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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 creates the immune reaction in acute rhuematic fever?

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2. What is the rate of congenital heart defects?
1%
CK- MB
Slow HR - decreasing O2 demand and risk for arrhythmia
Acute inflammation

3. What is eythema marginatum? What parts of the body does it commonly involve?
Inability to fill ventricles
Troponin I
Stable angina
Annular - non pruritic rash w/erythematous borders trunks and limbs

4. What is the cause of the red border around granulation tissue?
R-->L
Endocardial fibroelastosis
Low voltage EKG w/diminished QRS amplitude
Blood vessels coming in from normal tissue

5. What is the tx for dilated cardiomyopathy?
Heart transplant
Valve replacement
Systemic venous congestion
Breast and lung carcinoma - melanoma - lymphoma

6. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Valve replacement
Atria and RV
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

7. What does granulation tissue contain?
Fetal alcohol syndrome
Prinzmetal
Reperfusion injury
Plump fibroblasts - collagen - blood vessels

8. How does ischemia cause LHF?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Harmartoma
Loss of fx
Left -->right

9. What heart sound manifest with an ASD?
IV drug users
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Fetal alcohol syndrome
Split S2 on auscultation

10. What is the gold standard blood marker for MI?
Troponin I
Loss of fx
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Ventricle

11. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
S aureus
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Autoimmune pericarditis 6-8 wks post MI

12. What are the clinical features of endocarditis? What causes each feature?
Open blocked vessels
Inability to fill ventricles
Contraction band necrosis - reperfusion injury
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

13. What are other (not atherosclerotic) causes of MI?
Ventricles cannot pump
Coronary artery vasospasm - emboli - vasculitis
Pericardial effusion due to pericardial involvement
Nitroglycerin

14. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
ASD - R-->L
Fibrosis and dystrophic calcification
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

15. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
4-6 hours - 24 hours - 72 hours
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Red border granulation tissue

16. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Prinzmetal
Decreased forward perfusion pulmonary congestion
Coexisting mitral stenosis and fusion of commisures exist

17. What two things happen when a blocked vessel is opened after an MI?
Yellow pallor macrophages
Contraction band necrosis - reperfusion injury
Pericarditits
Day 1-7

18. What is a Quincke pulse?
Cardiogenic shock - CHF - arrhythmia
Libman - Sacks endocarditis
Gelatinous - abundant ground substance
Pulsating nail bed

19. What iis the tx for aortic regurg?
Libman - Sacks endocarditis
Valve replacement once LV dysfx develops
Endocardial fibroelastosis
Prophylactic abx during dental procedures

20. How does O2 tx MI?
Right -->left
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
45%
Minimizes ischemia

21. What is the tx for LHF?
Autoimmune pericarditis 6-8 wks post MI
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
ACE inhibitor
S viridans

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

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23. What cardiac enzyme is useful for detecting reinfarction?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Acute inflammation
CK- MB

24. What type of vegetations are associated with Libman - Sacks endocarditis?
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
Mitral valve prolapse
Sterile vegetations on surface and undersurface on mitral valve
Hypercoagulable state or underlying adenocarcinoma

25. What is the most common valve infected by S aureus?
Contraction band necrosis
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Tricuspid
S viridans

26. What is a complication of chronic rheumatic heart disease?
Left -->right
Decreases LV dilation by decreasing volume
Infectious endocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

27. What complications occur within 4 hrs post MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rupture of free wall - IV septum - or papillary muscle
Cardiogenic shock - CHF - arrhythmia
Reversible

28. How do you tx prinzmetal angina?
Chronic rheumatic heart disease
NG or Ca channel blocker
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Congested central veins

29. What is the JOneS mneumonic?
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
Systolic dysfx leading to biventricular CHF
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Osler nodes (ouch - ouch Osler)

30. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Group A beta - hemolytic streptococci
Prinzmetal angina - cocaine
Reversible

31. Which congenital heart defect is associated with maternal diabetes?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Transposition of the great vessels
Metastasis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

32. How does Eisenmeger syndrome occur?
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
Endocardial fibroelastosis
Decrease in blood flow to an organ
Surgical closure small defects may close spontaneously

33. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Spontaneous
When a bacterial protein resembles a protein in human tissue
Day 1-7

34. What are the complications that occur months after an MI?
Type I
Aneurysm - mural thrombus - Dressler syndrome
Ventricle
1%

35. Which angina is relieved by Ca channel blockers?
Prinzmetal
Degree of pulmonary artery stenosis
Shunt - PGE to maintain PDA until surgical repair can be performed
Valve replacement

36. What are the clinical features of RHF due to?
Coronary artery vasospasm
Systemic venous congestion
Hemosiderin laden macrophages
Blood vessels coming in from normal tissue

37. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Streptococcus viridans
Aneurysm - mural thrombus - Dressler syndrome
Libman - Sacks endocarditis

38. What are Osler nodes?
Tender lesions on fingers or toes.
ST- segment elevation
Pancarditis
Boot shaped heart

39. Why are cardiac enzymes elevated after an MI?
Decreases LV dilation by decreasing volume
Myocarditis
R-->L
Membrane damage

40. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
CHF
Nonspecific - eg fever and elevated ESR
Nonbacterial thrombotic endocarditis (marantic endocarditis)

41. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Infectious endocarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

42. What does chronic ischemic heart disease progress to?
ST- segment depression
Aschoff bodies
Nitroglycerin
CHF

43. What tests show prior group A beta - hemolytic strep infection?
Shunt
Yellow pallor macrophages
Elevated ASO anti - DNase B titers
Valve scarring that arises as a consequence of rheumatic fever

44. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Right to left
S aureus
Stable and unstable prinzmetal

45. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Erythematous nontender lesions on palms and soles.
Right to left
Janeway lesions

46. What is the most common type of endocarditis?
Shunt
Limits thrombosis
Infectious
Boot shaped heart

47. What are the sx of aortic regurg?
Shunt - PGE to maintain PDA until surgical repair can be performed
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Pericardial effusion due to pericardial involvement

48. What is the characteristic murmur of aortic stenosis?
Small - nondestructive vegetations (subacute endocarditis)
4-7 days macrophage infiltration
Systolic ejection click followed by crescendo - decrescendo murmur
Open blocked vessels

49. Dilated cardiomyopathy is a late complication of what illness?
ASD - R-->L
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Myocarditis

50. What % of MIs involve the LAD?
45%
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Breast and lung carcinoma - melanoma - lymphoma
R-->L