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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 genetic conditions predispose a pt to mitral valve prolapse?
Pericardial effusion due to pericardial involvement
Positive blood cultures anemia of chronic disease
Mitral stenosis
Ehlers - Danlow and Marfan syndrome

2. What is the most common cause of myocarditis?
Tuberous sclerosis
Months out fibrosis
Coxsackie A or B
Heart can't fill

3. What is the characteristic murmurr of mitral stenosis?
Hypertrophic cardiomyopathy
Paradoxical emboli
Opening snap followed by diastolic rumble
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

4. What is the most common type of ASD? What %?
4-6 hours - 24 hours - 72 hours
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
Hypertrophic cardiomyopathy
Ostium secundum (90%)

5. What are the tx for MI?
PDA
Intercostal arteries enlarged due to collateral circulation
Ventricles cannot pump
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

6. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Granulation tissue
Turner syndrome
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Stable and unstable prinzmetal

7. How does contraction band necrosis occur?
>70%
Atherosclerosis of coronary arteries
Small - nondestructive vegetations (subacute endocarditis)
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

8. What type of shunt does transposition of the great vessels cause?
Increased hydrostatic pressure
LA dilation
Loss of LV fx
R-->L

9. When do macrophagess infiltrate the myocardium post MI?
4-7 days
RHF
Left -->right
Increased hydrostatic pressure

10. Boot - shaped heart on x- ray?
Indomethacin - decreases PGE
Tetralogy of fallot
1-3 days
Nonbacterial thrombotic endocarditis (marantic endocarditis)

11. What causes a mid - systolic click followed by a regurgitation murmur?
Right -->left
Libman - Sacks endocarditis
Mitral valve prolapse
Ventricle

12. How does asprin/heparin tx MI?
Fibrosis and dystrophic calcification
Limits thrombosis
Coronary artery vasospasm
Mitral and tricuspid regurg - arrhythmia

13. What is the most common cause of aortic stenosis?
Janeway lesions
4-6 hours - 24 hours - 72 hours
Wear and tear
Louder - increased systemic resistence decreases LV emptying

14. How does restrictive cardiomyopathy present?
Congestive heart failure
4-7 days macrophage infiltration
PDA
Streptococcus viridans

15. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Large - destructive vegetations
Left -->right
Ischemic heart disease

16. What two things happen when a blocked vessel is opened after an MI?
Infantile coarctation of the aorta
Mitral regurgitation due to vegetations
Dressler syndrome
Contraction band necrosis - reperfusion injury

17. What iis the tx for aortic regurg?
Congenital rubella
Decrease in blood flow to an organ
Valve replacement once LV dysfx develops
Sterile vegetations on surface and undersurface on mitral valve

18. How does restrictive cardiomyopathy cause LHF?

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19. What endocarditis is commonly found in patients with colon cancer?
Pericarditits
IV drug users
Degree of pulmonary artery stenosis
Streptococcus bovis/

20. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral mitral+aortic
ST- segment depression
Ehlers - Danlow and Marfan syndrome

21. What typically causes hypertrophic cardiomyopathy?
4-7 days
Chronic ischemic heart disease
AD mutation in sarcomere proteins
Ischemic heart disease

22. Why would cardiac enzymes continue to increase after the initial MI?
Cardiogenic shock - CHF - arrhythmia
Dilation of all four chambers of the heart
Preductal - post aortic arch
Reperfusion injury

23. What disesase has Aschoff bodies?
Coxsackie A or B
Months out fibrosis
Myocarditis in acute rheumatic heart fever
Ventricular arrhythmia

24. Opening snap followed by diastolic rumble.
Trisomy 21
Mitral stenosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Rhadbomyoma - benign

25. What is the JOneS mneumonic?
Myocarditis in acute rheumatic heart fever
Thickening of chrodae tendinae and cusps - mitral 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
Coxsackie A or B

26. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
RHF
Contraction band necrosis
Coexisting mitral stenosis and fusion of commisures exist
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

27. What are the sx/complications of myocarditis?
Pump failure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
IV drug users

28. What is the characteristic finding on CXR in tetralogy of fallot?
Systolic dysfx leading to biventricular CHF
Left -->right
Boot shaped heart
Mitral regurg

29. What are the forward and backward sx of LHF?
4-6 hours - 24 hours - 72 hours
20 min
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
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

30. What does rupture of a papillary muscle cause?
Acute inflammation
Stable angina
2-3 weeks
Mitral insufficiency

31. With what developmental disorder is VSD associated?
Sterile vegetations on surface and undersurface on mitral valve
CHF
Posterior wall of LV - posterior septum - papillary muscles
Fetal alcohol syndrome

32. How do you tx prinzmetal angina?
RBC damaged while crossing the calcified valve causing schistocytes
NG or Ca channel blocker
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
IV drug users

33. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Libman - Sacks endocarditis
RCA
Myocardium

34. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Myocarditis in acute rheumatic heart fever
Surgical closure small defects may close spontaneously
SLE

35. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
4-6 hours - 24 hours - 72 hours
Months out fibrosis
Coronary artery vasospasm

36. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Infectious
Myofiber hypertrophy with disarray
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

37. What effect does chronic rheumatic heart disease have the mitral valve?
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
Squat in response to cyanotic spell
R-->L
Thickening of chrodae tendinae and cusps - mitral stenosis

38. What are heart failure cells?
Hypertrophic cardiomyopathy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
PDA
Hemosiderin laden macrophages

39. What does chronic ischemic heart disease progress to?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
CHF
Bicuspid aortic valve
Nonspecific - eg fever and elevated ESR

40. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Fibrinous pericarditis
Rhadbomyoma - benign

41. Tender lesions on fingers or toes.
Bicuspid aortic valve
Osler nodes (ouch - ouch Osler)
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
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

42. What are the clinical features of endocarditis? What causes each feature?
Stretched muscle loses contractility
Fibrosis and dystrophic calcification
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
Mitral stenosis

43. What causes endocarditis of prosthetic valves?
S epidermidis
Mitral regurgitation due to vegetations
Pancarditis
CHF

44. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Pericardial effusion due to pericardial involvement
>70%
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

45. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
4-7 days macrophage infiltration
Myocarditis
ASD - R-->L

46. What is the murmur of mitral regurg?
4-24 hours
Holosystolic blowing murmur
Chest pain <20 min brought on by exertion or emotional stress
Type I

47. What is the major cause of MI?
Right -->left
Split S2 on auscultation
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
CHF

48. How does O2 tx MI?
Loss of fx
Minimizes ischemia
Hypercoagulable state or underlying adenocarcinoma
Sterile vegetations on mitral valve along lines of closure

49. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Right -->left
Mitral valve prolapse
Coxsackie A or B
Months out fibrosis

50. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Heart can't fill
Ventricles cannot pump
Months out fibrosis
Bacterial endocarditis