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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 type of shunt results in cyanosis at birth?
Chronic ischemic heart disease
Opening snap followed by diastolic rumble
Hypertrophic cardiomyopathy
Right to left

2. What is the JOneS mneumonic?
>70%
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
Inability to fill ventricles
Mitral mitral+aortic

3. What is the characteristic murmur of aortic stenosis?
Ostium secundum (90%)
Right -->left
ST- segment depression
Systolic ejection click followed by crescendo - decrescendo murmur

4. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Prinzmetal angina - cocaine
Endocarditis of prosthetic valves
Gelatinous - abundant ground substance

5. What is the tx for aortic stenosis?
Limits thrombosis
Hemosiderin laden macrophages
Valve replacement AFTER the onset of complications
LHF

6. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Circumflex
1%
Concentric LV hypertophy

7. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Friction rub and chest pain
Valve replacement
Increased hydrostatic pressure

8. What is the effect of mitral regurg on the heart?
Posterior wall of LV - posterior septum - papillary muscles
Sterile vegetations on surface and undersurface on mitral valve
Dilation of all four chambers of the heart
Volume overload and LHF

9. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
S epidermidis
Libman - Sacks endocarditis
Sterile vegetations on mitral valve along lines of closure

10. What effect does chronic rheumatic heart disease have the mitral valve?
Myxoma - benign
Thickening of chrodae tendinae and cusps - mitral stenosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Reactive histiocyte with caterpillar nucleus

11. When do CK- MB levels rise - peak - and return to normal?
Prinzmetal angina - cocaine
IV drug users
Prinzmetal angina
4-6 hours - 24 hours - 72 hours

12. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
>60 years - bicuspid aortic valve
Decreases LV dilation by decreasing volume
Ventricle

13. What does rupture of the IV septum cause?
ST- segment depression
2-3%
Ventricle
Shunt

14. How does contraction band necrosis 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
Thickening of chrodae tendinae and cusps - mitral stenosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral mitral+aortic

15. What drugs can cause dilated cardiomyopathy?
Valve scarring that arises as a consequence of rheumatic fever
2-3%
Doxorubicin - cocaine
Intercostal arteries enlarged due to collateral circulation

16. In which chamber of the heart are rhabdomyomas found?
Ventricle
Troponin I
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
2-3 weeks

17. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
L->R
LAD
Pulsating nail bed

18. What structures are susceptible to rupture post MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Papillary muscle - free wall - IV septum
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
Pump failure

19. What is the most common cause of infectious endocarditis?
Streptococcus viridans
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
S aureus
Coxsackie A or B

20. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Breast and lung carcinoma - melanoma - lymphoma
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

21. Vegetations on surface and undersurface of mitral valve.
Tetralogy of fallot
IV drug users
Libman - Sacks endocarditis
Membrane damage

22. What type of tumor is a rhabdomyoma?
Loss of LV fx
Coronary artery vasospasm - emboli - vasculitis
Harmartoma
>60 years - bicuspid aortic valve

23. L- to - R shunt switching to R- to - L shunt.
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Fetal alcohol syndrome
Eisenmenger syndrome
Months out fibrosis

24. What are heart failure cells?
Spontaneous
Rhabdomyoma
Hemosiderin laden macrophages
Preductal - post aortic arch

25. What is a complication of chronic rheumatic heart disease?
RCA
Decrease preload -->lowers myocardial stress
Infectious endocarditis
MI

26. What type of shunt does ASD cause?
Left -->right
Congested central veins
Papillary muscle - free wall - IV septum
Circumflex

27. When would arrhythmia occur after MI?
Dark discoloration coagulative necrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
4-6 hours - 24 hours - 72 hours
Within the first day

28. At what point in development do congenital heart defects arise?
Degree of pulmonary artery stenosis
3-8 wks
Aortic regurg
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

29. How do you tx prinzmetal angina?
Increased blood in right heart delays closure of P valve
Inability to maintain systemic pressure w/lack of O2 to vital organs
Large vegetations of S aureus
NG or Ca channel blocker

30. What does chronic ischemic heart disease progress to?
Intercostal arteries enlarged due to collateral circulation
Myocarditis
SLE
CHF

31. What is the etiology of S viridans endocarditis?
Large vegetations of S aureus
Opening snap followed by diastolic rumble
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

32. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Libman - Sacks endocarditis
Type I
LAD

33. In transposition of the great vessels - What is required for survival? How is this achieved?
Stable angina
Gelatinous - abundant ground substance
Shunt - PGE to maintain PDA until surgical repair can be performed
Squat in response to cyanotic spell

34. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Mid - systolic click followed by regurgitation murmur
Atria and RV
Sterile vegetations on mitral valve along lines of closure

35. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Eisenmenger syndrome
Cyanosis - RV hypertrophy - polycythemia - clubbing
Kawasaki disease

36. What is the basic principle of CHF?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Nonspecific - eg fever and elevated ESR
Troponin I
Pump failure

37. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Troponin I
LAD
Pts w/previously damaged valves
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

38. What causes mitral valve prolapse?
Myxoid degeneration
Aschoff bodies
Coronary artery vasospasm - emboli - vasculitis
Split S2 on auscultation

39. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Months out fibrosis
Ventricle
Louder - increased systemic resistence decreases LV emptying
Colon cancer

40. What artery is the 2nd most often occluded in an MI?
RCA
Ostium primum
Myofiber hypertrophy with disarray
Myocarditis

41. What endocarditis is commonly found in patients with colon cancer?
Anitschow cell
Streptococcus bovis/
Paradoxical emboli
Streptococcus viridans

42. What is the most common cause of death during the acute phase of rheumatic fever?
Small vegetations along the line of closure
Myofiber hypertrophy with disarray
Large - destructive vegetations
Myocarditis

43. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Ischemic heart disease
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

44. What causes notching of the ribs in adult coarctation of the aorta?
Mitral regurg
Hypertophy of RV atrophy of LV
Intercostal arteries enlarged due to collateral circulation
LHF

45. What is the tx for VSD?
Stable and unstable prinzmetal
Sterile vegetations on mitral valve along lines of closure
Surgical closure small defects may close spontaneously
Myxoid degeneration

46. What are the sx of cardiac myxoma?
Systolic ejection click followed by crescendo - decrescendo murmur
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Bounding pulse

47. 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.
SLE
Congestive heart failure
Stable angina
Within the first day

48. What gross and microscopic changes occur 4-7 days after an MI?
LAD
Yellow pallor macrophages
Day 1-7
PDA

49. What effect does aortic stenosis have on the chambers of the heart?
Metastasis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Concentric LV hypertophy
Myocarditis

50. What is cardiogenic shock?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral and tricuspid regurg - arrhythmia
Endocarditis of prosthetic valves
Inability to maintain systemic pressure w/lack of O2 to vital organs