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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. Friction rub and chest pain.
Decrease preload -->lowers myocardial stress
PDA
Granulation tissue
Pericarditits

2. What is chronic rheumatic heart disease?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Subendocardial
Valve scarring that arises as a consequence of rheumatic fever
CHF

3. Is injury due angina reversible or irreversible?
Increased blood in right heart delays closure of P valve
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Congenital rubella
Reversible

4. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
RHF
Adult coarctation of the aorta
Pts w/previously damaged valves
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

5. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
3-8 wks
Aschoff bodies
Nonspecific - eg fever and elevated ESR

6. What is a complication of chronic rheumatic heart disease?
MI
Infectious endocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Right side - serotonin and other secretory products detoxified in the lung

7. What is the basic principle of CHF?
Small - nondestructive vegetations (subacute endocarditis)
Valve scarring that arises as a consequence of rheumatic fever
Pump failure
PDA

8. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Circumflex
Doxorubicin - cocaine
Months out fibrosis
Hypercoagulable state or underlying adenocarcinoma

9. How does aortic regurg affect the heart chambers?
Dark discoloration coagulative necrosis
Yellow pallor macrophages
Dressler syndrome
LV dilation and eccentric hypertrophy

10. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Preductal - post aortic arch
Infectious endocarditis - arrythmias - severe mitral regurg no
Pancarditis

11. What generally causes ischemic heart disease?
Contraction band necrosis - reperfusion injury
Transesophageal echo
Atherosclerosis of coronary arteries
4-24 hours

12. What are the sx of right - to - left shunt?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Cyanosis - RV hypertrophy - polycythemia - clubbing
Regurg vs stenosis
NG or Ca channel blocker

13. What are the complications of mitral stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Congenital rubella
Aneurysm - mural thrombus - Dressler syndrome
Backward LHF pulm htn and RHF - afib and associated mural thombis

14. What drugs can cause dilated cardiomyopathy?
Endocardial fibroelastosis (rare)
Doxorubicin - cocaine
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Split S2 on auscultation

15. Large vegetations on tricuspid valve?
Pericardial effusion due to pericardial involvement
Systolic ejection click followed by crescendo - decrescendo murmur
S aureus
Limits thrombosis

16. What is the tx for dilated cardiomyopathy?
Cardiogenic shock - CHF - arrhythmia
Heart transplant
Transesophageal echo
Ventricles cannot pump

17. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Granulation tissue
Open blocked vessels
PGE

18. With what endocarditis is S epidermidis associated?
Right side - serotonin and other secretory products detoxified in the lung
Stable and unstable prinzmetal
Endocarditis of prosthetic valves
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

19. Myofiber hypertrophy with disarray.
Dense layer of elastic and fibrotic tissue in the endocardium - children
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Positive blood cultures anemia of chronic disease
Hypertrophic cardiomyopathy

20. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Endocardial fibroelastosis (rare)
Sterile vegetations on surface and undersurface on mitral valve
Preductal - post aortic arch

21. What is the most common type of endocarditis?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
LA
Aortic regurg
Infectious

22. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Wear and tear
Systemic venous congestion
20 min
Myocarditis

23. What congenital heart defect does indomethacin tx?
4-6 hours - 24 hours - 72 hours
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
PDA
RBC damaged while crossing the calcified valve causing schistocytes

24. With what condition are rhabdomyomas associated?
Eisenmenger syndrome
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Tuberous sclerosis

25. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Heart transplant
Shunt

26. How does ischemia cause LHF?
Surgical closure small defects may close spontaneously
Months out fibrosis
Loss of fx
LV dilation and eccentric hypertrophy

27. What are the clinical features of RHF?
Pulsating nail bed
Aortic regurg
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Nonbacterial thrombotic endocarditis (marantic endocarditis)

28. In what pt population does S aureus commonly cause valvular disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
IV drug users
Aortic regurg
Turner syndrome

29. In which chamber of the heart are cardiac myxomas found?
Maternal diabetes
Ventricular arrhythmia
LA
Pulsating nail bed

30. What iis the tx for aortic regurg?
Gelatinous - abundant ground substance
Valve replacement once LV dysfx develops
Regurg vs stenosis
Migratory polyarthritis

31. What gross and microscopic changes occur months after an MI?
Infectious
White scar fibrosis
Stable and unstable prinzmetal
NG or Ca channel blocker

32. When do CK- MB levels rise - peak - and return to normal?
Degree of pulmonary artery stenosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Cardiogenic shock - CHF - arrhythmia
4-6 hours - 24 hours - 72 hours

33. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Mitral valve prolapse
Decreased forward perfusion pulmonary congestion
RHF

34. How do you tx prinzmetal angina?
Concentric LV hypertophy
Reversible
NG or Ca channel blocker
Mitral mitral+aortic

35. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Group A beta - hemolytic streptococci
Squatting - increased systemic resistence decreases LV emptying
Volume overload and LHF
Nonbacterial thrombotic endocarditis (marantic endocarditis)

36. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Infectious
Systolic dysfx leading to biventricular CHF
S aureus

37. Systolic ejection click followed by crescendo - decrescendo murmur.
Type I
Troponin I
Preductal - post aortic arch
Aortic stenosis

38. What coronary artery supplies the mitral valve papillary muscles?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
RCA
Eisenmenger syndrome

39. With what congenital heart defect is ADULT coarctation of the aorta associated?
Small - nondestructive vegetations (subacute endocarditis)
20 min
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Bicuspid aortic valve

40. Lower extremity cyanosis in infants? In adults?
Congested central veins
4-6 hours - 24 hours - 72 hours
PDA
Infantile coarctation of the aorta PDA

41. What determines the extent of shunting and cyanosis in tetralogy of fallot?
1-3 days
Degree of pulmonary artery stenosis
2-3%
4-7 days macrophage infiltration

42. What is Dressler syndrome? When does it occur?
Bicuspid aortic valve
Congested central veins
Transesophageal echo
Autoimmune pericarditis 6-8 wks post MI

43. What causes endocarditis of prosthetic valves?
S epidermidis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Large - destructive vegetations
Congested central veins

44. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Anitschow cell
Opening snap followed by diastolic rumble

45. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
R-->L
VSD

46. Opening snap followed by diastolic rumble.
Systemic venous congestion
Mitral stenosis
Systolic ejection click followed by crescendo - decrescendo murmur
Myofiber hypertrophy with disarray

47. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
2-3 weeks
4-7 days macrophage infiltration
Months out fibrosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

48. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Reactive histiocyte with caterpillar nucleus
Yellow pallor macrophages
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

49. What maintains patency of the PDA?
Rhabdomyoma
PGE
ASD - R-->L
Rupture of free wall - IV septum - or papillary muscle

50. Why are cardiac enzymes elevated after an MI?
Squat in response to cyanotic spell
Membrane damage
Prophylactic abx during dental procedures
Limits thrombosis