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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 complication occurs 1-3 days post MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
CK- MB
Cyanosis - RV hypertrophy - polycythemia - clubbing
Fibrinous pericarditis

2. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Systemic venous congestion
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Streptococcus bovis/

3. What % of MIs involve the LAD?
Contraction band necrosis - reperfusion injury
Fibrosis and dystrophic calcification
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
45%

4. What causes a mid - systolic click followed by a regurgitation murmur?
Day 1-7
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Mitral valve prolapse
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

5. What are the four defects in tetralogy of fallot?
Chronic ischemic heart disease
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Troponin I
Osler nodes (ouch - ouch Osler)

6. What does rupture of a papillary muscle cause?
Mitral insufficiency
ST- segment depression
Sudden cardiac death
Squatting - increased systemic resistence decreases LV emptying

7. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Valve scarring that arises as a consequence of rheumatic fever
Decrease in blood flow to an organ
SLE

8. Lower extremity cyanosis in infants? In adults?
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
LHF
Infantile coarctation of the aorta PDA
Blood vessels coming in from normal tissue

9. What is a water - hammer pulse?
Bounding pulse
Congenital rubella
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

10. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Tender lesions on fingers or toes.
Degree of pulmonary artery stenosis

11. What is the most comon cause of aortic regurg? What are the other causes?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
2-3 weeks

12. How do you tx prinzmetal angina?
Fetal alcohol syndrome
Decrease in blood flow to an organ
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
NG or Ca channel blocker

13. What coronary arterysupplies the lateral wall of the LV?
Fibrinous pericarditis
S aureus
Stable and unstable prinzmetal
Circumflex

14. What are the sx/complications of myocarditis?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
ST- segment depression
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Tetralogy of fallot

15. What is an Aschoff body?
Shunt - PGE to maintain PDA until surgical repair can be performed
PGE
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Circumflex

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

17. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Bounding pulse
Group A beta - hemolytic streptococci

18. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
1-3 days
Mitral and tricuspid regurg - arrhythmia
Infantile coarctation of the aorta

19. What are the causes of restrictive cardiomyopathy in adults?
Decrease preload -->lowers myocardial stress
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Pericarditits
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Reperfusion injury
Myocarditis
Bounding pulse

21. What heart sound manifest with an ASD?
Split S2 on auscultation
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
RHF
4-7 days

22. What are the complications of mitral valve prolapse? Are they common?
Circumflex
Infectious endocarditis - arrythmias - severe mitral regurg no
Infantile coarctation of the aorta
Degree of pulmonary artery stenosis

23. What are Janeway lesions?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Erythematous nontender lesions on palms and soles.
Bounding pulse
Breast and lung carcinoma - melanoma - lymphoma

24. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
White scar fibrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1%

25. What is the leading cause of death in the US?
Doxorubicin - cocaine
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Opening snap followed by diastolic rumble
Ischemic heart disease

26. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
When a bacterial protein resembles a protein in human tissue
Rupture of free wall - IV septum - or papillary muscle
Myocarditis

27. What conditions can cause nonbacterial thrombotic endocarditis?
Within the first day
>60 years - bicuspid aortic valve
2-3%
Hypercoagulable state or underlying adenocarcinoma

28. What type of ischemia does stable angina cause?
Pulsating nail bed
Chest pain <20 min brought on by exertion or emotional stress
R-->L
Subendocardial

29. What are the laboratory findings of bacterial endocarditis?
Ventricles cannot pump
Positive blood cultures anemia of chronic disease
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Valve replacement once LV dysfx develops

30. Why are cardiac enzymes elevated after an MI?
Minimizes ischemia
Membrane damage
RCA
Sterile vegetations on surface and undersurface on mitral valve

31. What is the most common tumor of the heart?
Heart transplant
Metastasis
20 min
Tuberous sclerosis

32. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Large vegetations of S aureus
Fetal alcohol syndrome
Coxsackie A or B

33. EKG for stable angina?
Mid - systolic click followed by regurgitation murmur
ST- segment depression
Aortic stenosis
Large - destructive vegetations

34. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Anitschow cell
Prinzmetal
20 min
Myocardium

35. What coronary artery supplies the mitral valve papillary muscles?
AD mutation in sarcomere proteins
Ostium primum
ASD - R-->L
RCA

36. With what condition are rhabdomyomas associated?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dense layer of elastic and fibrotic tissue in the endocardium - children
Tuberous sclerosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

37. What are the complications of aortic stenosis?
Trisomy 21
Sterile vegetations on mitral valve along lines of closure
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

38. What always follows necrosis?
Doxorubicin - cocaine
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Acute inflammation
Infantile coarctation of the aorta

39. What are the cancers that most commonly metastasize to the heart?
Prinzmetal stable and unstable
Spontaneous
Hypertrophic cardiomyopathy
Breast and lung carcinoma - melanoma - lymphoma

40. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Paradoxical emboli
Slow HR - decreasing O2 demand and risk for arrhythmia
Degree of pulmonary artery stenosis
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

41. How does stable angina present?
Mitral insufficiency
Chest pain <20 min brought on by exertion or emotional stress
Stretched muscle loses contractility
Group A beta - hemolytic streptococci

42. What complications occur 4-7 days post MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Rupture of free wall - IV septum - or papillary muscle
Restrictive cardiomyopathy
4-7 days

43. How does transmural MI/ischemia present on EKG?
Chest pain <20 min brought on by exertion or emotional stress
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
ST- segment elevation
Wear and tear

44. What is an Anitschow cell?
Yellow pallor macrophages
Colon cancer
Reactive histiocyte with caterpillar nucleus
Yellow pallor neutrophils

45. What is the JOneS mneumonic?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
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
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
CHF

46. What is the tx for mitral valve prolapse?
Restrictive cardiomyopathy
Stable and unstable prinzmetal
Valve replacement
Pericarditits

47. How does subendocardial MI/ischemia present on EKG?
>60 years - bicuspid aortic valve
Transesophageal echo
ST- segment depression
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

48. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Paradoxical emboli
Right -->left
Months out fibrosis

49. What areas of the heart does the RCA supply?
3-8 wks
Posterior wall of LV - posterior septum - papillary muscles
Squat in response to cyanotic spell
Volume overload and LHF

50. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Decrease in blood flow to an organ
Endocardial fibroelastosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia