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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. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Infectious endocarditis
Decrease preload -->lowers myocardial stress
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

2. When is an MI patent at highest risk for fibrionous pericarditis?
Myocarditis
Prinzmetal angina
1-3 days out
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

3. In transposition of the great vessels - What is required for survival? How is this achieved?
Pulsating nail bed
Shunt - PGE to maintain PDA until surgical repair can be performed
Valve scarring that arises as a consequence of rheumatic fever
Tricuspid

4. What drug relieves stable angina?
Loss of fx
Loeffler syndrome
S epidermidis
Nitroglycerin

5. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Coronary artery vasospasm - emboli - vasculitis
Infectious endocarditis
Bacterial endocarditis

6. What is the tx for dilated cardiomyopathy?
Myxoid degeneration
Heart transplant
Kawasaki disease
Fibrinous pericarditis

7. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Type I
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
>60 years - bicuspid aortic valve

8. What is the most common congenital heart defect?
VSD
4-24 hours
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Increased blood in right heart delays closure of P valve

9. What effect does aortic stenosis have on the chambers of the heart?
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
Concentric LV hypertophy
Hypertrophic cardiomyopathy
Chronic ischemic heart disease

10. What characterizes acute rheumatic fever endocarditiis?
Ostium secundum (90%)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Cyanosis - RV hypertrophy - polycythemia - clubbing
Small vegetations along the line of closure

11. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
PGE
Systolic dysfx leading to biventricular CHF
Membrane damage

12. What gross and microscopic changes occur 1-3 weeks after an MI?
Within the first day
S viridans
Red border granulation tissue
Chest pain <20 min brought on by exertion or emotional stress

13. What typically causes hypertrophic cardiomyopathy?
Right to left
1-3 days out
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
AD mutation in sarcomere proteins

14. What shunt does tetralogy of fallot produce?
Aortic regurg
Shunt - PGE to maintain PDA until surgical repair can be performed
PDA
Right -->left

15. What does rupture of the IV septum cause?
LHF
Breast and lung carcinoma - melanoma - lymphoma
Prophylactic abx during dental procedures
Shunt

16. What are other (not atherosclerotic) causes of MI?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Coronary artery vasospasm - emboli - vasculitis
Anitschow cell
ST- segment elevation

17. What are heart failure cells?
Hemosiderin laden macrophages
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Valve replacement
Systolic ejection click followed by crescendo - decrescendo murmur

18. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
Decrease preload -->lowers myocardial stress
Transposition of the great vessels
Gelatinous - abundant ground substance

19. What are the cancers that most commonly metastasize to the heart?
Chronic ischemic heart disease
Stretched muscle loses contractility
Valve replacement
Breast and lung carcinoma - melanoma - lymphoma

20. What valves are involved in rhuematic endocarditis?
Hemosiderin laden macrophages
Within the first day
Mitral mitral+aortic
Annular - non pruritic rash w/erythematous borders trunks and limbs

21. When do neutrophils infiltrate the myocardium post MI?
1-3 days
PDA
Tetralogy of fallot
Inability to maintain systemic pressure w/lack of O2 to vital organs

22. What complications occur within 4 hrs post MI?
Contraction band necrosis - reperfusion injury
Ehlers - Danlow and Marfan syndrome
PDA
Cardiogenic shock - CHF - arrhythmia

23. What type of valvular vegetations does S aureus cause?
Dilated
Large - destructive vegetations
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Infectious

24. What are the tx for MI?
Pancarditis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Bacterial endocarditis
Tender lesions on fingers or toes.

25. Which angina(s) show ST elevation on EKG? ST depression?
Dark discoloration coagulative necrosis
Erythematous nontender lesions on palms and soles.
Prinzmetal stable and unstable
White scar fibrosis

26. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
RCA
Prinzmetal

27. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Myocardium
Decrease in blood flow to an organ
Ostium secundum (90%)

28. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Endocarditis of prosthetic valves
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Mitral and tricuspid regurg - arrhythmia
Months out fibrosis

29. Why would cardiac enzymes continue to increase after the initial MI?
2-3 weeks
4-24 hours
Chest pain <20 min brought on by exertion or emotional stress
Reperfusion injury

30. How does adult coarctation of the aorta present?
Libman - Sacks endocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Fibrinous pericarditis
Atherosclerosis of coronary arteries

31. What is the tx for aortic stenosis?
Prinzmetal angina - cocaine
Myxoma - benign
Valve replacement AFTER the onset of complications
1-3 days

32. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
LHF
Systolic dysfx leading to biventricular CHF
Aschoff bodies
20 min

33. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Prophylactic abx during dental procedures
Prinzmetal angina
Dilated

34. What coronary arterysupplies the lateral wall of the LV?
Loeffler syndrome
Circumflex
Infantile coarctation of the aorta PDA
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

35. What two things happen when a blocked vessel is opened after an MI?
Shunt
Contraction band necrosis - reperfusion injury
L->R
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

36. What causes the dependent pitting edema in RHF?
Hypercoagulable state or underlying adenocarcinoma
Ischemic heart disease
Increased hydrostatic pressure
Systolic dysfx leading to biventricular CHF

37. What causes angina and syncope in aortic stenosis?

38. What is Loeffler syndrome?
RHF
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Mitral stenosis
Rhadbomyoma - benign

39. What is Dressler syndrome? When does it occur?
Squatting - expiration
Autoimmune pericarditis 6-8 wks post MI
Friction rub and chest pain
Group A beta - hemolytic streptococci

40. Dense layer of elastic and fibrotic tissue in the endocardium.
Backward LHF pulm htn and RHF - afib and associated mural thombis
Myocarditis
Doxorubicin - cocaine
Endocardial fibroelastosis

41. Which artery is most often occluded in an MI?
Cardiogenic shock - CHF - arrhythmia
LAD
ASD - R-->L
1-3 days out

42. What valves are most commonly involved in chronic rheumatic heart disease?
Squatting - increased systemic resistence decreases LV emptying
Decrease in blood flow to an organ
Reperfusion injury
Mitral mitral+aortic

43. What type of shunt does truncus arteriosus cause?
R-->L
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Prinzmetal stable and unstable
VSD

44. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Rhabdomyoma
Endocarditis of prosthetic valves
NG or Ca channel blocker

45. What is chronic rheumatic heart disease?
Congested central veins
Mid - systolic click followed by regurgitation murmur
Valve scarring that arises as a consequence of rheumatic fever
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

46. What is the most common form of cardiomyopathy?
Preductal - post aortic arch
Dilated
Group A beta - hemolytic streptococci
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

47. Which coronary artery supplies the anterior wall and anterior septum?
Reperfusion injury
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Dense layer of elastic and fibrotic tissue in the endocardium - children
LAD

48. What causes endocarditis of prosthetic valves?
S aureus
Reactive histiocyte with caterpillar nucleus
S epidermidis
Right -->left

49. What congenital heart defect does indomethacin tx?
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
Decrease in blood flow to an organ
PDA
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

50. What are the four defects in tetralogy of fallot?
Adult coarctation of the aorta
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Red border granulation tissue
>60 years - bicuspid aortic valve