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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. When would arrhythmia occur after MI?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Red border granulation tissue
Within the first day
RHF

2. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Valve scarring that arises as a consequence of rheumatic fever
1-3 days
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

3. With what virus is PDA associated?
Chest pain <20 min brought on by exertion or emotional stress
CK- MB
3-8 wks
Congenital rubella

4. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Transposition of the great vessels
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Kawasaki disease

5. What type of tumor is a rhabdomyoma?
Fetal alcohol syndrome
Reactive histiocyte with caterpillar nucleus
Harmartoma
Endocarditis of prosthetic valves

6. What are the sx of cardiac myxoma?
Infectious endocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV
3-8 wks
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

7. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Aortic regurg
Reperfusion injury
S aureus

8. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Right to left
Hypercoagulable state or underlying adenocarcinoma
Degree of pulmonary artery stenosis
Systemic venous congestion

9. What two things happen when a blocked vessel is opened after an MI?
Coronary artery vasospasm
Contraction band necrosis - reperfusion injury
Thickening of chrodae tendinae and cusps - mitral stenosis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

10. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Cardiogenic shock - CHF - arrhythmia
ACE inhibitor
Transesophageal echo
Rhadbomyoma - benign

11. What causes mitral valve prolapse?
Myxoid degeneration
Valve scarring that arises as a consequence of rheumatic fever
Increased hydrostatic pressure
Fibrinous pericarditis

12. What is the tx for mitral valve prolapse?
Valve replacement
Contraction band necrosis - reperfusion injury
Months out fibrosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

13. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Gelatinous - abundant ground substance
Shunt
Small vegetations along the line of closure

14. What are the forward and backward sx of LHF?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
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
Indomethacin - decreases PGE
Fibrosis and dystrophic calcification

15. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
MI
Mitral mitral+aortic

16. How does stable angina present?
Janeway lesions
Infectious
Chest pain <20 min brought on by exertion or emotional stress
Pump failure

17. How do you prevent S viridans endocarditis?
Left -->right
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
Prophylactic abx during dental procedures
Decrease preload -->lowers myocardial stress

18. What complications occur within 4 hrs post MI?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
AD mutation in sarcomere proteins
Sterile vegetations on surface and undersurface on mitral valve
Cardiogenic shock - CHF - arrhythmia

19. What is the foundation of a scar?
Granulation tissue
Thickening of chrodae tendinae and cusps - mitral stenosis
First 4 hours
Reactive histiocyte with caterpillar nucleus

20. What are the sx of right - to - left shunt?
Inability to fill ventricles
Coexisting mitral stenosis and fusion of commisures exist
Cyanosis - RV hypertrophy - polycythemia - clubbing
Volume overload and LHF

21. What structures are susceptible to rupture post MI?
S viridans
Pericarditits
Pts w/previously damaged valves
Papillary muscle - free wall - IV septum

22. Large vegetations on tricuspid valve?
Decreases LV dilation by decreasing volume
Rupture of free wall - IV septum - or papillary muscle
Aortic regurg
S aureus

23. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
LAD
Papillary muscle - free wall - IV septum
Ventricular arrhythmia

24. What type of shunt results in cyanosis at birth?
First 4 hours
Right to left
Endocarditis of prosthetic valves
Holosystolic machine like murmur

25. How does adult coarctation of the aorta present?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Large - destructive vegetations
Ventricle

26. What is the most common cause of aortic stenosis?
Wear and tear
Slow HR - decreasing O2 demand and risk for arrhythmia
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
R-->L

27. When is an MI patent at highest risk for fibrionous pericarditis?
Opening snap followed by diastolic rumble
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Heart transplant
1-3 days out

28. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Posterior wall of LV - posterior septum - papillary muscles
ST- segment elevation
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

29. What is the classic EKG finding of restrictive cardiomyopathy?
PDA
Pericardial effusion due to pericardial involvement
Type I
Low voltage EKG w/diminished QRS amplitude

30. What is the basic principle of CHF?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Increased blood in right heart delays closure of P valve
Pump failure
Blood vessels coming in from normal tissue

31. Which angina(s) show ST elevation on EKG? ST depression?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
ASD - R-->L
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Prinzmetal stable and unstable

32. What are Osler nodes?
ASD - R-->L
Eisenmenger syndrome
Sterile vegetations on mitral valve along lines of closure
Tender lesions on fingers or toes.

33. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Granulation tissue
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

34. What tests show prior group A beta - hemolytic strep infection?
Paradoxical emboli
Libman - Sacks endocarditis
Congested central veins
Elevated ASO anti - DNase B titers

35. What is the cause of restrictive cardiomyopathy in children?
Atria and RV
Adult coarctation of the aorta
Coronary artery vasospasm - emboli - vasculitis
Endocardial fibroelastosis (rare)

36. What are the complications that occur months after an MI?
Squatting - expiration
Hypertrophic cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
Aneurysm - mural thrombus - Dressler syndrome

37. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Squatting - expiration
Indomethacin - decreases PGE
AD mutation in sarcomere proteins

38. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Infantile coarctation of the aorta
Regurg vs stenosis
Hemosiderin laden macrophages

39. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Papillary muscle - free wall - IV septum
Prinzmetal
Myocarditis

40. What are the four defects in tetralogy of fallot?
Posterior wall of LV - posterior septum - papillary muscles
Hypertophy of RV atrophy of LV
Thickening of chrodae tendinae and cusps - mitral stenosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

41. What increases the risk for chronic rheumatic heart disease?
Coxsackie A or B
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
CHF
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

42. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Dense layer of elastic and fibrotic tissue in the endocardium - children
Concentric LV hypertophy
Months out fibrosis

43. Why would cardiac enzymes continue to increase after the initial MI?
Pericardial effusion due to pericardial involvement
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Reperfusion injury
Ventricle

44. What increases the volume of mitral regurg murmur?
Infectious endocarditis - arrythmias - severe mitral regurg no
Rhabdomyoma
Squatting - expiration
Hypertrophic cardiomyopathy

45. What is a common complication of cardiac metastasis?
Aortic regurg
Pericardial effusion due to pericardial involvement
Tuberous sclerosis
Mitral regurg

46. How does aortic regurg affect the heart chambers?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LV dilation and eccentric hypertrophy
Infectious endocarditis - arrythmias - severe mitral regurg no

47. What effect does chronic rheumatic heart disease have on the aortic valve?

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48. Why are cardiac enzymes elevated after an MI?
Large vegetations of S aureus
Indomethacin - decreases PGE
2-3 weeks
Membrane damage

49. What areas of the heart does the RCA supply?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Colon cancer
Posterior wall of LV - posterior septum - papillary muscles

50. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Loeffler syndrome
Mid - systolic click followed by regurgitation murmur
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