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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. What is the characteristic finding on CXR in tetralogy of fallot?
Day 1-7
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Boot shaped heart
Left -->right

2. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
ST- segment depression
Paradoxical emboli
Bounding pulse

3. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Dilation of all four chambers of the heart
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Bounding pulse

4. What are Osler nodes?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Tender lesions on fingers or toes.
Valve replacement AFTER the onset of complications
Coexisting mitral stenosis and fusion of commisures exist

5. What are other (not atherosclerotic) causes of MI?
Endocarditis of prosthetic valves
Transposition of the great vessels
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Coronary artery vasospasm - emboli - vasculitis

6. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Myofiber hypertrophy with disarray
Louder - increased systemic resistence decreases LV emptying
Mitral regurg

7. How does hypertension cause LHF?

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8. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Anterior wall of LV and anterior septum
Coronary artery vasospasm
Myxoma - benign

9. Tender lesions on fingers or toes.
Minimizes ischemia
Osler nodes (ouch - ouch Osler)
Eisenmenger syndrome
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

10. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Loss of fx
Valve replacement
PDA

11. What are the major criteria of the Jones criteria?
Large vegetations of S aureus
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
R-->L
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

12. What is the most common cause of aortic stenosis?
Wear and tear
Libman - Sacks endocarditis
Trisomy 21
Troponin I

13. How does ischemia cause LHF?
Decreases LV dilation by decreasing volume
Loss of fx
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nitroglycerin

14. How does dilated cardiomyopathy cause LHF?
Congested central veins
Stretched muscle loses contractility
Myocarditis in acute rheumatic heart fever
Tetralogy of fallot

15. What is systolic dysfx?
Adult coarctation of the aorta
Ventricles cannot pump
Squat in response to cyanotic spell
Indomethacin - decreases PGE

16. What causes notching of the ribs in adult coarctation of the aorta?
Troponin I
Intercostal arteries enlarged due to collateral circulation
Decrease preload -->lowers myocardial stress
Valve replacement

17. What is the most common cause of endocarditis in IV drug users?
Pump failure
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Type I
S aureus

18. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Myocardium
Coronary artery vasospasm
Tender lesions on fingers or toes.

19. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Aortic regurg
Within the first day
Pulsating nail bed

20. L- to - R shunt switching to R- to - L shunt.
Right to left
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Eisenmenger syndrome
Plump fibroblasts - collagen - blood vessels

21. Opening snap followed by diastolic rumble.
Autoimmune pericarditis 6-8 wks post MI
Friction rub and chest pain
Mitral stenosis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

22. When does the heart have a yellow pallor post MI?
ST- segment elevation
Stable and unstable prinzmetal
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Day 1-7

23. Where is the coarctation in infantile coarctation of the aorta?
Hypercoagulable state or underlying adenocarcinoma
Intercostal arteries enlarged due to collateral circulation
Preductal - post aortic arch
Slow HR - decreasing O2 demand and risk for arrhythmia

24. What does rupture of a papillary muscle cause?
Loss of LV fx
PDA
1%
Mitral insufficiency

25. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
PDA
Right side - serotonin and other secretory products detoxified in the lung
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
RHF

26. Which angina is relieved by Ca channel blockers?
Prinzmetal
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
PDA
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

27. What is the characteristic murmur of aortic stenosis?
ACE inhibitor
Endocardial fibroelastosis
Systolic ejection click followed by crescendo - decrescendo murmur
4-7 days macrophage infiltration

28. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Myofiber hypertrophy with disarray
RCA
Mid - systolic click followed by regurgitation murmur

29. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
RHF
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

30. What are the tx for MI?
Congenital rubella
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Elevated ASO anti - DNase B titers
ASD - R-->L

31. What congenital heart defect is associated with fetal alcohol syndrome?
VSD
Nonspecific - eg fever and elevated ESR
Gelatinous - abundant ground substance
Atria and RV

32. What are the complications that occur months after an MI?
2-4 hours - 24 hours - 7-10 days
MI
Erythematous nontender lesions on palms and soles.
Aneurysm - mural thrombus - Dressler syndrome

33. What effect does mitral stenosis have on the heart chambers?
4-24 hours
Myocarditis
Decreases LV dilation by decreasing volume
LA dilation

34. What two things cause coronary artery vasospasm?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Prinzmetal angina - cocaine
Membrane damage
Fetal alcohol syndrome

35. What typically causes hypertrophic cardiomyopathy?
Fetal alcohol syndrome
LAD
AD mutation in sarcomere proteins
Mid - systolic click followed by regurgitation murmur

36. How do you prevent S viridans endocarditis?
Split S2 on auscultation
MI
Spontaneous
Prophylactic abx during dental procedures

37. What causes acute endocarditis?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Large vegetations of S aureus
Ventricular arrhythmia
Atherosclerosis of coronary arteries

38. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Sterile vegetations on mitral valve along lines of closure
Pancarditis
Mitral insufficiency

39. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Janeway lesions
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
4-7 days macrophage infiltration
First 4 hours

40. Pericarditis 6-8 wks post MI.
Decrease preload -->lowers myocardial stress
Mitral regurg
Dressler syndrome
S epidermidis

41. What are the complications of mitral valve prolapse? Are they common?
Membrane damage
Infectious endocarditis - arrythmias - severe mitral regurg no
Libman - Sacks endocarditis
2-3 weeks

42. When do troponin levels rise - peak - and return to normal?
First 4 hours
Increased hydrostatic pressure
2-4 hours - 24 hours - 7-10 days
Coxsackie A or B

43. What effect does chronic rheumatic heart disease have on the aortic valve?

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44. What artery is the 2nd most often occluded in an MI?
Opening snap followed by diastolic rumble
Holosystolic blowing murmur
Tricuspid
RCA

45. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Posterior wall of LV - posterior septum - papillary muscles
Ischemic heart disease
4-7 days

46. Tx for PDA?
Ehlers - Danlow and Marfan syndrome
Prinzmetal
Nitroglycerin
Indomethacin - decreases PGE

47. What effect does dilated cardiomyopathy have on the heart?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
>60 years - bicuspid aortic valve
Systolic dysfx leading to biventricular CHF
Chronic rheumatic heart disease

48. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
4-7 days
PDA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Anitschow cell

49. With what disease is Libman - Sacks endocarditis associated?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
S epidermidis
Rhabdomyoma
SLE

50. What gross and microscopic changes occur 4-24 hours after an MI?
LA dilation
PDA
Dark discoloration coagulative necrosis
Dressler syndrome