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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 gross and microscopic changes occur 1-3 weeks after an MI?
Ehlers - Danlow and Marfan syndrome
Pump failure
Blood vessels coming in from normal tissue
Red border granulation tissue

2. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Yellow pallor neutrophils
PGE
Months out fibrosis
R-->L

3. What gross and microscopic changes occur months after an MI?
Myofiber hypertrophy with disarray
White scar fibrosis
Ventricular arrhythmia
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

4. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Coronary artery vasospasm - emboli - vasculitis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Yellow pallor neutrophils

5. When is an MI pt at greatest risk for cardiogenic shock?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Kawasaki disease
Dilation of all four chambers of the heart
First 4 hours

6. How does ischemia cause LHF?
Dilated
Annular - non pruritic rash w/erythematous borders trunks and limbs
Loss of fx
Intercostal arteries enlarged due to collateral circulation

7. What are the complications of mitral valve prolapse? Are they common?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Ischemic heart disease
Within the first day
Infectious endocarditis - arrythmias - severe mitral regurg no

8. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Indomethacin - decreases PGE
Bacterial endocarditis
RCA
Systemic venous congestion

9. What valves are most commonly involved in chronic rheumatic heart disease?
RCA
Bacterial endocarditis
Mitral mitral+aortic
Left -->right

10. What is the most common cause of death during the acute phase of rheumatic fever?
45%
Endocardial fibroelastosis
Myocardium
Myocarditis

11. What always follows necrosis?
45%
Open blocked vessels
Acute inflammation
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

12. What is the only Jones criteria that doesn't resolve with time?
Valve scarring that arises as a consequence of rheumatic fever
Hemosiderin laden macrophages
Pancarditis
Tender lesions on fingers or toes.

13. With what disease is infantile coarctation of the aorta associated?
Mitral regurg
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Turner syndrome
Systemic venous congestion

14. What congenital heart defect often is present with infantile coarctation of the aorta?
Endocarditis of prosthetic valves
Prinzmetal
Mitral regurg
PDA

15. What iis the tx for aortic regurg?
Prinzmetal stable and unstable
4-24 hours
Pts w/previously damaged valves
Valve replacement once LV dysfx develops

16. What is the definition of ischemia?
R-->L
IV drug users
Decrease in blood flow to an organ
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

17. What areas of the heart does the RCA supply?
Chronic rheumatic heart disease
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Posterior wall of LV - posterior septum - papillary muscles

18. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
Metastasis
PDA
Stretched muscle loses contractility

19. How does asprin/heparin tx MI?
Right side - serotonin and other secretory products detoxified in the lung
Limits thrombosis
LAD
Within the first day

20. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Myocarditis in acute rheumatic heart fever
Positive blood cultures anemia of chronic disease
Rhadbomyoma - benign

21. What type of shunt does ASD cause?
ASD - R-->L
Preductal - post aortic arch
Left -->right
Inability to maintain systemic pressure w/lack of O2 to vital organs

22. What type of shunt does transposition of the great vessels cause?
R-->L
Reperfusion injury
Preductal - post aortic arch
PDA

23. What are the clinical features of endocarditis? What causes each feature?
Valve replacement once LV dysfx develops
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
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Transposition of the great vessels

24. What effect does transposition of the great vessels have on the ventricles?
SLE
Hypertophy of RV atrophy of LV
Colon cancer
Squatting - increased systemic resistence decreases LV emptying

25. What is an Anitschow cell?
4-6 hours - 24 hours - 72 hours
Reactive histiocyte with caterpillar nucleus
Dense layer of elastic and fibrotic tissue in the endocardium - children
Type I

26. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Trisomy 21
Mitral stenosis
Positive blood cultures anemia of chronic disease

27. What is the most common cause of infectious endocarditis?
Membrane damage
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Streptococcus viridans
Fetal alcohol syndrome

28. With what disease is transposition of the great vessels associated?
Maternal diabetes
Regurg vs stenosis
Boot shaped heart
Libman - Sacks endocarditis

29. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Troponin I
When a bacterial protein resembles a protein in human tissue

30. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Myofiber hypertrophy with disarray
Trisomy 21
Libman - Sacks endocarditis

31. What cardiac enzyme is useful for detecting reinfarction?
2-3%
Decrease in blood flow to an organ
Asymptomatic
CK- MB

32. What does rupture of the LV free wall cause?
LAD
Cardiac tamponade
Holosystolic machine like murmur
Mitral insufficiency

33. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Day 1-7
Spontaneous
Louder - increased systemic resistence decreases LV emptying

34. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA
Increased hydrostatic pressure
Breast and lung carcinoma - melanoma - lymphoma

35. In which chamber of the heart are rhabdomyomas found?
Circumflex
Ventricles cannot pump
Ventricle
Rhabdomyoma

36. What causes the nutmeg color in nutmeg liver?
PDA
Aortic stenosis
Valve replacement
Congested central veins

37. What is the main cause of MV regurg? What are other causes?
Coronary artery vasospasm - emboli - vasculitis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
4-6 hours - 24 hours - 72 hours
Blood vessels coming in from normal tissue

38. Infects predamaged valves after transient bacteremia?
Increased hydrostatic pressure
Bounding pulse
Rupture of free wall - IV septum - or papillary muscle
S viridans

39. What is the tx for aortic stenosis?
RHF
Valve replacement once LV dysfx develops
Anterior wall of LV and anterior septum
Valve replacement AFTER the onset of complications

40. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
ST- segment elevation
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Fibrinous pericarditis

41. What characterizes acute rheumatic fever endocarditiis?
Circumflex
Small vegetations along the line of closure
Reversible
Breast and lung carcinoma - melanoma - lymphoma

42. What is the tx for dilated cardiomyopathy?
Congestive heart failure
Heart transplant
Wear and tear
Myocarditis

43. In transposition of the great vessels - What is required for survival? How is this achieved?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Aortic regurg
Shunt - PGE to maintain PDA until surgical repair can be performed
Type I

44. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Annular - non pruritic rash w/erythematous borders trunks and limbs
Type I
Decreases LV dilation by decreasing volume

45. What is the most common cause of dilated cardiomyopathy? What are other causes?
Mitral insufficiency
Atherosclerosis of coronary arteries
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Migratory polyarthritis

46. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Anitschow cell
PGE
Yellow pallor neutrophils
Degree of pulmonary artery stenosis

47. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Inability to maintain systemic pressure w/lack of O2 to vital organs
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

48. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Systolic ejection click followed by crescendo - decrescendo murmur
Reperfusion injury
Doxorubicin - cocaine
Congested central veins

49. What increases the risk for chronic rheumatic heart disease?
Reactive histiocyte with caterpillar nucleus
Red border granulation tissue
Limits thrombosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

50. What endocarditis is commonly found in patients with colon cancer?
PDA
Streptococcus bovis/
Split S2 on auscultation
Left -->right