign
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
ST- segment depression

22. What type of shunt dose PDA cause?
Anitschow cell
Stretched muscle loses contractility
Left -->right
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

23. What causes notching of the ribs in adult coarctation of the aorta?
Day 1-7
LV dilation and eccentric hypertrophy
Intercostal arteries enlarged due to collateral circulation
Congenital rubella

24. What are Janeway lesions?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Tricuspid
Erythematous nontender lesions on palms and soles.
Yellow pallor neutrophils

25. What is the cause of the red border around granulation tissue?
Contraction band necrosis - reperfusion injury
Blood vessels coming in from normal tissue
Nonbacterial thrombotic endocarditis (marantic endocarditis)
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

26. What causes mitral valve prolapse?
Myxoid degeneration
Infantile coarctation of the aorta
Valve scarring that arises as a consequence of rheumatic fever
Eisenmenger syndrome

27. What are the sx/complications of myocarditis?
Plump fibroblasts - collagen - blood vessels
PDA
Coronary artery vasospasm
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

28. What causes the split S2 in ASD?
Right side - serotonin and other secretory products detoxified in the lung
Nitroglycerin
Increased blood in right heart delays closure of P valve
Open blocked vessels

29. What are the laboratory findings of bacterial endocarditis?
S viridans
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Turner syndrome
Positive blood cultures anemia of chronic disease

30. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Within the first day
Dilation of all four chambers of the heart
R-->L

31. What gross and microscopic changes occur 4-7 days after an MI?
Harmartoma
Pancarditis
Yellow pallor macrophages
Pericarditits

32. What is molecular mimicry?
Streptococcus viridans
When a bacterial protein resembles a protein in human tissue
Membrane damage
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

33. What coronary artery supplies the mitral valve papillary muscles?
RCA
Holosystolic machine like murmur
Right to left
ST- segment elevation

34. What causes the nutmeg color in nutmeg liver?
Janeway lesions
Congested central veins
Prinzmetal
PDA

35. With what congenital heart defect is ADULT coarctation of the aorta associated?
Hypertrophic cardiomyopathy
Boot shaped heart
Dilated
Bicuspid aortic valve

36. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Right -->left
Trisomy 21
Months out fibrosis

37. What causes endocarditis of prosthetic valves?
RCA
Reversible
2-3%
S epidermidis

38. When does the heart have a yellow pallor post MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LAD
Reperfusion injury
Day 1-7

39. What is a complication of chronic rheumatic heart disease?
Yellow pallor macrophages
Chronic ischemic heart disease
Anterior wall of LV and anterior septum
Infectious endocarditis

40. What is typically the mechanims of sudden cardiac death?
Cardiogenic shock - CHF - arrhythmia
Ventricular arrhythmia
VSD
Infectious endocarditis - arrythmias - severe mitral regurg no

41. Pericarditis 6-8 wks post MI.
Myofiber hypertrophy with disarray
L->R
Dressler syndrome
Within the first day

42. At what point in development do congenital heart defects arise?
Split S2 on auscultation
Mitral regurg
Metastasis
3-8 wks

43. Infects predamaged valves after transient bacteremia?
Squatting - increased systemic resistence decreases LV emptying
Dilated
PDA
S viridans

44. What vavular defect results from acute rheumatic fever?
Plump fibroblasts - collagen - blood vessels
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Mitral regurgitation due to vegetations

45. What complication occurs 1-3 days post MI?
Heart can't fill
Fibrinous pericarditis
Atherosclerosis of coronary arteries
Myxoma - benign

46. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Yellow pallor neutrophils
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Tetralogy of fallot

47. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Gelatinous - abundant ground substance
PDA
Concentric LV hypertophy

48. How does squating decrease hypoxemia in tetralogy of fallot?
Systolic ejection click followed by crescendo - decrescendo murmur
Restrictive cardiomyopathy
First 4 hours
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

49. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Prinzmetal angina - cocaine
Valve replacement
>70%

50. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Myocarditis
Contraction band necrosis - reperfusion injury
Louder - increased systemic resistence decreases LV emptying
Valve replacement