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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. Is scar tissue or myocardium stronger?
Squatting - increased systemic resistence decreases LV emptying
Hypertophy of RV atrophy of LV
Myocardium
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

2. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Ventricle
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
>60 years - bicuspid aortic valve

3. EKG for stable angina?
ST- segment depression
LA
IV drug users
Shunt

4. What type of vegetations are associated with Libman - Sacks endocarditis?
Autoimmune pericarditis 6-8 wks post MI
Sterile vegetations on surface and undersurface on mitral valve
Small - nondestructive vegetations (subacute endocarditis)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

5. What % of MIs involve the LAD?
Friction rub and chest pain
45%
Prinzmetal stable and unstable
Mid - systolic click followed by regurgitation murmur

6. What are the complications of mitral stenosis?
Transesophageal echo
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Backward LHF pulm htn and RHF - afib and associated mural thombis
Right to left

7. What complications occur 4-7 days post MI?
Mitral regurg
Rupture of free wall - IV septum - or papillary muscle
Eisenmenger syndrome
Asymptomatic

8. What is a water - hammer pulse?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Bounding pulse
Mid - systolic click followed by regurgitation murmur
Trisomy 21

9. With what developmental disorder is VSD associated?
Myocardium
Degree of pulmonary artery stenosis
Fetal alcohol syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)

10. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
2-3%
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Degree of pulmonary artery stenosis

11. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Mitral and tricuspid regurg - arrhythmia
Positive blood cultures anemia of chronic disease
Osler nodes (ouch - ouch Osler)

12. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Mitral mitral+aortic
Surgical closure small defects may close spontaneously

13. What type of shunt does truncus arteriosus cause?
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
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
R-->L
Doxorubicin - cocaine

14. What are the complications that occur months after an MI?
Infantile coarctation of the aorta
Streptococcus bovis/
Inability to maintain systemic pressure w/lack of O2 to vital organs
Aneurysm - mural thrombus - Dressler syndrome

15. What genetic conditions predispose a pt to mitral valve prolapse?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ehlers - Danlow and Marfan syndrome
4-7 days macrophage infiltration

16. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Migratory polyarthritis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
CK- MB

17. What is the most common cause of dilated cardiomyopathy? What are other causes?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
CHF
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Fibrosis and dystrophic calcification

18. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
VSD
Nitroglycerin
Backward LHF pulm htn and RHF - afib and associated mural thombis

19. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Chronic ischemic heart disease
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
Paradoxical emboli

20. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Infectious endocarditis
Streptococcus viridans
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

21. How does asprin/heparin tx MI?
Surgical closure small defects may close spontaneously
Backward LHF pulm htn and RHF - afib and associated mural thombis
Limits thrombosis
Subendocardial

22. Pericarditis 6-8 wks post MI.
PGE
Mid - systolic click followed by regurgitation murmur
Dressler syndrome
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

23. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Myofiber hypertrophy with disarray
Transposition of the great vessels
1%

24. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Pulsating nail bed
PDA
S aureus

25. What bug causes acute rheumatic fever?
CK- MB
Group A beta - hemolytic streptococci
Fibrosis and dystrophic calcification
Holosystolic machine like murmur

26. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Prinzmetal angina - cocaine
Sterile vegetations on surface and undersurface on mitral valve
Chest pain <20 min brought on by exertion or emotional stress
Adult coarctation of the aorta

27. What is the rate of mitral valve prolapse in the US?
Sudden cardiac death
2-3%
Chronic rheumatic heart disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

28. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Reactive histiocyte with caterpillar nucleus
Valve replacement
Prinzmetal angina

29. What is the classic EKG finding of restrictive cardiomyopathy?
Valve replacement once LV dysfx develops
Ventricle
Low voltage EKG w/diminished QRS amplitude
Dressler syndrome

30. What is typically the mechanims of sudden cardiac death?
Libman - Sacks endocarditis
Yellow pallor macrophages
PGE
Ventricular arrhythmia

31. What does granulation tissue contain?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Stretched muscle loses contractility
Libman - Sacks endocarditis
Plump fibroblasts - collagen - blood vessels

32. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Mitral regurgitation due to vegetations
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
RCA
Mitral regurg

33. What does a biopsy of hypertrophic cardiomyopathy look like?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Coexisting mitral stenosis and fusion of commisures exist
Dense layer of elastic and fibrotic tissue in the endocardium - children
Myofiber hypertrophy with disarray

34. Infects predamaged valves after transient bacteremia?
Bacterial endocarditis
Infectious endocarditis - arrythmias - severe mitral regurg no
S viridans
Pulsating nail bed

35. What effect does transposition of the great vessels have on the ventricles?
Myocarditis
Hypertophy of RV atrophy of LV
Pancarditis
Hypertrophic cardiomyopathy

36. When is an MI pt at greatest risk for cardiogenic shock?
NG or Ca channel blocker
First 4 hours
Squat in response to cyanotic spell
Papillary muscle - free wall - IV septum

37. What is the JOneS mneumonic?
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
Harmartoma
Right to left
Ehlers - Danlow and Marfan syndrome

38. What type of ASD is associated w/Down syndrome?
Nitroglycerin
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Inability to fill ventricles
Ostium primum

39. How does restrictive cardiomyopathy cause LHF?

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40. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Mid - systolic click followed by regurgitation murmur
Libman - Sacks endocarditis
Tuberous sclerosis

41. Which congenital heart defect is associated with maternal diabetes?
Anitschow cell
Transposition of the great vessels
3-8 wks
Nonbacterial thrombotic endocarditis (marantic endocarditis)

42. When do troponin levels rise - peak - and return to normal?
Trisomy 21
2-4 hours - 24 hours - 7-10 days
Blood vessels coming in from normal tissue
Posterior wall of LV - posterior septum - papillary muscles

43. What is diastolic dysfx?
Dark discoloration coagulative necrosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Inability to fill ventricles
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

44. When does the heart have dark discoloration post MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Transposition of the great vessels
Rupture of free wall - IV septum - or papillary muscle
4-24 hours

45. What does rupture of a papillary muscle cause?
1%
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral insufficiency
Blood vessels coming in from normal tissue

46. What type of vegetations form in nonbacterial thrombotic endocarditis?
IV drug users
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Sterile vegetations on mitral valve along lines of closure
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

47. How do you tx prinzmetal angina?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Granulation tissue
PDA
NG or Ca channel blocker

48. What causes a mid - systolic click followed by a regurgitation murmur?
Paradoxical emboli
Dilated
1-3 days
Mitral valve prolapse

49. What is Loeffler syndrome?
When a bacterial protein resembles a protein in human tissue
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Infectious
Asymptomatic

50. What % stenosis causes stable angina?
Valve scarring that arises as a consequence of rheumatic fever
2-4 hours - 24 hours - 7-10 days
MI
>70%