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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 side of the heart do carcinoid tumors affect? Why?
Intercostal arteries enlarged due to collateral circulation
ST- segment elevation
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Right side - serotonin and other secretory products detoxified in the lung

2. Which angina(s) show ST elevation on EKG? ST depression?
Infantile coarctation of the aorta
Red border granulation tissue
45%
Prinzmetal stable and unstable

3. What type of valvular vegetations does S aureus cause?
PDA
Chest pain <20 min brought on by exertion or emotional stress
Large - destructive vegetations
Mitral regurg

4. What are the forward and backward sx of LHF?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
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
Dense layer of elastic and fibrotic tissue in the endocardium - children
4-7 days

5. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Red border granulation tissue
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Months out fibrosis
Surgical closure small defects may close spontaneously

6. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
ASD - R-->L
4-24 hours
Yellow pallor macrophages

7. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Autoimmune pericarditis 6-8 wks post MI
PGE
Ventricles cannot pump

8. What is Dressler syndrome? When does it occur?
Prinzmetal angina - cocaine
Autoimmune pericarditis 6-8 wks post MI
Thickening of chrodae tendinae and cusps - mitral stenosis
Maternal diabetes

9. How does dilated cardiomyopathy cause LHF?
Valve replacement once LV dysfx develops
When a bacterial protein resembles a protein in human tissue
Stretched muscle loses contractility
Gelatinous - abundant ground substance

10. How does restrictive cardiomyopathy cause LHF?

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11. What causes endocarditis of prosthetic valves?
Contraction band necrosis
Surgical closure small defects may close spontaneously
Eisenmenger syndrome
S epidermidis

12. What endocarditis is commonly found in patients with colon cancer?
Anitschow cell
Congestive heart failure
Streptococcus bovis/
Mid - systolic click followed by regurgitation murmur

13. What effect does mitral stenosis have on the heart chambers?
LA dilation
Janeway lesions
Inability to fill ventricles
VSD

14. What are Osler nodes?
Opening snap followed by diastolic rumble
1%
Mitral valve prolapse
Tender lesions on fingers or toes.

15. What imaging test is useful for detecting lesions on valves?
Hypercoagulable state or underlying adenocarcinoma
Transesophageal echo
Systolic ejection click followed by crescendo - decrescendo murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

16. How does transmural MI/ischemia present on EKG?
S aureus
Decrease in blood flow to an organ
ST- segment elevation
Sterile vegetations on mitral valve along lines of closure

17. What effect does dilated cardiomyopathy have on the heart?
Friction rub and chest pain
Systolic dysfx leading to biventricular CHF
Membrane damage
S epidermidis

18. How does restrictive cardiomyopathy present?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
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
Congestive heart failure
Sudden cardiac death

19. What increases the volume of mitral regurg murmur?
2-3 weeks
LHF
Coxsackie A or B
Squatting - expiration

20. What is the tx for dilated cardiomyopathy?
Positive blood cultures anemia of chronic disease
Systolic ejection click followed by crescendo - decrescendo murmur
Aneurysm - mural thrombus - Dressler syndrome
Heart transplant

21. What are the causes of restrictive cardiomyopathy in adults?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Reversible
Open blocked vessels
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

22. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Left -->right
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

23. What causes the nutmeg color in nutmeg liver?
Congested central veins
Intercostal arteries enlarged due to collateral circulation
Contraction band necrosis - reperfusion injury
Aortic stenosis

24. What is the foundation of a scar?
Granulation tissue
Anterior wall of LV and anterior septum
LA dilation
3-8 wks

25. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Myxoid degeneration
2-3%
Mitral valve prolapse

26. What is the 1day-1wk -1mo mneumonic for MI?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Endocarditis of prosthetic valves
First 4 hours

27. What gross and microscopic changes occur 1-3 days after an MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
RHF
Minimizes ischemia
Yellow pallor neutrophils

28. What are the complications of mitral valve prolapse? Are they common?
Coexisting mitral stenosis and fusion of commisures exist
Open blocked vessels
Infectious endocarditis - arrythmias - severe mitral regurg no
20 min

29. Is injury due angina reversible or irreversible?
Endocarditis of prosthetic valves
Reversible
Maternal diabetes
Reperfusion injury

30. With what congenital heart defect is ADULT coarctation of the aorta associated?
Decreases LV dilation by decreasing volume
Tender lesions on fingers or toes.
Bicuspid aortic valve
Myocarditis

31. What type of shunt does a VSD cause?
Prinzmetal
Aortic stenosis
L->R
Left -->right

32. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Asymptomatic
VSD
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ventricular arrhythmia

33. What are the sx/complications of myocarditis?
LAD
Janeway lesions
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Subendocardial

34. What type of shunt does transposition of the great vessels cause?
Shunt
Intercostal arteries enlarged due to collateral circulation
R-->L
Split S2 on auscultation

35. Turner syndrome is associated with which congenital heart defect?
Increased hydrostatic pressure
Infantile coarctation of the aorta
Dark discoloration coagulative necrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

36. What causes an early - blowing diastolic murmur?
Maternal diabetes
Trisomy 21
Aortic regurg
ASD - R-->L

37. What congenital heart defect presents later in life with lower extremity cyanosis?
Decreased forward perfusion pulmonary congestion
PDA
Degree of pulmonary artery stenosis
LHF

38. What is the tx for LHF?
Valve replacement
Infectious endocarditis - arrythmias - severe mitral regurg no
RBC damaged while crossing the calcified valve causing schistocytes
ACE inhibitor

39. What causes heart failure cells?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1-3 days out
Granulation tissue

40. What % of MIs involve the LAD?
Congested central veins
Loeffler syndrome
45%
Eisenmenger syndrome

41. What complication occurs 1-3 days post MI?
Hypertophy of RV atrophy of LV
Fibrinous pericarditis
Libman - Sacks endocarditis
Aortic regurg

42. What is the most common form of cardiomyopathy?
PDA
Aortic stenosis
Left -->right
Dilated

43. When is an MI pt at greatest risk for cardiogenic shock?
Systolic ejection click followed by crescendo - decrescendo murmur
First 4 hours
Fetal alcohol syndrome
Membrane damage

44. What does a biopsy of hypertrophic cardiomyopathy look like?
Infectious endocarditis - arrythmias - severe mitral regurg no
20 min
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Myofiber hypertrophy with disarray

45. What % stenosis causes stable angina?
2-4 hours - 24 hours - 7-10 days
Right -->left
>70%
Paradoxical emboli

46. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Aneurysm - mural thrombus - Dressler syndrome
Myocarditis in acute rheumatic heart fever
RCA

47. What does nonbacterial thrombotic endocarditis cause?
Right -->left
MI
Mitral regurg
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

48. Is scar tissue or myocardium stronger?
Myocardium
1-3 days out
Mitral regurg
Red border granulation tissue

49. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Ventricular arrhythmia
Increased blood in right heart delays closure of P valve

50. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Prinzmetal stable and unstable
Within the first day
Mid - systolic click followed by regurgitation murmur