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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?
Bacterial endocarditis
Left -->right
Red border granulation tissue
Trisomy 21

2. What are the complications of aortic stenosis?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Positive blood cultures anemia of chronic disease
Membrane damage

3. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Trisomy 21
>70%
Split S2 on auscultation

4. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Paradoxical emboli
LHF
Mitral regurgitation due to vegetations

5. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Nitroglycerin
ST- segment depression
Streptococcus viridans
RHF

6. What effect does aortic stenosis have on the chambers of the heart?
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
Concentric LV hypertophy
Colon cancer
Positive blood cultures anemia of chronic disease

7. What is Dressler syndrome? When does it occur?
Squat in response to cyanotic spell
Reactive histiocyte with caterpillar nucleus
Eisenmenger syndrome
Autoimmune pericarditis 6-8 wks post MI

8. What effect does chronic rheumatic heart disease have on the aortic valve?

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9. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Coronary artery vasospasm - emboli - vasculitis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Prinzmetal angina
Boot shaped heart

10. What effect does aortic regurg have on the pulse pressure? Why?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Contraction band necrosis - reperfusion injury
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Streptococcus bovis/

11. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Ehlers - Danlow and Marfan syndrome
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

12. Dilated cardiomyopathy is a late complication of what illness?
Increased blood in right heart delays closure of P valve
Pancarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Myocarditis

13. In what pt population does S aureus commonly cause valvular disease?
Nonspecific - eg fever and elevated ESR
IV drug users
Transesophageal echo
Reactive histiocyte with caterpillar nucleus

14. When do macrophagess infiltrate the myocardium post MI?
Decreased forward perfusion pulmonary congestion
Cardiogenic shock - CHF - arrhythmia
4-7 days
Spontaneous

15. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Paradoxical emboli
Harmartoma
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
When a bacterial protein resembles a protein in human tissue

16. What does nonbacterial thrombotic endocarditis cause?
Prinzmetal
PDA
Mitral regurg
Degree of pulmonary artery stenosis

17. What are the clinical features of endocarditis? What causes each feature?
Endocardial fibroelastosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
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
When a bacterial protein resembles a protein in human tissue

18. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
1-3 days
Months out fibrosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
1%

19. What is the foundation of a scar?
Myocarditis
Breast and lung carcinoma - melanoma - lymphoma
Membrane damage
Granulation tissue

20. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Eisenmenger syndrome
Aschoff bodies
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
S epidermidis

21. How does asprin/heparin tx MI?
Hypertophy of RV atrophy of LV
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Limits thrombosis

22. What is endocardial fibroelastosis? In what population is it found?
Libman - Sacks endocarditis
Aschoff bodies
Transposition of the great vessels
Dense layer of elastic and fibrotic tissue in the endocardium - children

23. What causes endocarditis of prosthetic valves?
Bacterial endocarditis
VSD
S epidermidis
Pancarditis

24. What type of collagen is involved in fibrosis?
Reperfusion injury
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Type I
First 4 hours

25. In which chamber of the heart are cardiac myxomas found?
1-3 days out
LA
Right to left
Decrease preload -->lowers myocardial stress

26. What is the characteristic murmurr of mitral stenosis?
Cardiogenic shock - CHF - arrhythmia
Opening snap followed by diastolic rumble
Congestive heart failure
Left -->right

27. What is the JOneS mneumonic?
Trisomy 21
4-7 days macrophage infiltration
Papillary muscle - free wall - IV septum
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

28. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Yellow pallor macrophages
Degree of pulmonary artery stenosis
Rupture of free wall - IV septum - or papillary muscle
PDA

29. What type of tumor is a rhabdomyoma?
Ostium secundum (90%)
Tricuspid
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Harmartoma

30. What does Libman - Sacks endocarditis cause?
Concentric LV hypertophy
Mitral regurg
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
Streptococcus viridans

31. What are the laboratory findings of bacterial endocarditis?
4-7 days
Hemosiderin laden macrophages
PDA
Positive blood cultures anemia of chronic disease

32. At what point in development do congenital heart defects arise?
Heart transplant
Chronic rheumatic heart disease
Transesophageal echo
3-8 wks

33. What is chronic rheumatic heart disease?
Pericardial effusion due to pericardial involvement
RCA
Mitral regurg
Valve scarring that arises as a consequence of rheumatic fever

34. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Reversible
Valve scarring that arises as a consequence of rheumatic fever
Group A beta - hemolytic streptococci

35. What type of vegetations form in nonbacterial thrombotic endocarditis?
RCA
Sterile vegetations on mitral valve along lines of closure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Subendocardial

36. Where is the coarctation in infantile coarctation of the aorta?
Systolic dysfx leading to biventricular CHF
AD mutation in sarcomere proteins
Infantile coarctation of the aorta PDA
Preductal - post aortic arch

37. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Group A beta - hemolytic streptococci
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Infectious

38. In which chamber of the heart are rhabdomyomas found?
Contraction band necrosis - reperfusion injury
Ventricle
Pulsating nail bed
4-7 days macrophage infiltration

39. Ostium primum ASD is associated with what congenital disorder?
Endocardial fibroelastosis
Trisomy 21
Yellow pallor neutrophils
Streptococcus viridans

40. What makes the MV prolapse murmur louder? Why?
Mitral regurg
Squatting - increased systemic resistence decreases LV emptying
Holosystolic machine like murmur
Valve replacement once LV dysfx develops

41. Which congenital heart defect is associated with congenital rubella?
LAD
CHF
Chest pain <20 min brought on by exertion or emotional stress
PDA

42. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Prinzmetal stable and unstable
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Prinzmetal angina - cocaine

43. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Erythematous nontender lesions on palms and soles.
Myocarditis
PDA
Prinzmetal angina

44. How does stable angina present?
Ischemic heart disease
Chest pain <20 min brought on by exertion or emotional stress
Tuberous sclerosis
VSD

45. What are the clinical features of RHF due to?
Trisomy 21
Heart can't fill
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Systemic venous congestion

46. What iis the tx for aortic regurg?
When a bacterial protein resembles a protein in human tissue
RCA
Bounding pulse
Valve replacement once LV dysfx develops

47. Which angina is relieved by Ca channel blockers?
Prinzmetal
Mitral valve prolapse
Stable and unstable prinzmetal
S aureus

48. What type of ASD is associated w/Down syndrome?
CHF
Ostium primum
1-3 days out
Sterile vegetations on mitral valve along lines of closure

49. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Metastasis
Posterior wall of LV - posterior septum - papillary muscles
Plump fibroblasts - collagen - blood vessels

50. How does subendocardial MI/ischemia present on EKG?
Day 1-7
ST- segment depression
Inability to fill ventricles
Infectious endocarditis