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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 causes the split S2 in ASD?
Anitschow cell
Squat in response to cyanotic spell
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Increased blood in right heart delays closure of P valve

2. When does the heart have a yellow pallor post MI?
Regurg vs stenosis
Day 1-7
Granulation tissue
Holosystolic machine like murmur

3. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Infectious endocarditis - arrythmias - severe mitral regurg no
RCA
Streptococcus bovis/
Coronary artery vasospasm

4. What are the major criteria of the Jones criteria?
Dressler syndrome
LV dilation and eccentric hypertrophy
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Endocardial fibroelastosis (rare)

5. What complications occur 4-7 days post MI?
Coexisting mitral stenosis and fusion of commisures exist
Slow HR - decreasing O2 demand and risk for arrhythmia
Dark discoloration coagulative necrosis
Rupture of free wall - IV septum - or papillary muscle

6. What maintains patency of the PDA?
Regurg vs stenosis
Atherosclerosis of coronary arteries
PGE
Fetal alcohol syndrome

7. When do macrophagess infiltrate the myocardium post MI?
Troponin I
LHF
Granulation tissue
4-7 days

8. What causes microangiopathic hemolytic anemia in aortic stenosis?
Preductal - post aortic arch
Boot shaped heart
Decrease in blood flow to an organ
RBC damaged while crossing the calcified valve causing schistocytes

9. What is the most common type of endocarditis?
Mitral mitral+aortic
Infectious
Myxoid degeneration
Annular - non pruritic rash w/erythematous borders trunks and limbs

10. With what disease is Libman - Sacks endocarditis associated?
Concentric LV hypertophy
AD mutation in sarcomere proteins
Hypertophy of RV atrophy of LV
SLE

11. Lower extremity cyanosis in infants? In adults?
Congenital rubella
Infantile coarctation of the aorta PDA
Increased blood in right heart delays closure of P valve
Wear and tear

12. What valves are most commonly involved in chronic rheumatic heart disease?
Ostium primum
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Ischemic heart disease
Mitral mitral+aortic

13. How do you prevent S viridans endocarditis?
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
Prophylactic abx during dental procedures
Myxoma - benign
Shunt

14. What is the most common cause of mitral stenosis?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral mitral+aortic
1-3 days out
Chronic rheumatic heart disease

15. Poor myocardial fx due to chronic ischemic damage?
Prinzmetal stable and unstable
Chronic ischemic heart disease
RCA
AD mutation in sarcomere proteins

16. What type of shunt results in cyanosis at birth?
Right to left
Myocarditis in acute rheumatic heart fever
Circumflex
ST- segment elevation

17. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Libman - Sacks endocarditis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Increased blood in right heart delays closure of P valve

18. What is typically the mechanims of sudden cardiac death?
LA dilation
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ventricular arrhythmia
Myocarditis

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

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20. What is the rate of mitral valve prolapse in the US?
PGE
Systolic ejection click followed by crescendo - decrescendo murmur
Trisomy 21
2-3%

21. What causes mitral valve prolapse?
Aortic regurg
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Myxoid degeneration
Preductal - post aortic arch

22. What increases the risk for chronic rheumatic heart disease?
Turner syndrome
S aureus
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Mid - systolic click followed by regurgitation murmur

23. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Sterile vegetations on mitral valve along lines of closure
Reperfusion injury
Loeffler syndrome
Tetralogy of fallot

24. What is the gross and microscopic appearance of cardiac myxomas?
Right to left
Papillary muscle - free wall - IV septum
Gelatinous - abundant ground substance
Surgical closure small defects may close spontaneously

25. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
ASD - R-->L
4-24 hours
NG or Ca channel blocker

26. What is the most common valve infected by S aureus?
Reperfusion injury
Tricuspid
S aureus
Myocarditis

27. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Rhadbomyoma - benign
S aureus
Squatting - expiration

28. Dilated cardiomyopathy is a late complication of what illness?
Cyanosis - RV hypertrophy - polycythemia - clubbing
S epidermidis
Gelatinous - abundant ground substance
Myocarditis

29. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Chronic rheumatic heart disease
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Colon cancer

30. What effect does aortic regurg have on the pulse pressure? Why?
Day 1-7
Limits thrombosis
Months out fibrosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

31. What valves are involved in rhuematic endocarditis?
Erythematous nontender lesions on palms and soles.
Mitral mitral+aortic
Pericardial effusion due to pericardial involvement
Fibrosis and dystrophic calcification

32. Pericarditis 6-8 wks post MI.
Dressler syndrome
Myocarditis in acute rheumatic heart fever
20 min
Tricuspid

33. What congenital heart defect does indomethacin tx?
PDA
Chest pain <20 min brought on by exertion or emotional stress
Endocardial fibroelastosis
Congestive heart failure

34. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Fetal alcohol syndrome
Inability to fill ventricles
Chest pain <20 min brought on by exertion or emotional stress

35. What type of shunt does ASD cause?
Holosystolic machine like murmur
Erythematous nontender lesions on palms and soles.
Left -->right
Cardiogenic shock - CHF - arrhythmia

36. What % of MIs involve the LAD?
45%
4-24 hours
ACE inhibitor
Reversible

37. What is an Aschoff body?
Group A beta - hemolytic streptococci
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Systolic dysfx leading to biventricular CHF
Degree of pulmonary artery stenosis

38. What does rupture of the IV septum cause?
Cardiac tamponade
1%
Shunt
Ostium secundum (90%)

39. With what congenital heart defect is ADULT coarctation of the aorta associated?
Hypercoagulable state or underlying adenocarcinoma
Bicuspid aortic valve
Reactive histiocyte with caterpillar nucleus
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

40. What typically causes hypertrophic cardiomyopathy?
Left -->right
Infectious endocarditis
Backward LHF pulm htn and RHF - afib and associated mural thombis
AD mutation in sarcomere proteins

41. When do neutrophils infiltrate the myocardium post MI?
Mitral regurg
Blood vessels coming in from normal tissue
Sudden cardiac death
1-3 days

42. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Contraction band necrosis
Aortic regurg
Minimizes ischemia

43. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Hypercoagulable state or underlying adenocarcinoma
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Yellow pallor neutrophils

44. What are the clinical features of RHF?
Increased hydrostatic pressure
1-3 days
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Cardiac tamponade

45. What drugs can cause dilated cardiomyopathy?
Pericardial effusion due to pericardial involvement
Mitral regurg
Mitral stenosis
Doxorubicin - cocaine

46. Myofiber hypertrophy with disarray.
LAD
Hypertrophic cardiomyopathy
Plump fibroblasts - collagen - blood vessels
Doxorubicin - cocaine

47. What is the only Jones criteria that doesn't resolve with time?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Tuberous sclerosis
Congenital rubella
Pancarditis

48. Infects predamaged valves after transient bacteremia?
Autoimmune pericarditis 6-8 wks post MI
Squatting - expiration
VSD
S viridans

49. What are the cancers that most commonly metastasize to the heart?
LHF
Plump fibroblasts - collagen - blood vessels
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Breast and lung carcinoma - melanoma - lymphoma

50. What bug causes acute rheumatic fever?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Group A beta - hemolytic streptococci
Mitral regurgitation due to vegetations
Ostium primum