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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. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Months out fibrosis
Membrane damage
Restrictive cardiomyopathy

2. What is the most common congenital heart defect?
Paradoxical emboli
Decrease preload -->lowers myocardial stress
VSD
3-8 wks

3. Why would cardiac enzymes continue to increase after the initial MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
LAD
Reperfusion injury
LV dilation and eccentric hypertrophy

4. What is a Quincke pulse?
Right side - serotonin and other secretory products detoxified in the lung
Fibrinous pericarditis
Pulsating nail bed
Dilation of all four chambers of the heart

5. In which chamber of the heart are rhabdomyomas found?
Ventricle
3-8 wks
Endocardial fibroelastosis
Posterior wall of LV - posterior septum - papillary muscles

6. What is the most common tumor of the heart?
Metastasis
Squatting - increased systemic resistence decreases LV emptying
Pump failure
Libman - Sacks endocarditis

7. Erythematous nontender lesions on palms and soles.
Heart transplant
Thickening of chrodae tendinae and cusps - mitral stenosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Janeway lesions

8. What effect does aortic stenosis have on the chambers of the heart?
Granulation tissue
Restrictive cardiomyopathy
Concentric LV hypertophy
Split S2 on auscultation

9. What are the sx of pericardiits?
Sterile vegetations on mitral valve along lines of closure
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Friction rub and chest pain
Limits thrombosis

10. How does dilated cardiomyopathy cause LHF?
Volume overload and LHF
Infantile coarctation of the aorta PDA
Stretched muscle loses contractility
Reperfusion injury

11. What maintains patency of the PDA?
Pancarditis
RCA
Inability to maintain systemic pressure w/lack of O2 to vital organs
PGE

12. Myofiber hypertrophy with disarray.
White scar fibrosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Hypertrophic cardiomyopathy
Tetralogy of fallot

13. What is the most common cause of RHF? What are others?
Endocarditis of prosthetic valves
Squat in response to cyanotic spell
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
IV drug users

14. What increases the volume of mitral regurg murmur?
Chronic rheumatic heart disease
ST- segment depression
Squatting - expiration
Fibrosis and dystrophic calcification

15. What is the tx for LHF?
Circumflex
Pump failure
Left -->right
ACE inhibitor

16. What is the foundation of a scar?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Granulation tissue
CK- MB

17. What areas of the heart does the RCA supply?
Chest pain <20 min brought on by exertion or emotional stress
Bicuspid aortic valve
Posterior wall of LV - posterior septum - papillary muscles
VSD

18. What type of shunt dose PDA cause?
Doxorubicin - cocaine
RHF
Left -->right
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

19. What type of tumor is a rhabdomyoma?
Harmartoma
Cardiac tamponade
Pericarditits
Hypertophy of RV atrophy of LV

20. Low voltage EKG w/diminished QRS amplitude.
Heart can't fill
Increased hydrostatic pressure
Restrictive cardiomyopathy
Bicuspid aortic valve

21. How does transmural MI/ischemia present on EKG?
SLE
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
ST- segment elevation
Day 1-7

22. What is the most common cause of dilated cardiomyopathy? What are other causes?
Chronic rheumatic heart disease
LAD
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Pulsating nail bed

23. What causes prinzmetal angina?
Coronary artery vasospasm
Yellow pallor macrophages
RCA
Pericarditits

24. What causes angina and syncope in aortic stenosis?

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25. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Hypertrophic cardiomyopathy
Limits thrombosis
>60 years - bicuspid aortic valve

26. Which chambers of the heart are generally spared in an MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Surgical closure small defects may close spontaneously
Atria and RV
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

27. What drugs can cause dilated cardiomyopathy?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Decreases LV dilation by decreasing volume
Doxorubicin - cocaine
Squat in response to cyanotic spell

28. What is the tx for aortic stenosis?
Troponin I
Posterior wall of LV - posterior septum - papillary muscles
20 min
Valve replacement AFTER the onset of complications

29. What type of shunt results in cyanosis at birth?
Right to left
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Positive blood cultures anemia of chronic disease

30. What causes wear and tear aortic stenosis?
Dilation of all four chambers of the heart
Fibrosis and dystrophic calcification
Chronic rheumatic heart disease
Rhadbomyoma - benign

31. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Infectious endocarditis - arrythmias - severe mitral regurg no
LHF
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

32. What is the most common cause of aortic stenosis?
Opening snap followed by diastolic rumble
PDA
Wear and tear
Nonbacterial thrombotic endocarditis (marantic endocarditis)

33. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Mitral insufficiency
Systolic ejection click followed by crescendo - decrescendo murmur
Myxoma - benign

34. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Endocardial fibroelastosis (rare)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
4-7 days macrophage infiltration
Stable angina

35. Dense layer of elastic and fibrotic tissue in the endocardium.
MI
Endocardial fibroelastosis
Pts w/previously damaged valves
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

36. What is molecular mimicry?
Reversible
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Large vegetations of S aureus
When a bacterial protein resembles a protein in human tissue

37. What typically causes hypertrophic cardiomyopathy?
Ventricular arrhythmia
When a bacterial protein resembles a protein in human tissue
Kawasaki disease
AD mutation in sarcomere proteins

38. Why are cardiac enzymes elevated after an MI?
Decreased forward perfusion pulmonary congestion
Hypertrophic cardiomyopathy
Osler nodes (ouch - ouch Osler)
Membrane damage

39. What is the JOneS mneumonic?
Red border granulation tissue
Tender lesions on fingers or toes.
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
RCA

40. Which angina is relieved by Ca channel blockers?
S viridans
Colon cancer
Prinzmetal
Coronary artery vasospasm - emboli - vasculitis

41. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Papillary muscle - free wall - IV septum
Adult coarctation of the aorta
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Kawasaki disease

42. What is a water - hammer pulse?
Increased blood in right heart delays closure of P valve
Gelatinous - abundant ground substance
Bounding pulse
Increased hydrostatic pressure

43. What cardiac enzyme is useful for detecting reinfarction?
Adult coarctation of the aorta
CK- MB
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA

44. What are Janeway lesions?
Type I
Erythematous nontender lesions on palms and soles.
Left -->right
20 min

45. How does adult coarctation of the aorta present?
Migratory polyarthritis
Reactive histiocyte with caterpillar nucleus
Adult coarctation of the aorta
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

46. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Ischemic heart disease
Sudden cardiac death
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

47. What is the definition of ischemia?
Mitral regurgitation due to vegetations
Decrease in blood flow to an organ
CK- MB
Asymptomatic

48. What iis the tx for aortic regurg?
Systolic dysfx leading to biventricular CHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Valve replacement once LV dysfx develops
Left -->right

49. What are the complications of mitral stenosis?
S aureus
Shunt
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Backward LHF pulm htn and RHF - afib and associated mural thombis

50. What are the complications of aortic stenosis?
Infantile coarctation of the aorta PDA
Systemic venous congestion
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Bicuspid aortic valve