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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. EKG for stable angina?
Fetal alcohol syndrome
Low voltage EKG w/diminished QRS amplitude
ST- segment depression
Congenital rubella

2. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Colon cancer
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
CK- MB

3. What creates the immune reaction in acute rhuematic fever?

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4. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Cardiogenic shock - CHF - arrhythmia
PDA
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

5. Pericarditis 6-8 wks post MI.
Nitroglycerin
LA dilation
Endocardial fibroelastosis (rare)
Dressler syndrome

6. What is the most common cause of infectious endocarditis?
LA
Mitral mitral+aortic
Streptococcus viridans
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

7. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Wear and tear
Libman - Sacks endocarditis
Louder - increased systemic resistence decreases LV emptying
Coexisting mitral stenosis and fusion of commisures exist

8. What gross and microscopic changes occur 1-3 days after an MI?
Left -->right
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Yellow pallor neutrophils
Tender lesions on fingers or toes.

9. What is the most common cause of myocarditis?
CK- MB
Systolic ejection click followed by crescendo - decrescendo murmur
S viridans
Coxsackie A or B

10. In which chamber of the heart are cardiac myxomas found?
Chronic ischemic heart disease
LA
Maternal diabetes
Circumflex

11. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
First 4 hours
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Janeway lesions

12. With what disease is transposition of the great vessels associated?
ST- segment depression
Maternal diabetes
Atria and RV
Loeffler syndrome

13. What is dilated cardiomyopathy?
Tricuspid
Dilation of all four chambers of the heart
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
ASD - R-->L

14. What causes acute endocarditis?
Bacterial endocarditis
ST- segment depression
Fibrinous pericarditis
Large vegetations of S aureus

15. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Slow HR - decreasing O2 demand and risk for arrhythmia
Fetal alcohol syndrome
S epidermidis

16. What does rupture of the IV septum cause?
Shunt
Yellow pallor neutrophils
Cardiogenic shock - CHF - arrhythmia
Minimizes ischemia

17. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
4-7 days macrophage infiltration
Fibrinous pericarditis
Turner syndrome

18. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
>60 years - bicuspid aortic valve
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

19. In what pt population does S aureus commonly cause valvular disease?
Osler nodes (ouch - ouch Osler)
Spontaneous
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
IV drug users

20. What causes endocarditis of prosthetic valves?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Preductal - post aortic arch
S epidermidis
Mitral regurg

21. What does rupture of a papillary muscle cause?
Mitral insufficiency
Colon cancer
Nitroglycerin
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

22. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Yellow pallor neutrophils
Congested central veins
Ventricles cannot pump

23. What is the foundation of a scar?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Granulation tissue
Group A beta - hemolytic streptococci

24. Erythematous nontender lesions on palms and soles.
Louder - increased systemic resistence decreases LV emptying
Janeway lesions
Inability to maintain systemic pressure w/lack of O2 to vital organs
CHF

25. What is the cause of the red border around granulation tissue?
CK- MB
Increased hydrostatic pressure
Blood vessels coming in from normal tissue
Ostium primum

26. What type of vegetations are associated with Libman - Sacks endocarditis?
Pts w/previously damaged valves
4-6 hours - 24 hours - 72 hours
Mitral stenosis
Sterile vegetations on surface and undersurface on mitral valve

27. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Group A beta - hemolytic streptococci
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Degree of pulmonary artery stenosis

28. What side of the heart do carcinoid tumors affect? Why?
2-3%
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Right side - serotonin and other secretory products detoxified in the lung
Erythematous nontender lesions on palms and soles.

29. How does restrictive cardiomyopathy cause LHF?

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30. What is the tx for VSD?
Myofiber hypertrophy with disarray
Small - nondestructive vegetations (subacute endocarditis)
Surgical closure small defects may close spontaneously
Infantile coarctation of the aorta

31. Friction rub and chest pain.
R-->L
Wear and tear
Inability to fill ventricles
Pericarditits

32. How do nitrates tx MI?
Breast and lung carcinoma - melanoma - lymphoma
Left -->right
Decrease preload -->lowers myocardial stress
Aschoff bodies

33. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Coronary artery vasospasm - emboli - vasculitis
RHF
Pancarditis

34. What causes an early - blowing diastolic murmur?
S aureus
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Chronic ischemic heart disease
Aortic regurg

35. How does asprin/heparin tx MI?
Mitral valve prolapse
Valve replacement once LV dysfx develops
R-->L
Limits thrombosis

36. With what disease is infantile coarctation of the aorta associated?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Turner syndrome
L->R

37. When is an MI patent at highest risk for fibrionous pericarditis?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
1-3 days out
Systolic ejection click followed by crescendo - decrescendo murmur
Pericardial effusion due to pericardial involvement

38. What are the sx of pericardiits?
Friction rub and chest pain
Turner syndrome
Reactive histiocyte with caterpillar nucleus
Infantile coarctation of the aorta

39. What % of MIs involve the LAD?
R-->L
ST- segment depression
45%
Papillary muscle - free wall - IV septum

40. How long after pharyngitis does acute rheumatic fever occur?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
ST- segment depression
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
2-3 weeks

41. What is the most common form of cardiomyopathy?
Prinzmetal stable and unstable
Dilated
Aortic stenosis
Posterior wall of LV - posterior septum - papillary muscles

42. What is Dressler syndrome? When does it occur?
Squatting - expiration
RCA
Autoimmune pericarditis 6-8 wks post MI
Tetralogy of fallot

43. What shunt does tetralogy of fallot produce?
Right -->left
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Myofiber hypertrophy with disarray
Mitral regurg

44. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Increased blood in right heart delays closure of P valve
Papillary muscle - free wall - IV septum
Surgical closure small defects may close spontaneously

45. What are heart failure cells?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Hemosiderin laden macrophages
Stable angina

46. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Group A beta - hemolytic streptococci
Inability to maintain systemic pressure w/lack of O2 to vital organs
R-->L

47. What gross and microscopic changes occur months after an MI?
Boot shaped heart
Colon cancer
Libman - Sacks endocarditis
White scar fibrosis

48. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
PGE
Dilated
Transesophageal echo

49. At what point in development do congenital heart defects arise?
Large vegetations of S aureus
LAD
3-8 wks
Endocardial fibroelastosis (rare)

50. What gross and microscopic changes occur 4-24 hours after an MI?
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
Dark discoloration coagulative necrosis
Friction rub and chest pain
Transesophageal echo