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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 tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Cardiogenic shock - CHF - arrhythmia
Slow HR - decreasing O2 demand and risk for arrhythmia
Infectious

2. In which pts does S viridans cause endocarditits?
Congested central veins
Restrictive cardiomyopathy
Pts w/previously damaged valves
Granulation tissue

3. What is the gross and microscopic appearance of cardiac myxomas?
3-8 wks
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Gelatinous - abundant ground substance
Elevated ASO anti - DNase B titers

4. What does nonbacterial thrombotic endocarditis cause?
Valve replacement
Mitral regurg
Libman - Sacks endocarditis
CHF

5. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Troponin I
Breast and lung carcinoma - melanoma - lymphoma

6. What is the foundation of a scar?
Prinzmetal angina
Papillary muscle - free wall - IV septum
Mitral mitral+aortic
Granulation tissue

7. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Blood vessels coming in from normal tissue
PDA
RCA
Stable angina

8. What causes acute endocarditis?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Large vegetations of S aureus
Reactive histiocyte with caterpillar nucleus
Ventricular arrhythmia

9. What areas of the heart does the RCA supply?
Right side - serotonin and other secretory products detoxified in the lung
Left -->right
Posterior wall of LV - posterior septum - papillary muscles
Yellow pallor macrophages

10. With what disease is infantile coarctation of the aorta associated?
Small vegetations along the line of closure
RBC damaged while crossing the calcified valve causing schistocytes
Turner syndrome
Ehlers - Danlow and Marfan syndrome

11. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
R-->L

12. What congenital heart defect presents later in life with lower extremity cyanosis?
Mitral regurg
ACE inhibitor
Pulsating nail bed
PDA

13. What is the most common cause of RHF? What are others?
Coronary artery vasospasm
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Increased blood in right heart delays closure of P valve
Prinzmetal angina

14. What complication occurs 1-3 days post MI?
Transesophageal echo
Fibrinous pericarditis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Harmartoma

15. How does reperfusion injury occur?
Granulation tissue
Dense layer of elastic and fibrotic tissue in the endocardium - children
Tuberous sclerosis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

16. What genetic conditions predispose a pt to mitral valve prolapse?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Ehlers - Danlow and Marfan syndrome
Intercostal arteries enlarged due to collateral circulation
LV dilation and eccentric hypertrophy

17. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Prinzmetal angina - cocaine
PGE
LA

18. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Decreased forward perfusion pulmonary congestion
R-->L
Tuberous sclerosis

19. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
RHF
Mitral regurg
Mitral regurgitation due to vegetations

20. What is the only Jones criteria that doesn't resolve with time?
Aortic regurg
Pancarditis
PDA
S epidermidis

21. What is the gold standard blood marker for MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Stable angina
Troponin I
Aschoff bodies

22. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Coronary artery vasospasm
Libman - Sacks endocarditis
Bacterial endocarditis

23. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pancarditis
Regurg vs stenosis
LV dilation and eccentric hypertrophy

24. Opening snap followed by diastolic rumble.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Gelatinous - abundant ground substance
Mitral stenosis

25. Lower extremity cyanosis in infants? In adults?
Shunt - PGE to maintain PDA until surgical repair can be performed
ASD - R-->L
Reversible
Infantile coarctation of the aorta PDA

26. What is the most common cause of myocarditis?
Coxsackie A or B
Prophylactic abx during dental procedures
Congestive heart failure
VSD

27. What is the definition of ischemia?
Decrease in blood flow to an organ
RHF
LHF
Squatting - expiration

28. What is cardiogenic shock?
Atherosclerosis of coronary arteries
Inability to maintain systemic pressure w/lack of O2 to vital organs
MI
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

29. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Colon cancer
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Dense layer of elastic and fibrotic tissue in the endocardium - children

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

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31. What coronary artery supplies the mitral valve papillary muscles?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Tender lesions on fingers or toes.
Cardiac tamponade
RCA

32. What is the main cause of MV regurg? What are other causes?
Sterile vegetations on surface and undersurface on mitral valve
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mitral valve prolapse
Atherosclerosis of coronary arteries

33. With what disease is transposition of the great vessels associated?
Prinzmetal angina
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Minimizes ischemia
Maternal diabetes

34. Which vasculitis can cause MI?
Congestive heart failure
Kawasaki disease
Preductal - post aortic arch
Decreased forward perfusion pulmonary congestion

35. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Large - destructive vegetations
Aneurysm - mural thrombus - Dressler syndrome
Boot shaped heart

36. What is a common complication of cardiac metastasis?
Bounding pulse
Elevated ASO anti - DNase B titers
PDA
Pericardial effusion due to pericardial involvement

37. What are the complications of aortic stenosis?
Heart transplant
Squatting - expiration
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

38. What increases the volume of mitral regurg murmur?
4-6 hours - 24 hours - 72 hours
Mitral stenosis
Squatting - expiration
Fibrosis and dystrophic calcification

39. How does dilated cardiomyopathy cause LHF?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Stretched muscle loses contractility
Granulation tissue
MI

40. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Concentric LV hypertophy
Prophylactic abx during dental procedures

41. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Blood vessels coming in from normal tissue
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Rupture of free wall - IV septum - or papillary muscle
ASD - R-->L

42. What endocarditis is commonly found in patients with colon cancer?
Kawasaki disease
Regurg vs stenosis
Streptococcus bovis/
R-->L

43. What is the tx for dilated cardiomyopathy?
Backward LHF pulm htn and RHF - afib and associated mural thombis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Heart transplant
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

44. What iis the tx for aortic regurg?
Elevated ASO anti - DNase B titers
Osler nodes (ouch - ouch Osler)
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Valve replacement once LV dysfx develops

45. How does Eisenmeger syndrome occur?
Aschoff bodies
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Valve replacement AFTER the onset of complications
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt

46. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Libman - Sacks endocarditis
Right to left

47. What causes notching of the ribs in adult coarctation of the aorta?
Small - nondestructive vegetations (subacute endocarditis)
4-24 hours
Intercostal arteries enlarged due to collateral circulation
Erythematous nontender lesions on palms and soles.

48. What shunt does tetralogy of fallot produce?
Systolic dysfx leading to biventricular CHF
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Hemosiderin laden macrophages
Right -->left

49. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Friction rub and chest pain
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

50. How long after pharyngitis does acute rheumatic fever occur?
Libman - Sacks endocarditis
2-3 weeks
Slow HR - decreasing O2 demand and risk for arrhythmia
Hypertrophic cardiomyopathy