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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. Poor myocardial fx due to chronic ischemic damage?
Shunt - PGE to maintain PDA until surgical repair can be performed
Chronic ischemic heart disease
Aschoff bodies
ACE inhibitor

2. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Plump fibroblasts - collagen - blood vessels
Squatting - increased systemic resistence decreases LV emptying
Indomethacin - decreases PGE

3. What does rupture of the LV free wall cause?
Dressler syndrome
Tuberous sclerosis
PGE
Cardiac tamponade

4. What is diastolic dysfx?
Turner syndrome
Inability to fill ventricles
Osler nodes (ouch - ouch Osler)
Libman - Sacks endocarditis

5. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
PDA
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Valve scarring that arises as a consequence of rheumatic fever

6. What type of valvular vegetations does S aureus cause?
Left -->right
Minimizes ischemia
Metastasis
Large - destructive vegetations

7. What are the minor critera of the Jones criteria?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Inability to maintain systemic pressure w/lack of O2 to vital organs
PDA
Nonspecific - eg fever and elevated ESR

8. What type of shunt results in cyanosis at birth?
Mitral mitral+aortic
Gelatinous - abundant ground substance
Right to left
Mitral insufficiency

9. What is chronic rheumatic heart disease?
LHF
Valve scarring that arises as a consequence of rheumatic fever
20 min
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

10. How does restrictive cardiomyopathy present?
Congestive heart failure
Transposition of the great vessels
Rhabdomyoma
Reversible

11. What is the most common type of endocarditis?
Red border granulation tissue
Infectious
Doxorubicin - cocaine
VSD

12. Infects predamaged valves after transient bacteremia?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
When a bacterial protein resembles a protein in human tissue
2-3 weeks
S viridans

13. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Loss of fx
Papillary muscle - free wall - IV septum
Osler nodes (ouch - ouch Osler)

14. What type of shunt does transposition of the great vessels cause?
R-->L
LA dilation
4-24 hours
Tuberous sclerosis

15. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Mitral mitral+aortic
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
2-3%
20 min

16. What are the clinical features of RHF due to?
Cardiac tamponade
Systemic venous congestion
LA dilation
PGE

17. What is the rate of mitral valve prolapse in the US?
Ventricle
2-3%
Right -->left
LA

18. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Nitroglycerin
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
LAD

19. What causes the dependent pitting edema in RHF?
Large - destructive vegetations
Increased hydrostatic pressure
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
3-8 wks

20. What is the definition of ischemia?
Ventricle
Prinzmetal stable and unstable
Squatting - increased systemic resistence decreases LV emptying
Decrease in blood flow to an organ

21. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Hypercoagulable state or underlying adenocarcinoma
Rhabdomyoma
S epidermidis

22. What is the tx for dilated cardiomyopathy?
Increased hydrostatic pressure
Heart transplant
Prinzmetal stable and unstable
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

23. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Minimizes ischemia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Atria and RV

24. What increases the risk for chronic rheumatic heart disease?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hemosiderin laden macrophages
Stable and unstable prinzmetal

25. How does O2 tx MI?
Prophylactic abx during dental procedures
Degree of pulmonary artery stenosis
Minimizes ischemia
Increased hydrostatic pressure

26. What is an Anitschow cell?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Reactive histiocyte with caterpillar nucleus
Acute inflammation
White scar fibrosis

27. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Slow HR - decreasing O2 demand and risk for arrhythmia
Pericardial effusion due to pericardial involvement
Dense layer of elastic and fibrotic tissue in the endocardium - children

28. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Prinzmetal
Dilation of all four chambers of the heart
Aortic regurg
Regurg vs stenosis

29. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Migratory polyarthritis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Posterior wall of LV - posterior septum - papillary muscles

30. What type of collagen is involved in fibrosis?
Mid - systolic click followed by regurgitation murmur
Type I
Holosystolic machine like murmur
Cyanosis - RV hypertrophy - polycythemia - clubbing

31. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Maternal diabetes
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
Pericarditits

32. What is the most common type of ASD? What %?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Coexisting mitral stenosis and fusion of commisures exist
Ostium secundum (90%)
Stretched muscle loses contractility

33. What congenital heart defect often is present with infantile coarctation of the aorta?
Right side - serotonin and other secretory products detoxified in the lung
PDA
Maternal diabetes
Degree of pulmonary artery stenosis

34. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Wear and tear
Infectious
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

35. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
SLE
Ostium secundum (90%)
Dressler syndrome

36. What are heart failure cells?
Hypercoagulable state or underlying adenocarcinoma
Right to left
Breast and lung carcinoma - melanoma - lymphoma
Hemosiderin laden macrophages

37. What is systolic dysfx?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Ventricles cannot pump
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Myxoid degeneration

38. Why would cardiac enzymes continue to increase after the initial MI?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Reperfusion injury
Hemosiderin laden macrophages

39. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Atria and RV
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Coexisting mitral stenosis and fusion of commisures exist
Tricuspid

40. What structures are susceptible to rupture post MI?
Thickening of chrodae tendinae and cusps - mitral stenosis
Colon cancer
Paradoxical emboli
Papillary muscle - free wall - IV septum

41. What is dilated cardiomyopathy?
Migratory polyarthritis
PGE
Dilation of all four chambers of the heart
Congested central veins

42. What disesase has Aschoff bodies?
Nitroglycerin
Squatting - expiration
Myocarditis in acute rheumatic heart fever
LV dilation and eccentric hypertrophy

43. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
S epidermidis
Dense layer of elastic and fibrotic tissue in the endocardium - children

44. What is typically the mechanims of sudden cardiac death?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Contraction band necrosis
R-->L
Ventricular arrhythmia

45. How do you prevent S viridans endocarditis?
NG or Ca channel blocker
Maternal diabetes
Rhadbomyoma - benign
Prophylactic abx during dental procedures

46. 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
Maternal diabetes
RBC damaged while crossing the calcified valve causing schistocytes
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

47. What makes the MV prolapse murmur louder? Why?
Chronic rheumatic heart disease
Squatting - increased systemic resistence decreases LV emptying
2-4 hours - 24 hours - 7-10 days
LA dilation

48. 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)
Breast and lung carcinoma - melanoma - lymphoma
Limits thrombosis
Months out fibrosis

49. Systolic ejection click followed by crescendo - decrescendo murmur.
Rhabdomyoma
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Endocarditis of prosthetic valves
Aortic stenosis

50. What coronary artery supplies the mitral valve papillary muscles?
RCA
Pts w/previously damaged valves
PDA
Janeway lesions