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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. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Chronic rheumatic heart disease
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
Rhabdomyoma

2. What are the sx of PDA at birth?
Large - destructive vegetations
White scar fibrosis
Asymptomatic
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

3. Tender lesions on fingers or toes.
S aureus
Inability to maintain systemic pressure w/lack of O2 to vital organs
Osler nodes (ouch - ouch Osler)
Papillary muscle - free wall - IV septum

4. What imaging test is useful for detecting lesions on valves?
Decreased forward perfusion pulmonary congestion
Libman - Sacks endocarditis
Transesophageal echo
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

5. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
IV drug users
Gelatinous - abundant ground substance
ASD - R-->L
Rupture of free wall - IV septum - or papillary muscle

6. What are the complications of mitral stenosis?
Rupture of free wall - IV septum - or papillary muscle
Circumflex
Backward LHF pulm htn and RHF - afib and associated mural thombis
Shunt

7. What endocarditis is commonly found in patients with colon cancer?
Heart can't fill
Concentric LV hypertophy
Streptococcus bovis/
Yellow pallor macrophages

8. Large vegetations on tricuspid valve?
ASD - R-->L
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
S aureus

9. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

10. How does restrictive cardiomyopathy present?
Aortic regurg
Doxorubicin - cocaine
Congestive heart failure
Pericardial effusion due to pericardial involvement

11. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
4-24 hours
Reversible
Aneurysm - mural thrombus - Dressler syndrome

12. Turner syndrome is associated with which congenital heart defect?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Infantile coarctation of the aorta

13. How does ischemia cause LHF?
Loss of fx
Stable angina
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Sterile vegetations on mitral valve along lines of closure

14. What gross and microscopic changes occur 4-24 hours after an MI?
Gelatinous - abundant ground substance
Dark discoloration coagulative necrosis
Pericardial effusion due to pericardial involvement
Atherosclerosis of coronary arteries

15. What two things happen when a blocked vessel is opened after an MI?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Contraction band necrosis - reperfusion injury
Libman - Sacks endocarditis
Decreased forward perfusion pulmonary congestion

16. Which angina(s) show ST elevation on EKG? ST depression?
Heart transplant
Prinzmetal stable and unstable
Mitral stenosis
2-3 weeks

17. What is migratory polyarthritis?
Restrictive cardiomyopathy
Metastasis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Positive blood cultures anemia of chronic disease

18. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Papillary muscle - free wall - IV septum
Coxsackie A or B
Aortic regurg

19. What are the sx of cardiac myxoma?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Small vegetations along the line of closure
Yellow pallor macrophages
Pedunculated mass in the LA that causes syncope due to obstruction of MV

20. What is the most common cause of RHF? What are others?
Degree of pulmonary artery stenosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Atria and RV
Prinzmetal angina - cocaine

21. What is the characteristic finding on CXR in tetralogy of fallot?
Systolic ejection click followed by crescendo - decrescendo murmur
Boot shaped heart
Hypertrophic cardiomyopathy
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

22. What % of MIs involve the LAD?
PGE
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
45%
Red border granulation tissue

23. What are the laboratory findings of bacterial endocarditis?
Increased hydrostatic pressure
Harmartoma
Dressler syndrome
Positive blood cultures anemia of chronic disease

24. What type of tumor is a rhabdomyoma?
Harmartoma
Janeway lesions
CK- MB
Posterior wall of LV - posterior septum - papillary muscles

25. What side of the heart do carcinoid tumors affect? Why?
Osler nodes (ouch - ouch Osler)
Gelatinous - abundant ground substance
Right side - serotonin and other secretory products detoxified in the lung
Hypertrophic cardiomyopathy

26. What gross and microscopic changes occur 1-3 weeks after an MI?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Prophylactic abx during dental procedures
Red border granulation tissue
Hypertrophic cardiomyopathy

27. L- to - R shunt switching to R- to - L shunt.
Months out fibrosis
Eisenmenger syndrome
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Dressler syndrome

28. Vegetations on surface and undersurface of mitral valve.
S epidermidis
Bacterial endocarditis
20 min
Libman - Sacks endocarditis

29. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Papillary muscle - free wall - IV septum
1%
Loss of fx
4-7 days macrophage infiltration

30. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Small - nondestructive vegetations (subacute endocarditis)
Mitral insufficiency
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

31. What congenital heart defect is associated with fetal alcohol syndrome?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
White scar fibrosis
VSD
Fibrinous pericarditis

32. What causes endocarditis of prosthetic valves?
PDA
Nitroglycerin
S epidermidis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

33. How does adult coarctation of the aorta present?
Congestive heart failure
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Aschoff bodies
Concentric LV hypertophy

34. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Pancarditis
Contraction band necrosis - reperfusion injury
Pedunculated mass in the LA that causes syncope due to obstruction of MV

35. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Circumflex
LA
Aortic regurg
Transesophageal echo

36. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Endocarditis of prosthetic valves
Thickening of chrodae tendinae and cusps - mitral stenosis
Aschoff bodies

37. What vavular defect results from acute rheumatic fever?
IV drug users
Right to left
Mitral regurgitation due to vegetations
Left -->right

38. What are the two effects of ATII?
Gelatinous - abundant ground substance
S viridans
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Mitral mitral+aortic

39. In which chamber of the heart are rhabdomyomas found?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Systolic ejection click followed by crescendo - decrescendo murmur
Ventricle
Ehlers - Danlow and Marfan syndrome

40. Dilated cardiomyopathy is a late complication of what illness?
Stable and unstable prinzmetal
Myocarditis
Migratory polyarthritis
Myxoid degeneration

41. What maintains patency of the PDA?
Nitroglycerin
PGE
Erythematous nontender lesions on palms and soles.
Slow HR - decreasing O2 demand and risk for arrhythmia

42. What congenital heart defect does indomethacin tx?
Left -->right
S viridans
Coexisting mitral stenosis and fusion of commisures exist
PDA

43. What typically causes hypertrophic cardiomyopathy?
Granulation tissue
Contraction band necrosis
Decrease in blood flow to an organ
AD mutation in sarcomere proteins

44. What characterizes acute rheumatic fever endocarditiis?
Months out fibrosis
Preductal - post aortic arch
Small vegetations along the line of closure
2-3%

45. What type of shunt results in cyanosis at birth?
Right to left
LV dilation and eccentric hypertrophy
Nitroglycerin
S viridans

46. What does rupture of a papillary muscle cause?
Rhabdomyoma
Mitral mitral+aortic
Mitral insufficiency
Aortic stenosis

47. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Atherosclerosis of coronary arteries
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
Pump failure

48. What does chronic ischemic heart disease progress to?
Pulsating nail bed
PDA
LAD
CHF

49. How does MI cause LHF?
Loss of LV fx
PGE
Tender lesions on fingers or toes.
20 min

50. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Volume overload and LHF
MI