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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 compensatory mechanism do tetralogy of fallot pts learn?
Gelatinous - abundant ground substance
Squat in response to cyanotic spell
Chronic ischemic heart disease
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

2. How does restrictive cardiomyopathy cause LHF?

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3. What drugs can cause dilated cardiomyopathy?
Chronic rheumatic heart disease
Dilated
Congested central veins
Doxorubicin - cocaine

4. What type of shunt does truncus arteriosus cause?
Holosystolic blowing murmur
R-->L
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Myocarditis in acute rheumatic heart fever

5. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Systemic venous congestion
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Inability to fill ventricles

6. What is Loeffler syndrome?
Split S2 on auscultation
PDA
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Troponin I

7. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Rhabdomyoma
Louder - increased systemic resistence decreases LV emptying
Prinzmetal stable and unstable
ST- segment depression

8. What are the complications of mitral stenosis?
Streptococcus viridans
Metastasis
Backward LHF pulm htn and RHF - afib and associated mural thombis
PDA

9. What does nonbacterial thrombotic endocarditis cause?
2-4 hours - 24 hours - 7-10 days
Split S2 on auscultation
Mitral regurg
Reperfusion injury

10. What is the most common cause of mitral stenosis?
S aureus
Transposition of the great vessels
Chronic rheumatic heart disease
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

11. What drug relieves stable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Infantile coarctation of the aorta
Backward LHF pulm htn and RHF - afib and associated mural thombis
Nitroglycerin

12. What are the sx of hypertrophic cardiomyopathy?
Increased blood in right heart delays closure of P valve
Endocardial fibroelastosis (rare)
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
4-6 hours - 24 hours - 72 hours

13. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Restrictive cardiomyopathy
Infectious
Opening snap followed by diastolic rumble

14. What is the murmur of mitral regurg?
Months out fibrosis
2-3%
Holosystolic blowing murmur
Anterior wall of LV and anterior septum

15. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
First 4 hours
Aneurysm - mural thrombus - Dressler syndrome
Tuberous sclerosis
Adult coarctation of the aorta

16. What causes acute endocarditis?
Large vegetations of S aureus
Ventricles cannot pump
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal angina

17. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Decreases LV dilation by decreasing volume
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Left -->right

18. What causes angina and syncope in aortic stenosis?

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19. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Anitschow cell
Hypertrophic cardiomyopathy
Cardiac tamponade
Regurg vs stenosis

20. What endocarditis is commonly found in patients with colon cancer?
Autoimmune pericarditis 6-8 wks post MI
ST- segment depression
Streptococcus bovis/
Congenital rubella

21. What complications occur 4-7 days post MI?
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
Rupture of free wall - IV septum - or papillary muscle
Libman - Sacks endocarditis
Degree of pulmonary artery stenosis

22. What is the tx for aortic stenosis?
L->R
Right to left
Valve replacement AFTER the onset of complications
Inability to maintain systemic pressure w/lack of O2 to vital organs

23. What are complications of dilated cardiomyopathy?
Spontaneous
Mitral and tricuspid regurg - arrhythmia
Libman - Sacks endocarditis
Erythematous nontender lesions on palms and soles.

24. What type of collagen is involved in fibrosis?
Type I
RCA
Plump fibroblasts - collagen - blood vessels
Transesophageal echo

25. What are heart failure cells?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Hemosiderin laden macrophages
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Migratory polyarthritis

26. At what point in development do congenital heart defects arise?
3-8 wks
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Tuberous sclerosis
RCA

27. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Aneurysm - mural thrombus - Dressler syndrome
4-7 days macrophage infiltration
PDA
Squatting - expiration

28. What shunt does tetralogy of fallot produce?
Tricuspid
Endocarditis of prosthetic valves
Myocarditis in acute rheumatic heart fever
Right -->left

29. What type of ischemia does stable angina cause?
Within the first day
Infantile coarctation of the aorta
Subendocardial
Small - nondestructive vegetations (subacute endocarditis)

30. What is migratory polyarthritis?
PDA
Mid - systolic click followed by regurgitation murmur
Yellow pallor macrophages
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

31. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Valve replacement
S aureus
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

32. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Systolic ejection click followed by crescendo - decrescendo murmur
Circumflex
Chest pain <20 min brought on by exertion or emotional stress

33. What are Osler nodes?
Concentric LV hypertophy
Tender lesions on fingers or toes.
Valve replacement AFTER the onset of complications
Nitroglycerin

34. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Chronic ischemic heart disease
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

35. Sudden death in a young athlete.
>70%
Hypertrophic cardiomyopathy
Mitral mitral+aortic
PDA

36. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Low voltage EKG w/diminished QRS amplitude
Fibrosis and dystrophic calcification
Infectious

37. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Bounding pulse
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
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
VSD

38. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Acute inflammation
PDA
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
S viridans

39. What is diastolic dysfx?
MI
Inability to fill ventricles
AD mutation in sarcomere proteins
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

40. What is the major cause of MI?
Streptococcus viridans
Minimizes ischemia
S epidermidis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

41. Vegetations on surface and undersurface of mitral valve.
Increased blood in right heart delays closure of P valve
Libman - Sacks endocarditis
Anitschow cell
Restrictive cardiomyopathy

42. What are the Jones criteria?
Dressler syndrome
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Small vegetations along the line of closure
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

43. What generally causes ischemic heart disease?
Adult coarctation of the aorta
Atherosclerosis of coronary arteries
Mid - systolic click followed by regurgitation murmur
IV drug users

44. What type of shunt does transposition of the great vessels cause?
Decreases LV dilation by decreasing volume
R-->L
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
RHF

45. What is the most common cause of myocarditis?
Coxsackie A or B
3-8 wks
Reperfusion injury
Backward LHF pulm htn and RHF - afib and associated mural thombis

46. What causes heart failure cells?
ST- segment elevation
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Migratory polyarthritis

47. What are the major criteria of the Jones criteria?
>70%
Plump fibroblasts - collagen - blood vessels
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Coronary artery vasospasm - emboli - vasculitis

48. What disesase has Aschoff bodies?
RBC damaged while crossing the calcified valve causing schistocytes
Loss of LV fx
Myocarditis in acute rheumatic heart fever
Libman - Sacks endocarditis

49. Which chambers of the heart are generally spared in an MI?
Left -->right
Atria and RV
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
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

50. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Ostium primum
Surgical closure small defects may close spontaneously