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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 type of shunt dose PDA cause?
Streptococcus bovis/
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Left -->right
Mitral regurgitation due to vegetations

2. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Loss of LV fx
1-3 days out
Stable angina
Migratory polyarthritis

3. What is the most common type of endocarditis?
Infectious
Degree of pulmonary artery stenosis
Posterior wall of LV - posterior septum - papillary muscles
PDA

4. What is the rate of mitral valve prolapse in the US?
Dense layer of elastic and fibrotic tissue in the endocardium - children
2-3%
Rhadbomyoma - benign
Dark discoloration coagulative necrosis

5. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Hypertrophic cardiomyopathy
IV drug users
Increased hydrostatic pressure

6. What is the most common valve infected by S aureus?
S epidermidis
Tricuspid
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Left -->right

7. What is Dressler syndrome? When does it occur?
Ventricle
Autoimmune pericarditis 6-8 wks post MI
Aschoff bodies
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

8. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Libman - Sacks endocarditis
Autoimmune pericarditis 6-8 wks post MI
Mitral insufficiency

9. What type of shunt does a VSD cause?
Decrease preload -->lowers myocardial stress
Transposition of the great vessels
L->R
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

10. With what condition are rhabdomyomas associated?
Tuberous sclerosis
CK- MB
Increased blood in right heart delays closure of P valve
Decreases LV dilation by decreasing volume

11. What valves are involved in rhuematic endocarditis?
ST- segment elevation
Mitral mitral+aortic
Ventricle
Granulation tissue

12. What type of shunt does transposition of the great vessels cause?
Libman - Sacks endocarditis
Increased hydrostatic pressure
Open blocked vessels
R-->L

13. How does hypertension cause LHF?

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14. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Myxoid degeneration
Rhadbomyoma - benign
Endocarditis of prosthetic valves
Systolic ejection click followed by crescendo - decrescendo murmur

15. What are Janeway lesions?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Aortic regurg
Erythematous nontender lesions on palms and soles.
Plump fibroblasts - collagen - blood vessels

16. What are the four defects in tetralogy of fallot?
Backward LHF pulm htn and RHF - afib and associated mural thombis
RBC damaged while crossing the calcified valve causing schistocytes
Valve replacement
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

17. What congenital heart defect is associated with fetal alcohol syndrome?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Squat in response to cyanotic spell
Maternal diabetes
VSD

18. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Reperfusion injury
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Backward LHF pulm htn and RHF - afib and associated mural thombis

19. When do macrophagess infiltrate the myocardium post MI?
4-7 days
LA dilation
Coronary artery vasospasm - emboli - vasculitis
Bounding pulse

20. What characterizes acute rheumatic fever endocarditiis?
Prophylactic abx during dental procedures
Harmartoma
Small vegetations along the line of closure
S aureus

21. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
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
IV drug users

22. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Dilation of all four chambers of the heart
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
RCA

23. What are the clinical features of RHF?
Heart can't fill
Small - nondestructive vegetations (subacute endocarditis)
Myofiber hypertrophy with disarray
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

24. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
LA
Endocardial fibroelastosis (rare)
Type I

25. Erythematous nontender lesions on palms and soles.
Reperfusion injury
Annular - non pruritic rash w/erythematous borders trunks and limbs
Janeway lesions
Mitral mitral+aortic

26. What structures are susceptible to rupture post MI?
Squatting - expiration
Yellow pallor macrophages
Libman - Sacks endocarditis
Papillary muscle - free wall - IV septum

27. What does rupture of the LV free wall cause?
Increased hydrostatic pressure
Mitral regurg
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Cardiac tamponade

28. How does reperfusion injury occur?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Decrease preload -->lowers myocardial stress
Endocarditis of prosthetic valves

29. What makes the MV prolapse murmur louder? Why?
Trisomy 21
Endocardial fibroelastosis
R-->L
Squatting - increased systemic resistence decreases LV emptying

30. How does dilated cardiomyopathy cause LHF?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Eisenmenger syndrome
Stretched muscle loses contractility
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

31. What causes unstable angina?
Tricuspid
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
1-3 days out
Plump fibroblasts - collagen - blood vessels

32. What type of tumor is a rhabdomyoma?
Papillary muscle - free wall - IV septum
Reactive histiocyte with caterpillar nucleus
Membrane damage
Harmartoma

33. What is endocardial fibroelastosis? In what population is it found?
RCA
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Dense layer of elastic and fibrotic tissue in the endocardium - children
PDA

34. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Transesophageal echo
Annular - non pruritic rash w/erythematous borders trunks and limbs
Months out fibrosis

35. At what point in development do congenital heart defects arise?
PDA
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
3-8 wks
Small vegetations along the line of closure

36. What increases the volume of mitral regurg murmur?
Mitral regurgitation due to vegetations
ASD - R-->L
Squatting - expiration
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

37. What shunt does tetralogy of fallot produce?
Streptococcus viridans
Papillary muscle - free wall - IV septum
Right -->left
Aneurysm - mural thrombus - Dressler syndrome

38. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Valve replacement
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Heart can't fill
4-7 days macrophage infiltration

39. What effect does mitral stenosis have on the heart chambers?
LA dilation
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Congenital rubella
S aureus

40. What are complications of dilated cardiomyopathy?
Subendocardial
CHF
Plump fibroblasts - collagen - blood vessels
Mitral and tricuspid regurg - arrhythmia

41. What drug relieves stable angina?
Degree of pulmonary artery stenosis
Shunt - PGE to maintain PDA until surgical repair can be performed
Nitroglycerin
Aneurysm - mural thrombus - Dressler syndrome

42. What is the most common type of ASD? What %?
Ostium secundum (90%)
Coronary artery vasospasm
Erythematous nontender lesions on palms and soles.
Fibrinous pericarditis

43. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Rupture of free wall - IV septum - or papillary muscle
ACE inhibitor
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

44. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Large - destructive vegetations
Eisenmenger syndrome

45. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Positive blood cultures anemia of chronic disease
Rhadbomyoma - benign
Holosystolic blowing murmur

46. Is injury due angina reversible or irreversible?
Paradoxical emboli
Tuberous sclerosis
Reversible
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

47. What is the only Jones criteria that doesn't resolve with time?
Reversible
Pancarditis
Sterile vegetations on surface and undersurface on mitral valve
Contraction band necrosis - reperfusion injury

48. What type of valvular vegetations does S aureus cause?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Large - destructive vegetations
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
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

49. What type of ASD is associated w/Down syndrome?
Within the first day
Decrease in blood flow to an organ
Chronic rheumatic heart disease
Ostium primum

50. What gross and microscopic changes occur 1-3 weeks after an MI?
Within the first day
Anterior wall of LV and anterior septum
Janeway lesions
Red border granulation tissue