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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 coronary artery supplies the mitral valve papillary muscles?
RCA
Tetralogy of fallot
Mitral and tricuspid regurg - arrhythmia
Migratory polyarthritis

2. What is systolic dysfx?
R-->L
Ventricles cannot pump
RBC damaged while crossing the calcified valve causing schistocytes
Large vegetations of S aureus

3. What type of shunt does a VSD cause?
Mitral stenosis
L->R
Troponin I
LAD

4. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Coexisting mitral stenosis and fusion of commisures exist
Loeffler syndrome
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

5. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Stable and unstable prinzmetal
PDA
Pedunculated mass in the LA that causes syncope due to obstruction of MV

6. What gross and microscopic changes occur 4-24 hours after an MI?
Reversible
RBC damaged while crossing the calcified valve causing schistocytes
Dark discoloration coagulative necrosis
Group A beta - hemolytic streptococci

7. What causes a mid - systolic click followed by a regurgitation murmur?
Plump fibroblasts - collagen - blood vessels
Mitral valve prolapse
Within the first day
Contraction band necrosis - reperfusion injury

8. What characterizes acute rheumatic fever endocarditiis?
Low voltage EKG w/diminished QRS amplitude
Sterile vegetations on surface and undersurface on mitral valve
Small vegetations along the line of closure
Intercostal arteries enlarged due to collateral circulation

9. What congenital heart defect does indomethacin tx?
Type I
PDA
Granulation tissue
>60 years - bicuspid aortic valve

10. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nitroglycerin
Rhadbomyoma - benign
Mitral regurg

11. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Red border granulation tissue
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Regurg vs stenosis
RCA

12. What are the complications of mitral valve prolapse? Are they common?
Hypertrophic cardiomyopathy
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Infectious endocarditis - arrythmias - severe mitral regurg no
Coxsackie A or B

13. What murmur ccan be heard in PDA?
Spontaneous
Mitral stenosis
RHF
Holosystolic machine like murmur

14. Why would cardiac enzymes continue to increase after the initial MI?
Yellow pallor macrophages
Open blocked vessels
Spontaneous
Reperfusion injury

15. What causes an early - blowing diastolic murmur?
Aortic regurg
Right -->left
Minimizes ischemia
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

16. How does contraction band necrosis occur?
Valve replacement once LV dysfx develops
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Indomethacin - decreases PGE
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

17. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
CHF
Decrease preload -->lowers myocardial stress

18. What is the rate of mitral valve prolapse in the US?
Coronary artery vasospasm
Sterile vegetations on mitral valve along lines of closure
2-3%
Elevated ASO anti - DNase B titers

19. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Right to left
Prinzmetal angina
Membrane damage

20. Sudden death in a young athlete.
VSD
Paradoxical emboli
Mitral valve prolapse
Hypertrophic cardiomyopathy

21. What gross and microscopic changes occur 4-7 days after an MI?
Bicuspid aortic valve
Yellow pallor macrophages
Shunt
Dense layer of elastic and fibrotic tissue in the endocardium - children

22. In which chamber of the heart are rhabdomyomas found?
Trisomy 21
4-24 hours
Ventricle
Aortic stenosis

23. What two things cause coronary artery vasospasm?
Opening snap followed by diastolic rumble
CK- MB
S viridans
Prinzmetal angina - cocaine

24. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Large vegetations of S aureus
Cardiogenic shock - CHF - arrhythmia
CHF

25. What type of ischemia does stable angina cause?
Bounding pulse
Subendocardial
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Dressler syndrome

26. What is the tx for dilated cardiomyopathy?
Loeffler syndrome
Ventricular arrhythmia
L->R
Heart transplant

27. Pericarditis 6-8 wks post MI.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Indomethacin - decreases PGE
Myocarditis in acute rheumatic heart fever
Dressler syndrome

28. What are the clinical features of RHF?
Reactive histiocyte with caterpillar nucleus
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Congestive heart failure
Right to left

29. What % of MIs involve the LAD?
Prinzmetal angina - cocaine
Left -->right
45%
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

30. What is a complication of chronic rheumatic heart disease?
Breast and lung carcinoma - melanoma - lymphoma
Streptococcus viridans
Circumflex
Infectious endocarditis

31. What is a common complication of cardiac metastasis?
Acute inflammation
LA
Aschoff bodies
Pericardial effusion due to pericardial involvement

32. With what developmental disorder is VSD associated?
Sterile vegetations on surface and undersurface on mitral valve
1-3 days
Annular - non pruritic rash w/erythematous borders trunks and limbs
Fetal alcohol syndrome

33. What are the two effects of ATII?
Mitral regurg
CHF
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Inability to fill ventricles

34. What does rupture of the IV septum cause?
Eisenmenger syndrome
Louder - increased systemic resistence decreases LV emptying
Shunt
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

35. How does restrictive cardiomyopathy cause LHF?

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36. What are Janeway lesions?
Loss of fx
Erythematous nontender lesions on palms and soles.
IV drug users
Stretched muscle loses contractility

37. What heart sound manifest with an ASD?
Within the first day
Split S2 on auscultation
Infectious endocarditis - arrythmias - severe mitral regurg no
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

38. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Janeway lesions
Chronic rheumatic heart disease
2-3 weeks

39. How does MI cause LHF?
Endocardial fibroelastosis (rare)
Contraction band necrosis - reperfusion injury
Valve replacement
Loss of LV fx

40. What is the definition of ischemia?
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
Limits thrombosis
Decrease in blood flow to an organ
Louder - increased systemic resistence decreases LV emptying

41. What are the sx of PDA at birth?
Asymptomatic
4-6 hours - 24 hours - 72 hours
Reperfusion injury
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

42. What endocarditis is commonly found in patients with colon cancer?
LA
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Streptococcus bovis/
4-6 hours - 24 hours - 72 hours

43. With what disease is Libman - Sacks endocarditis associated?
Myocarditis in acute rheumatic heart fever
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
SLE
Colon cancer

44. With what virus is PDA associated?
Tender lesions on fingers or toes.
Tricuspid
Congenital rubella
Nonbacterial thrombotic endocarditis (marantic endocarditis)

45. What type of ASD is associated w/Down syndrome?
Prinzmetal angina
Posterior wall of LV - posterior septum - papillary muscles
Ostium primum
MI

46. What creates the immune reaction in acute rhuematic fever?

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47. Dense layer of elastic and fibrotic tissue in the endocardium.
Atria and RV
4-24 hours
Endocardial fibroelastosis
LA dilation

48. How does ischemia cause LHF?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Loss of fx
4-7 days macrophage infiltration
Congestive heart failure

49. What are heart failure cells?
Congenital rubella
PDA
Harmartoma
Hemosiderin laden macrophages

50. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
>70%
LAD
Coronary artery vasospasm
Aschoff bodies