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Cardiac

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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 increases the risk for chronic rheumatic heart disease?
Aortic regurg
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Trisomy 21
PDA

2. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
MI
AD mutation in sarcomere proteins
Regurg vs stenosis
Chest pain <20 min brought on by exertion or emotional stress

3. What is the most common type of endocarditis?
Myofiber hypertrophy with disarray
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Libman - Sacks endocarditis
Infectious

4. What is the most common cause of myocarditis?
Coxsackie A or B
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
4-24 hours
Migratory polyarthritis

5. What is an Aschoff body?
Mitral mitral+aortic
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Dense layer of elastic and fibrotic tissue in the endocardium - children

6. What type of tumor is a rhabdomyoma?
Harmartoma
Concentric LV hypertophy
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Sterile vegetations on mitral valve along lines of closure

7. What are the clinical features of LHF due to?
Myocarditis in acute rheumatic heart fever
Decreased forward perfusion pulmonary congestion
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
LAD

8. Is scar tissue or myocardium stronger?
Endocardial fibroelastosis (rare)
Janeway lesions
Myocardium
Prinzmetal

9. What is the most common form of cardiomyopathy?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Dilated
Cyanosis - RV hypertrophy - polycythemia - clubbing
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

10. What is the characteristic murmurr of mitral stenosis?
Gelatinous - abundant ground substance
Mid - systolic click followed by regurgitation murmur
VSD
Opening snap followed by diastolic rumble

11. What is the cause of restrictive cardiomyopathy in children?
S aureus
Louder - increased systemic resistence decreases LV emptying
Endocardial fibroelastosis (rare)
Aschoff bodies

12. What is migratory polyarthritis?
Tricuspid
Rupture of free wall - IV septum - or papillary muscle
S aureus
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

13. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Myocardium
RCA
Myxoma - benign
Reactive histiocyte with caterpillar nucleus

14. When does the heart have dark discoloration post MI?
Heart can't fill
CK- MB
Reperfusion injury
4-24 hours

15. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Harmartoma
Colon cancer
Wear and tear

16. How does asprin/heparin tx MI?
Yellow pallor neutrophils
Right side - serotonin and other secretory products detoxified in the lung
Limits thrombosis
Reperfusion injury

17. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Open blocked vessels
Migratory polyarthritis
Cyanosis - RV hypertrophy - polycythemia - clubbing

18. How does restrictive cardiomyopathy present?
2-4 hours - 24 hours - 7-10 days
4-7 days macrophage infiltration
Congestive heart failure
Small - nondestructive vegetations (subacute endocarditis)

19. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Wear and tear
Hemosiderin laden macrophages
PDA
Stable and unstable prinzmetal

20. What type of vegetations form in nonbacterial thrombotic endocarditis?
Red border granulation tissue
Ostium secundum (90%)
Myxoid degeneration
Sterile vegetations on mitral valve along lines of closure

21. What is the most comon cause of aortic regurg? What are the other causes?
RHF
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

22. What endocarditis is commonly found in patients with colon cancer?
Slow HR - decreasing O2 demand and risk for arrhythmia
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
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
Streptococcus bovis/

23. What type of shunt dose PDA cause?
Sterile vegetations on mitral valve along lines of closure
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Left -->right
Heart can't fill

24. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Aschoff bodies
Asymptomatic
Left -->right

25. What effect does transposition of the great vessels have on the ventricles?
Aschoff bodies
Chronic rheumatic heart disease
Coxsackie A or B
Hypertophy of RV atrophy of LV

26. What effect does chronic rheumatic heart disease have on the aortic valve?

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27. What imaging test is useful for detecting lesions on valves?
Atherosclerosis of coronary arteries
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Coxsackie A or B
Transesophageal echo

28. What is the characteristic murmur of aortic stenosis?
ST- segment elevation
CHF
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Systolic ejection click followed by crescendo - decrescendo murmur

29. What are complications of dilated cardiomyopathy?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Mitral and tricuspid regurg - arrhythmia
RCA
Surgical closure small defects may close spontaneously

30. Which chambers of the heart are generally spared in an MI?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Increased blood in right heart delays closure of P valve
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Atria and RV

31. Why would cardiac enzymes continue to increase after the initial MI?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Valve replacement
Reperfusion injury
RBC damaged while crossing the calcified valve causing schistocytes

32. Lower extremity cyanosis in infants? In adults?
Volume overload and LHF
Mitral and tricuspid regurg - arrhythmia
1%
Infantile coarctation of the aorta PDA

33. What is eythema marginatum? What parts of the body does it commonly involve?
Endocardial fibroelastosis (rare)
Circumflex
Annular - non pruritic rash w/erythematous borders trunks and limbs
Dilation of all four chambers of the heart

34. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Positive blood cultures anemia of chronic disease
Streptococcus bovis/
1-3 days out
4-7 days macrophage infiltration

35. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Contraction band necrosis - reperfusion injury
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
Red border granulation tissue

36. What typically causes hypertrophic cardiomyopathy?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Hypertrophic cardiomyopathy
AD mutation in sarcomere proteins

37. How does dilated cardiomyopathy cause LHF?
Spontaneous
Ventricular arrhythmia
Stretched muscle loses contractility
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

38. Infects predamaged valves after transient bacteremia?
S viridans
Louder - increased systemic resistence decreases LV emptying
Ehlers - Danlow and Marfan syndrome
Squat in response to cyanotic spell

39. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Doxorubicin - cocaine
White scar fibrosis
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
LHF

40. What gross and microscopic changes occur months after an MI?
Congested central veins
White scar fibrosis
PDA
Squat in response to cyanotic spell

41. What effect does mitral stenosis have on the heart chambers?
RCA
LA dilation
Chest pain <20 min brought on by exertion or emotional stress
Harmartoma

42. What always follows necrosis?
Surgical closure small defects may close spontaneously
Degree of pulmonary artery stenosis
Mitral regurg
Acute inflammation

43. What two things cause coronary artery vasospasm?
Osler nodes (ouch - ouch Osler)
RCA
Prinzmetal angina - cocaine
RCA

44. What areas of the heart does the LAD supply?
Mitral valve prolapse
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Anterior wall of LV and anterior septum
MI

45. What is the most common type of ASD? What %?
Ostium secundum (90%)
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Chronic ischemic heart disease
Hypercoagulable state or underlying adenocarcinoma

46. What is the tx for mitral valve prolapse?
Valve replacement
Aortic regurg
1%
LV dilation and eccentric hypertrophy

47. What congenital heart defect does indomethacin tx?
Nitroglycerin
PDA
Aortic stenosis
First 4 hours

48. Opening snap followed by diastolic rumble.
Stretched muscle loses contractility
Mitral stenosis
Months out fibrosis
4-7 days

49. What is the effect of mitral regurg on the heart?
Troponin I
Breast and lung carcinoma - melanoma - lymphoma
Janeway lesions
Volume overload and LHF

50. What characterizes acute rheumatic fever endocarditiis?
>70%
Small vegetations along the line of closure
Systolic ejection click followed by crescendo - decrescendo murmur
LAD