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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 are the cancers that most commonly metastasize to the heart?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Aortic stenosis
Breast and lung carcinoma - melanoma - lymphoma
ACE inhibitor

2. When do CK- MB levels rise - peak - and return to normal?
Stable and unstable prinzmetal
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Circumflex
4-6 hours - 24 hours - 72 hours

3. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Volume overload and LHF
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
VSD

4. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Congested central veins
Loeffler syndrome
Tricuspid
Posterior wall of LV - posterior septum - papillary muscles

5. What is migratory polyarthritis?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Large - destructive vegetations
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Inability to maintain systemic pressure w/lack of O2 to vital organs

6. What are the sx/complications of myocarditis?
1-3 days
Reperfusion injury
RCA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

7. What is the cause of restrictive cardiomyopathy in children?
Low voltage EKG w/diminished QRS amplitude
Paradoxical emboli
Endocardial fibroelastosis (rare)
Opening snap followed by diastolic rumble

8. At what point in development do congenital heart defects arise?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
3-8 wks
RCA
Congenital rubella

9. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Right to left
Months out fibrosis
Mitral regurgitation due to vegetations

10. What type of ischemia does stable angina cause?
Nonspecific - eg fever and elevated ESR
Osler nodes (ouch - ouch Osler)
Subendocardial
Myofiber hypertrophy with disarray

11. What are Janeway lesions?
3-8 wks
Erythematous nontender lesions on palms and soles.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Osler nodes (ouch - ouch Osler)

12. What congenital heart defect often is present with infantile coarctation of the aorta?
First 4 hours
PDA
Coxsackie A or B
Louder - increased systemic resistence decreases LV emptying

13. What causes acute endocarditis?
LAD
Large vegetations of S aureus
Subendocardial
Atria and RV

14. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Myofiber hypertrophy with disarray
Positive blood cultures anemia of chronic disease
Myxoid degeneration
Rhadbomyoma - benign

15. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
When a bacterial protein resembles a protein in human tissue
First 4 hours
Bacterial endocarditis

16. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
S viridans
Plump fibroblasts - collagen - blood vessels
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ischemic heart disease

17. What is the classic EKG finding of restrictive cardiomyopathy?
Autoimmune pericarditis 6-8 wks post MI
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Low voltage EKG w/diminished QRS amplitude
Positive blood cultures anemia of chronic disease

18. Is scar tissue or myocardium stronger?
4-7 days
Stable angina
Rupture of free wall - IV septum - or papillary muscle
Myocardium

19. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
RHF
Bacterial endocarditis
Heart transplant
Low voltage EKG w/diminished QRS amplitude

20. What is the most common type of ASD? What %?
Papillary muscle - free wall - IV septum
Valve scarring that arises as a consequence of rheumatic fever
Large - destructive vegetations
Ostium secundum (90%)

21. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Yellow pallor neutrophils
Myocarditis in acute rheumatic heart fever
R-->L

22. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Ehlers - Danlow and Marfan syndrome
Open blocked vessels
Myofiber hypertrophy with disarray
Regurg vs stenosis

23. What is the most common form of cardiomyopathy?
Tetralogy of fallot
20 min
Reperfusion injury
Dilated

24. What causes the dependent pitting edema in RHF?
Red border granulation tissue
45%
Preductal - post aortic arch
Increased hydrostatic pressure

25. With what congenital heart defect is ADULT coarctation of the aorta associated?
LA
>70%
Bicuspid aortic valve
Myocarditis

26. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Heart transplant
Trisomy 21
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Endocarditis of prosthetic valves

27. What are the sx of hypertrophic cardiomyopathy?
Erythematous nontender lesions on palms and soles.
Mitral regurg
IV drug users
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

28. What are the forward and backward sx of LHF?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
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
Months out fibrosis
Coronary artery vasospasm - emboli - vasculitis

29. What are the sx of cardiac myxoma?
1-3 days out
ST- segment depression
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Hypertrophic cardiomyopathy

30. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral and tricuspid regurg - arrhythmia
Atherosclerosis of coronary arteries

31. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
2-4 hours - 24 hours - 7-10 days
Myocarditis
L->R

32. What conditions can cause nonbacterial thrombotic endocarditis?
PGE
Nonspecific - eg fever and elevated ESR
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Hypercoagulable state or underlying adenocarcinoma

33. What is the most comon cause of aortic regurg? What are the other causes?
PDA
Hemosiderin laden macrophages
Sudden cardiac death
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

34. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
4-6 hours - 24 hours - 72 hours
Mitral regurg
Large - destructive vegetations

35. Which vasculitis can cause MI?
Kawasaki disease
Friction rub and chest pain
Myxoid degeneration
Dilation of all four chambers of the heart

36. What is the definition of ischemia?
Dilated
Myocarditis
Contraction band necrosis
Decrease in blood flow to an organ

37. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
VSD
1-3 days out
Ostium secundum (90%)

38. What does chronic ischemic heart disease progress to?
CHF
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Limits thrombosis
Coronary artery vasospasm - emboli - vasculitis

39. What tests show prior group A beta - hemolytic strep infection?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Elevated ASO anti - DNase B titers
Mitral and tricuspid regurg - arrhythmia
Reactive histiocyte with caterpillar nucleus

40. Is injury due angina reversible or irreversible?
Loss of LV fx
ACE inhibitor
Breast and lung carcinoma - melanoma - lymphoma
Reversible

41. What is the most common type of endocarditis?
Loss of fx
Infectious
1-3 days
S viridans

42. When is an MI pt at greatest risk for cardiogenic shock?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Cardiac tamponade
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
First 4 hours

43. What is the main cause of MV regurg? What are other causes?
Reperfusion injury
MI
Mid - systolic click followed by regurgitation murmur
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

44. How does dilated cardiomyopathy cause LHF?
RBC damaged while crossing the calcified valve causing schistocytes
Stretched muscle loses contractility
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Months out fibrosis

45. What gross and microscopic changes occur 4-7 days after an MI?
Positive blood cultures anemia of chronic disease
Myxoid degeneration
Yellow pallor macrophages
Metastasis

46. Tx for PDA?
Indomethacin - decreases PGE
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Valve replacement once LV dysfx develops
Limits thrombosis

47. What is the most common tumor of the heart?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Limits thrombosis
Metastasis
1-3 days

48. What type of endocarditis is associated with SLE?
Fibrinous pericarditis
Libman - Sacks endocarditis
Erythematous nontender lesions on palms and soles.
Inability to maintain systemic pressure w/lack of O2 to vital organs

49. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mitral mitral+aortic
Pericardial effusion due to pericardial involvement

50. What type of shunt does a VSD cause?
L->R
Shunt
Stable angina
Tricuspid