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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 is the leading cause of death in the US?
Squatting - increased systemic resistence decreases LV emptying
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Ischemic heart disease

2. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Right side - serotonin and other secretory products detoxified in the lung
Infectious endocarditis
Mitral regurgitation due to vegetations
Nonbacterial thrombotic endocarditis (marantic endocarditis)

3. What maintains patency of the PDA?
Decreased forward perfusion pulmonary congestion
Transesophageal echo
Day 1-7
PGE

4. What iis the tx for aortic regurg?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Papillary muscle - free wall - IV septum
Shunt - PGE to maintain PDA until surgical repair can be performed
Valve replacement once LV dysfx develops

5. What causes notching of the ribs in adult coarctation of the aorta?
Blood vessels coming in from normal tissue
Intercostal arteries enlarged due to collateral circulation
Aneurysm - mural thrombus - Dressler syndrome
Aschoff bodies

6. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Right to left
Low voltage EKG w/diminished QRS amplitude
>60 years - bicuspid aortic valve

7. What causes the nutmeg color in nutmeg liver?
Mid - systolic click followed by regurgitation murmur
Large vegetations of S aureus
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Congested central veins

8. How does restrictive cardiomyopathy present?
Congestive heart failure
>70%
VSD
Chronic ischemic heart disease

9. What are the Jones criteria?
Subendocardial
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Nitroglycerin
Autoimmune pericarditis 6-8 wks post MI

10. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Indomethacin - decreases PGE
Endocardial fibroelastosis (rare)
MI
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

11. How do ACE inhibitors tx MI?
Spontaneous
Ventricle
Decreases LV dilation by decreasing volume
Ventricular arrhythmia

12. What are Janeway lesions?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Dressler syndrome
Inability to maintain systemic pressure w/lack of O2 to vital organs
Erythematous nontender lesions on palms and soles.

13. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Prinzmetal stable and unstable
S epidermidis
Yellow pallor neutrophils

14. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Endocardial fibroelastosis (rare)
Intercostal arteries enlarged due to collateral circulation
Anitschow cell

15. What imaging test is useful for detecting lesions on valves?
Asymptomatic
Friction rub and chest pain
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Transesophageal echo

16. What gross and microscopic changes occur months after an MI?
White scar fibrosis
2-4 hours - 24 hours - 7-10 days
Small - nondestructive vegetations (subacute endocarditis)
Sterile vegetations on surface and undersurface on mitral valve

17. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Contraction band necrosis - reperfusion injury
Stretched muscle loses contractility
S aureus

18. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Type I
Nitroglycerin

19. What effect does transposition of the great vessels have on the ventricles?
Nonspecific - eg fever and elevated ESR
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
Stable and unstable prinzmetal
Hypertophy of RV atrophy of LV

20. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Adult coarctation of the aorta
ASD - R-->L
Holosystolic machine like murmur
Squatting - increased systemic resistence decreases LV emptying

21. What are the sx of right - to - left shunt?
Reperfusion injury
Squatting - increased systemic resistence decreases LV emptying
VSD
Cyanosis - RV hypertrophy - polycythemia - clubbing

22. What is the tx for LHF?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
20 min
Decrease in blood flow to an organ
ACE inhibitor

23. What are the complications of aortic stenosis?
Heart can't fill
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Volume overload and LHF
Mitral valve prolapse

24. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
4-7 days

25. What is diastolic dysfx?
Endocarditis of prosthetic valves
Inability to fill ventricles
Subendocardial
Mitral regurgitation due to vegetations

26. What is a Quincke pulse?
Dense layer of elastic and fibrotic tissue in the endocardium - children
MI
Myxoid degeneration
Pulsating nail bed

27. When does the heart have dark discoloration post MI?
Subendocardial
PDA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
4-24 hours

28. What type of shunt dose PDA cause?
S viridans
Elevated ASO anti - DNase B titers
Aortic regurg
Left -->right

29. With what disease is Libman - Sacks endocarditis associated?
Mitral and tricuspid regurg - arrhythmia
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
SLE
Large - destructive vegetations

30. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
NG or Ca channel blocker
Anterior wall of LV and anterior septum
Doxorubicin - cocaine

31. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Dilated
Decreased forward perfusion pulmonary congestion
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

32. What causes endocarditis of prosthetic valves?
Mitral regurg
CK- MB
S epidermidis
Shunt - PGE to maintain PDA until surgical repair can be performed

33. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
L->R
Doxorubicin - cocaine

34. What is Dressler syndrome? When does it occur?
Sudden cardiac death
Dark discoloration coagulative necrosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Autoimmune pericarditis 6-8 wks post MI

35. At what point in development do congenital heart defects arise?
Chronic rheumatic heart disease
3-8 wks
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Hemosiderin laden macrophages

36. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Elevated ASO anti - DNase B titers
Aschoff bodies
Myofiber hypertrophy with disarray
Erythematous nontender lesions on palms and soles.

37. What generally causes ischemic heart disease?
Increased hydrostatic pressure
Dilated
Coronary artery vasospasm - emboli - vasculitis
Atherosclerosis of coronary arteries

38. What is the rate of mitral valve prolapse in the US?
2-3%
Months out fibrosis
Mitral and tricuspid regurg - arrhythmia
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

39. Which coronary artery supplies the anterior wall and anterior septum?
Janeway lesions
S epidermidis
Prinzmetal
LAD

40. What does chronic ischemic heart disease progress to?
Ostium secundum (90%)
Systolic ejection click followed by crescendo - decrescendo murmur
CHF
Cardiogenic shock - CHF - arrhythmia

41. In what pt population does S aureus commonly cause valvular disease?
Mitral insufficiency
Valve scarring that arises as a consequence of rheumatic fever
IV drug users
>60 years - bicuspid aortic valve

42. What are the sx/complications of myocarditis?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
S aureus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
20 min

43. What complications occur within 4 hrs post MI?
>70%
Cardiogenic shock - CHF - arrhythmia
Gelatinous - abundant ground substance
RCA

44. How does subendocardial MI/ischemia present on EKG?
Bicuspid aortic valve
ST- segment depression
Cardiac tamponade
Backward LHF pulm htn and RHF - afib and associated mural thombis

45. Where is the coarctation in infantile coarctation of the aorta?
Prinzmetal angina - cocaine
Preductal - post aortic arch
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Tetralogy of fallot

46. What congenital heart defect presents later in life with lower extremity cyanosis?
Pancarditis
PDA
Infantile coarctation of the aorta PDA
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

47. What type of valvular vegetations does S aureus cause?
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
Large - destructive vegetations
Coexisting mitral stenosis and fusion of commisures exist
Myxoid degeneration

48. What is the most common cause of endocarditis in IV drug users?
Squatting - expiration
Shunt
Valve replacement AFTER the onset of complications
S aureus

49. What congenital heart defect is associated with fetal alcohol syndrome?
S aureus
Myocarditis
>60 years - bicuspid aortic valve
VSD

50. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Rupture of free wall - IV septum - or papillary muscle
Congestive heart failure
Rhabdomyoma