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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. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Yellow pallor neutrophils
When a bacterial protein resembles a protein in human tissue
Months out fibrosis
Endocarditis of prosthetic valves

2. What murmur ccan be heard in PDA?
Ehlers - Danlow and Marfan syndrome
Congested central veins
Ventricles cannot pump
Holosystolic machine like murmur

3. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
LAD
Stable and unstable prinzmetal
Squat in response to cyanotic spell

4. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Large vegetations of S aureus
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Systolic dysfx leading to biventricular CHF

5. In which pts does S viridans cause endocarditits?
LV dilation and eccentric hypertrophy
Volume overload and LHF
Pts w/previously damaged valves
Dark discoloration coagulative necrosis

6. With what condition are rhabdomyomas associated?
Mitral and tricuspid regurg - arrhythmia
Tuberous sclerosis
Metastasis
Troponin I

7. What is the murmur of mitral valve prolapse?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Squatting - increased systemic resistence decreases LV emptying
Mid - systolic click followed by regurgitation murmur

8. What is systolic dysfx?
Decreased forward perfusion pulmonary congestion
Ventricles cannot pump
Left -->right
1-3 days

9. How does dilated cardiomyopathy cause LHF?
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
Stretched muscle loses contractility
Degree of pulmonary artery stenosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

10. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Backward LHF pulm htn and RHF - afib and associated mural thombis
Nitroglycerin
Elevated ASO anti - DNase B titers

11. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
ST- segment depression
Mitral regurgitation due to vegetations

12. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Tender lesions on fingers or toes.
VSD
Transesophageal echo

13. What is the tx for VSD?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Surgical closure small defects may close spontaneously
Hypertrophic cardiomyopathy
Membrane damage

14. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Dense layer of elastic and fibrotic tissue in the endocardium - children
PDA
Increased hydrostatic pressure
Positive blood cultures anemia of chronic disease

15. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
R-->L
Myocarditis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
ASD - R-->L

16. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Congestive heart failure
Louder - increased systemic resistence decreases LV emptying
Large - destructive vegetations
Aschoff bodies

17. What two things cause coronary artery vasospasm?
Chest pain <20 min brought on by exertion or emotional stress
Prinzmetal angina - cocaine
Streptococcus bovis/
Yellow pallor neutrophils

18. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Nonspecific - eg fever and elevated ESR
S epidermidis
Decrease preload -->lowers myocardial stress
>60 years - bicuspid aortic valve

19. Large vegetations on tricuspid valve?
Ischemic heart disease
S aureus
Left -->right
Right side - serotonin and other secretory products detoxified in the lung

20. What are the four defects in tetralogy of fallot?
PDA
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Maternal diabetes
Heart transplant

21. What effect does mitral stenosis have on the heart chambers?
Holosystolic machine like murmur
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
LA dilation
Migratory polyarthritis

22. 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
Increased blood in right heart delays closure of P valve
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Small vegetations along the line of closure

23. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Metastasis
Months out fibrosis
Day 1-7
Ehlers - Danlow and Marfan syndrome

24. What are the sx of pericardiits?
Shunt
Blood vessels coming in from normal tissue
LA dilation
Friction rub and chest pain

25. What areas of the heart does the RCA supply?
Streptococcus bovis/
White scar fibrosis
Posterior wall of LV - posterior septum - papillary muscles
Bounding pulse

26. What is the etiology of S viridans endocarditis?
Streptococcus bovis/
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Mid - systolic click followed by regurgitation murmur
S epidermidis

27. What is typically the mechanims of sudden cardiac death?
Coronary artery vasospasm
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ventricular arrhythmia
Hypertophy of RV atrophy of LV

28. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Subendocardial
Rupture of free wall - IV septum - or papillary muscle

29. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Annular - non pruritic rash w/erythematous borders trunks and limbs
Dilation of all four chambers of the heart
Left -->right
Reperfusion injury

30. What is the cause of restrictive cardiomyopathy in children?
Heart can't fill
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Endocardial fibroelastosis (rare)
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

31. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Ostium primum
Cyanosis - RV hypertrophy - polycythemia - clubbing
Regurg vs stenosis
Intercostal arteries enlarged due to collateral circulation

32. How do beta blockers tx MI?
Mitral mitral+aortic
Turner syndrome
Indomethacin - decreases PGE
Slow HR - decreasing O2 demand and risk for arrhythmia

33. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Mitral and tricuspid regurg - arrhythmia
Shunt - PGE to maintain PDA until surgical repair can be performed
Low voltage EKG w/diminished QRS amplitude

34. What are heart failure cells?
Hemosiderin laden macrophages
Streptococcus viridans
L->R
Systemic venous congestion

35. What type of collagen is involved in fibrosis?
Type I
R-->L
First 4 hours
Hypertrophic cardiomyopathy

36. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Autoimmune pericarditis 6-8 wks post MI
Louder - increased systemic resistence decreases LV emptying
>60 years - bicuspid aortic valve

37. Which congenital heart defect is associated with maternal diabetes?
Reversible
Transposition of the great vessels
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Sudden cardiac death

38. What are the laboratory findings of bacterial endocarditis?
Bounding pulse
Chronic rheumatic heart disease
45%
Positive blood cultures anemia of chronic disease

39. What is the most common cause of dilated cardiomyopathy? What are other causes?
S viridans
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Coronary artery vasospasm - emboli - vasculitis
Metastasis

40. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
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
Autoimmune pericarditis 6-8 wks post MI
Aortic stenosis
Stable and unstable prinzmetal

41. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Congested central veins
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

42. What type of shunt dose PDA cause?
Left -->right
Transesophageal echo
Pts w/previously damaged valves
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

43. What is endocardial fibroelastosis? In what population is it found?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Endocardial fibroelastosis
VSD
Dense layer of elastic and fibrotic tissue in the endocardium - children

44. What % stenosis causes stable angina?
Nitroglycerin
R-->L
>70%
Loeffler syndrome

45. What type of ASD is associated w/Down syndrome?
Rupture of free wall - IV septum - or papillary muscle
Papillary muscle - free wall - IV septum
Surgical closure small defects may close spontaneously
Ostium primum

46. What is the only Jones criteria that doesn't resolve with time?
Valve scarring that arises as a consequence of rheumatic fever
Valve replacement AFTER the onset of complications
Pancarditis
Low voltage EKG w/diminished QRS amplitude

47. How does restrictive cardiomyopathy cause LHF?

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48. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Reactive histiocyte with caterpillar nucleus
20 min
Prinzmetal angina
Intercostal arteries enlarged due to collateral circulation

49. What does nonbacterial thrombotic endocarditis cause?
When a bacterial protein resembles a protein in human tissue
1%
Mitral regurg
Ehlers - Danlow and Marfan syndrome

50. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Elevated ASO anti - DNase B titers
Hypertrophic cardiomyopathy