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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 are the two effects of ATII?
Reperfusion injury
Chronic rheumatic heart disease
Preductal - post aortic arch
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

2. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Preductal - post aortic arch
Anterior wall of LV and anterior septum
Nitroglycerin
Migratory polyarthritis

3. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Nitroglycerin
Ostium secundum (90%)
Reactive histiocyte with caterpillar nucleus

4. What gross and microscopic changes occur 4-7 days after an MI?
Prinzmetal
Opening snap followed by diastolic rumble
S aureus
Yellow pallor macrophages

5. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Fetal alcohol syndrome
Rhabdomyoma
1-3 days out
Months out fibrosis

6. How does MI cause LHF?
RBC damaged while crossing the calcified valve causing schistocytes
Loss of LV fx
Mitral stenosis
NG or Ca channel blocker

7. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Endocardial fibroelastosis (rare)
Aschoff bodies
Adult coarctation of the aorta

8. What are the sx of hypertrophic cardiomyopathy?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Intercostal arteries enlarged due to collateral circulation
Infectious
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

9. What are heart failure cells?
Dilation of all four chambers of the heart
Stretched muscle loses contractility
PDA
Hemosiderin laden macrophages

10. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Turner syndrome
2-4 hours - 24 hours - 7-10 days
Endocardial fibroelastosis

11. What is the characteristic finding on CXR in tetralogy of fallot?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral regurgitation due to vegetations
Fibrinous pericarditis
Boot shaped heart

12. At what point in development do congenital heart defects arise?
Ostium secundum (90%)
3-8 wks
Decrease in blood flow to an organ
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

13. What is the gross and microscopic appearance of cardiac myxomas?
Months out fibrosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Acute inflammation
Gelatinous - abundant ground substance

14. What are the complications of mitral valve prolapse? Are they common?
PDA
Granulation tissue
Transposition of the great vessels
Infectious endocarditis - arrythmias - severe mitral regurg no

15. What conditions can cause nonbacterial thrombotic endocarditis?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Hypercoagulable state or underlying adenocarcinoma
Cardiac tamponade
Myxoid degeneration

16. Dilated cardiomyopathy is a late complication of what illness?
Prinzmetal stable and unstable
Right -->left
Myocarditis
Fibrinous pericarditis

17. With what virus is PDA associated?
Tuberous sclerosis
Squatting - increased systemic resistence decreases LV emptying
Congenital rubella
2-4 hours - 24 hours - 7-10 days

18. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Kawasaki disease
Surgical closure small defects may close spontaneously

19. What is a Quincke pulse?
Atria and RV
Pulsating nail bed
Right side - serotonin and other secretory products detoxified in the lung
Mitral regurg

20. What are the causes of LHF?
Myocarditis
White scar fibrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Autoimmune pericarditis 6-8 wks post MI

21. What imaging test is useful for detecting lesions on valves?
Endocardial fibroelastosis (rare)
Transesophageal echo
Mitral and tricuspid regurg - arrhythmia
VSD

22. Which chambers of the heart are generally spared in an MI?
Atria and RV
Posterior wall of LV - posterior septum - papillary muscles
Eisenmenger syndrome
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

23. What is endocardial fibroelastosis? In what population is it found?
Systemic venous congestion
Dense layer of elastic and fibrotic tissue in the endocardium - children
RCA
Decrease in blood flow to an organ

24. What are Janeway lesions?
Aortic stenosis
Reactive histiocyte with caterpillar nucleus
Erythematous nontender lesions on palms and soles.
Thickening of chrodae tendinae and cusps - mitral stenosis

25. What is the effect of mitral regurg on the heart?
4-7 days macrophage infiltration
MI
Volume overload and LHF
Months out fibrosis

26. In which chamber of the heart are cardiac myxomas found?
S epidermidis
LA
Squatting - expiration
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

27. What causes angina and syncope in aortic stenosis?

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28. How does restrictive cardiomyopathy present?
Tetralogy of fallot
Congestive heart failure
Day 1-7
S aureus

29. What type of shunt results in cyanosis at birth?
LAD
Right to left
Stretched muscle loses contractility
Tuberous sclerosis

30. What is the tx for dilated cardiomyopathy?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Tender lesions on fingers or toes.
Aneurysm - mural thrombus - Dressler syndrome
Heart transplant

31. What are the laboratory findings of bacterial endocarditis?
Coexisting mitral stenosis and fusion of commisures exist
Maternal diabetes
Positive blood cultures anemia of chronic disease
Right side - serotonin and other secretory products detoxified in the lung

32. What is molecular mimicry?
Split S2 on auscultation
Nitroglycerin
When a bacterial protein resembles a protein in human tissue
Mitral regurg

33. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
IV drug users
Stretched muscle loses contractility

34. What are the sx of cardiac myxoma?
CK- MB
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Systolic ejection click followed by crescendo - decrescendo murmur
Infantile coarctation of the aorta

35. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
IV drug users
Libman - Sacks endocarditis
L->R

36. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Yellow pallor neutrophils
Split S2 on auscultation
L->R

37. What is the most common congenital heart defect?
VSD
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Shunt
Decreases LV dilation by decreasing volume

38. Systolic ejection click followed by crescendo - decrescendo murmur.
Reperfusion injury
Increased blood in right heart delays closure of P valve
Aortic stenosis
Type I

39. What two things cause coronary artery vasospasm?
Congenital rubella
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Prinzmetal angina - cocaine
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

40. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Preductal - post aortic arch
First 4 hours
Circumflex

41. What effect does transposition of the great vessels have on the ventricles?
Left -->right
Myocardium
Ventricle
Hypertophy of RV atrophy of LV

42. In what pt population does S aureus commonly cause valvular disease?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
IV drug users
Erythematous nontender lesions on palms and soles.
Gelatinous - abundant ground substance

43. What are the sx of PDA at birth?
Small vegetations along the line of closure
Reactive histiocyte with caterpillar nucleus
Asymptomatic
Pedunculated mass in the LA that causes syncope due to obstruction of MV

44. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Limits thrombosis
45%
ST- segment elevation

45. Which congenital heart defect is associated with congenital rubella?
Loeffler syndrome
Bounding pulse
PDA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

46. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Heart transplant
PDA
Dark discoloration coagulative necrosis

47. Dense layer of elastic and fibrotic tissue in the endocardium.
Increased hydrostatic pressure
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
AD mutation in sarcomere proteins
Endocardial fibroelastosis

48. What is the murmur of mitral valve prolapse?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mid - systolic click followed by regurgitation murmur
Inability to fill ventricles
Pedunculated mass in the LA that causes syncope due to obstruction of MV

49. What type of shunt dose PDA cause?
Myocardium
Left -->right
Day 1-7
Ehlers - Danlow and Marfan syndrome

50. What type of shunt does a VSD cause?
Increased blood in right heart delays closure of P valve
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
L->R
2-3%