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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 most common congenital heart defect?
VSD
Transesophageal echo
1-3 days out
Pump failure

2. Which artery is most often occluded in an MI?
LAD
Friction rub and chest pain
VSD
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

3. What is the etiology of S viridans endocarditis?
Red border granulation tissue
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Louder - increased systemic resistence decreases LV emptying
Tuberous sclerosis

4. What does chronic ischemic heart disease progress to?
45%
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
CHF
Dilation of all four chambers of the heart

5. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Months out fibrosis
Ostium secundum (90%)
Open blocked vessels

6. What is the most comon cause of aortic regurg? What are the other causes?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Circumflex
Breast and lung carcinoma - melanoma - lymphoma
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

7. What is the effect of mitral regurg on the heart?
Autoimmune pericarditis 6-8 wks post MI
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Anitschow cell
Volume overload and LHF

8. What is the most common cause of death during the acute phase of rheumatic fever?
Fetal alcohol syndrome
Surgical closure small defects may close spontaneously
Myocarditis
Transesophageal echo

9. What genetic conditions predispose a pt to mitral valve prolapse?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Pulsating nail bed
Ehlers - Danlow and Marfan syndrome
Janeway lesions

10. How does adult coarctation of the aorta present?
S epidermidis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
2-4 hours - 24 hours - 7-10 days

11. With what disease is infantile coarctation of the aorta associated?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Turner syndrome
Prinzmetal angina
MI

12. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
SLE
Sudden cardiac death
Volume overload and LHF

13. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Spontaneous
Cyanosis - RV hypertrophy - polycythemia - clubbing

14. What is the murmur of mitral valve prolapse?
White scar fibrosis
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
Blood vessels coming in from normal tissue
Mid - systolic click followed by regurgitation murmur

15. What are the complications that occur months after an MI?
Atria and RV
Bacterial endocarditis
Aneurysm - mural thrombus - Dressler syndrome
Minimizes ischemia

16. What are the clinical features of endocarditis? What causes each feature?
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
Intercostal arteries enlarged due to collateral circulation
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Infectious

17. What causes an early - blowing diastolic murmur?
Increased hydrostatic pressure
Aortic regurg
R-->L
Annular - non pruritic rash w/erythematous borders trunks and limbs

18. With what disease is transposition of the great vessels associated?
Degree of pulmonary artery stenosis
Prinzmetal stable and unstable
Maternal diabetes
RHF

19. Dilated cardiomyopathy is a late complication of what illness?
Libman - Sacks endocarditis
ST- segment elevation
Myocarditis
Yellow pallor macrophages

20. What artery is the 2nd most often occluded in an MI?
RCA
Reperfusion injury
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

21. Dense layer of elastic and fibrotic tissue in the endocardium.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Contraction band necrosis
Transesophageal echo
Endocardial fibroelastosis

22. What causes wear and tear aortic stenosis?
Rhadbomyoma - benign
Fibrosis and dystrophic calcification
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Yellow pallor macrophages

23. What is the gold standard blood marker for MI?
Troponin I
Mitral regurgitation due to vegetations
Anterior wall of LV and anterior septum
Infectious

24. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Pulsating nail bed
Prinzmetal angina
Pump failure

25. When do CK- MB levels rise - peak - and return to normal?
Red border granulation tissue
Systolic ejection click followed by crescendo - decrescendo murmur
1-3 days out
4-6 hours - 24 hours - 72 hours

26. What is the most common cause of myocarditis?
Coxsackie A or B
Reperfusion injury
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

27. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Bacterial endocarditis
Louder - increased systemic resistence decreases LV emptying
Coexisting mitral stenosis and fusion of commisures exist
Mitral regurg

28. What is diastolic dysfx?
>60 years - bicuspid aortic valve
Inability to fill ventricles
Regurg vs stenosis
Infantile coarctation of the aorta

29. How do beta blockers tx MI?
Plump fibroblasts - collagen - blood vessels
Slow HR - decreasing O2 demand and risk for arrhythmia
Boot shaped heart
Heart can't fill

30. What is Loeffler syndrome?
Reperfusion injury
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Hemosiderin laden macrophages
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

31. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Bicuspid aortic valve
Louder - increased systemic resistence decreases LV emptying

32. What generally causes ischemic heart disease?
Mitral valve prolapse
Ventricles cannot pump
Elevated ASO anti - DNase B titers
Atherosclerosis of coronary arteries

33. What increases the volume of mitral regurg murmur?
Large vegetations of S aureus
Turner syndrome
Squatting - expiration
Stretched muscle loses contractility

34. How does aortic regurg affect the heart chambers?
LAD
Nitroglycerin
LV dilation and eccentric hypertrophy
Day 1-7

35. What is an Aschoff body?
Restrictive cardiomyopathy
Boot shaped heart
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Type I

36. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
3-8 wks
Stable angina
Loss of LV fx

37. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Systolic ejection click followed by crescendo - decrescendo murmur
Months out fibrosis
Bacterial endocarditis
Pulsating nail bed

38. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
2-3 weeks
Day 1-7
4-24 hours
Loeffler syndrome

39. In which chamber of the heart are cardiac myxomas found?
Autoimmune pericarditis 6-8 wks post MI
Hypercoagulable state or underlying adenocarcinoma
LA
Nitroglycerin

40. What causes prinzmetal angina?
Coronary artery vasospasm
45%
Chronic rheumatic heart disease
Concentric LV hypertophy

41. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Louder - increased systemic resistence decreases LV emptying
Inability to maintain systemic pressure w/lack of O2 to vital organs
Stable and unstable prinzmetal
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

42. What are the complications of aortic stenosis?
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
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Anitschow cell
Streptococcus viridans

43. When would arrhythmia occur after MI?
Plump fibroblasts - collagen - blood vessels
Within the first day
Prinzmetal stable and unstable
>70%

44. When do neutrophils infiltrate the myocardium post MI?
1-3 days
4-7 days macrophage infiltration
Degree of pulmonary artery stenosis
LV dilation and eccentric hypertrophy

45. Poor myocardial fx due to chronic ischemic damage?
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
Regurg vs stenosis
Chronic ischemic heart disease
R-->L

46. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Increased hydrostatic pressure
Open blocked vessels
Nonbacterial thrombotic endocarditis (marantic endocarditis)

47. What are the HACEK organisms? With what condition are they associated?
Tricuspid
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral and tricuspid regurg - arrhythmia

48. Tender lesions on fingers or toes.
Decreases LV dilation by decreasing volume
Myxoid degeneration
Osler nodes (ouch - ouch Osler)
Decreased forward perfusion pulmonary congestion

49. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
RCA
Shunt - PGE to maintain PDA until surgical repair can be performed
Hemosiderin laden macrophages

50. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Hypertrophic cardiomyopathy
Bacterial endocarditis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Friction rub and chest pain