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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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1. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Myocarditis in acute rheumatic heart fever
Mitral valve prolapse
Type I

2. What is the effect of mitral regurg on the heart?
2-4 hours - 24 hours - 7-10 days
Myocarditis
Volume overload and LHF
2-3 weeks

3. When is an MI patent at highest risk for fibrionous pericarditis?
Ischemic heart disease
1-3 days out
Subendocardial
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

4. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
ST- segment depression
Congestive heart failure
R-->L

5. What is the most common cause of RHF? What are others?
2-3%
AD mutation in sarcomere proteins
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Pulsating nail bed

6. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Pancarditis
R-->L
Transposition of the great vessels

7. What type of vegetations does Strep viridans cause?
Dilation of all four chambers of the heart
Ventricles cannot pump
Mitral stenosis
Small - nondestructive vegetations (subacute endocarditis)

8. What are the four defects in tetralogy of fallot?
Contraction band necrosis
Myxoma - benign
Mitral mitral+aortic
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

9. What causes microangiopathic hemolytic anemia in aortic stenosis?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Contraction band necrosis - reperfusion injury
RBC damaged while crossing the calcified valve causing schistocytes
Tetralogy of fallot

10. What increases the volume of mitral regurg murmur?
PDA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Squatting - expiration
Cyanosis - RV hypertrophy - polycythemia - clubbing

11. How does restrictive cardiomyopathy cause LHF?

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12. What are heart failure cells?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
ST- segment elevation
Myocarditis in acute rheumatic heart fever
Hemosiderin laden macrophages

13. What is an Aschoff body?
Myocarditis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Split S2 on auscultation
Sudden cardiac death

14. What creates the immune reaction in acute rhuematic fever?

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15. What is the foundation of a scar?
Pericardial effusion due to pericardial involvement
Slow HR - decreasing O2 demand and risk for arrhythmia
Granulation tissue
Nonbacterial thrombotic endocarditis (marantic endocarditis)

16. What is diastolic dysfx?
PDA
Inability to fill ventricles
Dilated
Streptococcus viridans

17. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Coexisting mitral stenosis and fusion of commisures exist
Shunt - PGE to maintain PDA until surgical repair can be performed
Limits thrombosis

18. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Aortic regurg
Friction rub and chest pain
Stretched muscle loses contractility

19. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Thickening of chrodae tendinae and cusps - mitral stenosis
Stable angina
Heart can't fill

20. Turner syndrome is associated with which congenital heart defect?
Inability to fill ventricles
Infantile coarctation of the aorta
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
S aureus

21. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Hemosiderin laden macrophages
>60 years - bicuspid aortic valve
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Congestive heart failure

22. Which coronary artery supplies the posterior wall of the LV and posterior septum?
S aureus
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
RCA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

23. What is the most common cause of myocarditis?
When a bacterial protein resembles a protein in human tissue
Coxsackie A or B
Dense layer of elastic and fibrotic tissue in the endocardium - children
Papillary muscle - free wall - IV septum

24. What type of valvular vegetations does S aureus cause?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Large - destructive vegetations
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Prinzmetal angina

25. What is a complication of chronic rheumatic heart disease?
2-3%
Acute inflammation
Infectious endocarditis
Increased blood in right heart delays closure of P valve

26. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
PDA
Volume overload and LHF
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

27. What cardiac enzyme is useful for detecting reinfarction?
Libman - Sacks endocarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
CK- MB

28. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Tender lesions on fingers or toes.
LAD
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

29. What is the cause of the red border around granulation tissue?
Ventricle
Louder - increased systemic resistence decreases LV emptying
Blood vessels coming in from normal tissue
Infectious endocarditis - arrythmias - severe mitral regurg no

30. How does MI cause LHF?
VSD
Squat in response to cyanotic spell
Osler nodes (ouch - ouch Osler)
Loss of LV fx

31. What is the basic principle of CHF?
Pump failure
Mitral mitral+aortic
Fetal alcohol syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

32. What is the tx for mitral valve prolapse?
Endocardial fibroelastosis (rare)
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Fetal alcohol syndrome
Valve replacement

33. What is the most common cause of infectious endocarditis?
Streptococcus viridans
PDA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Hypercoagulable state or underlying adenocarcinoma

34. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Left -->right
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Coronary artery vasospasm - emboli - vasculitis

35. What is the most common form of cardiomyopathy?
Dilated
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Volume overload and LHF
Pericardial effusion due to pericardial involvement

36. When does the heart have dark discoloration post MI?
4-24 hours
Anterior wall of LV and anterior septum
LA
Atherosclerosis of coronary arteries

37. How do ACE inhibitors tx MI?
Dark discoloration coagulative necrosis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Decreases LV dilation by decreasing volume
Infantile coarctation of the aorta

38. Systolic ejection click followed by crescendo - decrescendo murmur.
PDA
Aortic stenosis
Mitral regurg
Right side - serotonin and other secretory products detoxified in the lung

39. Is injury due angina reversible or irreversible?
Reversible
PDA
RBC damaged while crossing the calcified valve causing schistocytes
Ventricles cannot pump

40. When do macrophagess infiltrate the myocardium post MI?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Thickening of chrodae tendinae and cusps - mitral stenosis
4-7 days
>60 years - bicuspid aortic valve

41. What drugs can cause dilated cardiomyopathy?
Cardiogenic shock - CHF - arrhythmia
Doxorubicin - cocaine
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
S aureus

42. What is the most common cause of mitral stenosis?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Chronic rheumatic heart disease
Cardiac tamponade
Prinzmetal

43. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Inability to maintain systemic pressure w/lack of O2 to vital organs
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Dressler syndrome

44. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
PDA
Months out fibrosis
Mitral insufficiency
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

45. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Dilation of all four chambers of the heart
Reperfusion injury
Nitroglycerin
Dressler syndrome

46. What effect does mitral stenosis have on the heart chambers?
Pericarditits
Mid - systolic click followed by regurgitation murmur
Troponin I
LA dilation

47. What are the complications of aortic stenosis?
LHF
Tuberous sclerosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

48. Large vegetations on tricuspid valve?
S aureus
Shunt
ST- segment depression
Streptococcus viridans

49. How does transmural MI/ischemia present on EKG?
Trisomy 21
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
ST- segment elevation
R-->L

50. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Coexisting mitral stenosis and fusion of commisures exist
>60 years - bicuspid aortic valve