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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 endocardial fibroelastosis? In what population is it found?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
VSD
Dense layer of elastic and fibrotic tissue in the endocardium - children
Opening snap followed by diastolic rumble

2. What does chronic ischemic heart disease progress to?
Pericarditits
CHF
LV dilation and eccentric hypertrophy
Myofiber hypertrophy with disarray

3. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Concentric LV hypertophy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Subendocardial

4. What is the tx for mitral valve prolapse?
Valve scarring that arises as a consequence of rheumatic fever
Valve replacement
Prinzmetal angina - cocaine
Hypertophy of RV atrophy of LV

5. What is systolic dysfx?
Dilated
Mitral stenosis
Decrease preload -->lowers myocardial stress
Ventricles cannot pump

6. What effect does aortic regurg have on the pulse pressure? Why?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Rhabdomyoma
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
CHF

7. What effect does mitral stenosis have on the heart chambers?
Myxoid degeneration
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Decreased forward perfusion pulmonary congestion
LA dilation

8. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Type I
Valve replacement
Hypercoagulable state or underlying adenocarcinoma

9. Which chambers of the heart are generally spared in an MI?
Inability to fill ventricles
Transesophageal echo
Atria and RV
>60 years - bicuspid aortic valve

10. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Fetal alcohol syndrome
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

11. What is the classic EKG finding of restrictive cardiomyopathy?
Bounding pulse
Myxoid degeneration
Low voltage EKG w/diminished QRS amplitude
Rupture of free wall - IV septum - or papillary muscle

12. What does Libman - Sacks endocarditis cause?
ASD - R-->L
Within the first day
Mitral regurg
Ischemic heart disease

13. 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
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Yellow pallor neutrophils
CK- MB

14. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Mitral regurg
Prinzmetal
Reversible

15. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
4-24 hours
Nitroglycerin
Aortic stenosis

16. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
Months out fibrosis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Tuberous sclerosis

17. Poor myocardial fx due to chronic ischemic damage?
Ventricular arrhythmia
Chronic ischemic heart disease
Myofiber hypertrophy with disarray
Mitral mitral+aortic

18. When do macrophagess infiltrate the myocardium post MI?
Opening snap followed by diastolic rumble
4-7 days
Breast and lung carcinoma - melanoma - lymphoma
Coronary artery vasospasm - emboli - vasculitis

19. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
S aureus
Anitschow cell
RHF

20. What is the most common congenital heart defect?
Aortic regurg
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Tricuspid
VSD

21. What are the causes of LHF?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Fibrosis and dystrophic calcification

22. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral mitral+aortic
Mitral valve prolapse
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Annular - non pruritic rash w/erythematous borders trunks and limbs

23. In which chamber of the heart are rhabdomyomas found?
Bounding pulse
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Prinzmetal angina
Ventricle

24. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
MI
VSD
Myofiber hypertrophy with disarray

25. Which congenital heart defect is associated with maternal diabetes?
Low voltage EKG w/diminished QRS amplitude
Transposition of the great vessels
R-->L
Right -->left

26. What causes heart failure cells?
Pump failure
Harmartoma
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

27. Myofiber hypertrophy with disarray.
ACE inhibitor
Myocarditis in acute rheumatic heart fever
Reversible
Hypertrophic cardiomyopathy

28. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
>60 years - bicuspid aortic valve
Loss of fx
Fibrosis and dystrophic calcification

29. How does O2 tx MI?
Mitral regurgitation due to vegetations
Annular - non pruritic rash w/erythematous borders trunks and limbs
Loss of fx
Minimizes ischemia

30. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
>70%
Stretched muscle loses contractility
Sudden cardiac death

31. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Systolic dysfx leading to biventricular CHF
Hypertrophic cardiomyopathy
Nonbacterial thrombotic endocarditis (marantic endocarditis)

32. What is the effect of mitral regurg on the heart?
Blood vessels coming in from normal tissue
Volume overload and LHF
Concentric LV hypertophy
PDA

33. Is scar tissue or myocardium stronger?
LA dilation
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
PDA
Myocardium

34. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Nonbacterial thrombotic endocarditis (marantic endocarditis)
2-4 hours - 24 hours - 7-10 days
Bicuspid aortic valve

35. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Mitral insufficiency
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Small vegetations along the line of closure

36. How does reperfusion injury occur?
LA
Low voltage EKG w/diminished QRS amplitude
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
MI

37. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Decrease preload -->lowers myocardial stress
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
LHF

38. What type of shunt results in cyanosis at birth?
LA dilation
Cyanosis - RV hypertrophy - polycythemia - clubbing
Contraction band necrosis
Right to left

39. What are the cancers that most commonly metastasize to the heart?
Ventricle
Regurg vs stenosis
Hemosiderin laden macrophages
Breast and lung carcinoma - melanoma - lymphoma

40. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Concentric LV hypertophy
Migratory polyarthritis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

41. What disesase has Aschoff bodies?
PDA
Decrease preload -->lowers myocardial stress
Myocarditis in acute rheumatic heart fever
Hypertrophic cardiomyopathy

42. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Right to left
Heart can't fill
Restrictive cardiomyopathy

43. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Cardiac tamponade
Contraction band necrosis
Degree of pulmonary artery stenosis
Nitroglycerin

44. What is the most common type of ASD? What %?
Erythematous nontender lesions on palms and soles.
Small - nondestructive vegetations (subacute endocarditis)
Subendocardial
Ostium secundum (90%)

45. What is the tx for dilated cardiomyopathy?
Elevated ASO anti - DNase B titers
LA dilation
PDA
Heart transplant

46. What is the most common cause of death during the acute phase of rheumatic fever?
Day 1-7
Concentric LV hypertophy
Myocarditis
Mitral stenosis

47. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Large - destructive vegetations
Months out fibrosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Fibrosis and dystrophic calcification

48. Systolic ejection click followed by crescendo - decrescendo murmur.
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
Aortic stenosis
Valve scarring that arises as a consequence of rheumatic fever
Infantile coarctation of the aorta PDA

49. What congenital heart defect is associated with fetal alcohol syndrome?
PDA
VSD
LA
Pericardial effusion due to pericardial involvement

50. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Squatting - expiration
>60 years - bicuspid aortic valve
Erythematous nontender lesions on palms and soles.
Mitral regurg