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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 does nonbacterial thrombotic endocarditis cause?
Systemic venous congestion
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Mitral regurg
Stable and unstable prinzmetal

2. Pericarditis 6-8 wks post MI.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Maternal diabetes
Dressler syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

3. What are the causes of restrictive cardiomyopathy in adults?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Tricuspid
PGE

4. What is the leading cause of death in the US?
ST- segment elevation
Ischemic heart disease
Minimizes ischemia
Left -->right

5. What does granulation tissue contain?
Reversible
Plump fibroblasts - collagen - blood vessels
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
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

6. What generally causes ischemic heart disease?
1-3 days out
Atherosclerosis of coronary arteries
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
CHF

7. What congenital heart defect is associated with fetal alcohol syndrome?
Sudden cardiac death
NG or Ca channel blocker
LAD
VSD

8. What are the tx for MI?
Elevated ASO anti - DNase B titers
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Open blocked vessels
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

9. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
4-7 days
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Limits thrombosis

10. What are the complications of mitral valve prolapse? Are they common?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infectious endocarditis - arrythmias - severe mitral regurg no
S epidermidis
Dressler syndrome

11. What is the murmur of mitral regurg?
Inability to fill ventricles
Increased blood in right heart delays closure of P valve
Mitral insufficiency
Holosystolic blowing murmur

12. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Systemic venous congestion
Elevated ASO anti - DNase B titers
Asymptomatic

13. Is injury due angina reversible or irreversible?
2-3 weeks
Minimizes ischemia
Valve replacement once LV dysfx develops
Reversible

14. When is an MI pt at greatest risk for cardiogenic shock?
Tender lesions on fingers or toes.
1-3 days
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
First 4 hours

15. What causes the nutmeg color in nutmeg liver?
Congested central veins
Chest pain <20 min brought on by exertion or emotional stress
PDA
Anitschow cell

16. When does the heart have dark discoloration post MI?
Aortic regurg
4-24 hours
Pancarditis
Sudden cardiac death

17. What type of shunt results in cyanosis at birth?
Right to left
Atria and RV
Valve replacement
Maternal diabetes

18. What bug causes acute rheumatic fever?
IV drug users
Congestive heart failure
Infectious endocarditis - arrythmias - severe mitral regurg no
Group A beta - hemolytic streptococci

19. What is the definition of ischemia?
Decrease in blood flow to an organ
Restrictive cardiomyopathy
Inability to fill ventricles
Inability to maintain systemic pressure w/lack of O2 to vital organs

20. What effect does dilated cardiomyopathy have on the heart?
Acute inflammation
>70%
Papillary muscle - free wall - IV septum
Systolic dysfx leading to biventricular CHF

21. Dilated cardiomyopathy is a late complication of what illness?
4-7 days macrophage infiltration
ASD - R-->L
Hemosiderin laden macrophages
Myocarditis

22. What is the 1day-1wk -1mo mneumonic for MI?
L->R
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
ASD - R-->L
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

23. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Dilation of all four chambers of the heart
Asymptomatic
Metastasis

24. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Fibrosis and dystrophic calcification
Fetal alcohol syndrome
Degree of pulmonary artery stenosis

25. What are the sx of hypertrophic cardiomyopathy?
Myocarditis
Loss of fx
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
LAD

26. What is the gross and microscopic appearance of cardiac myxomas?
Preductal - post aortic arch
Infantile coarctation of the aorta PDA
Restrictive cardiomyopathy
Gelatinous - abundant ground substance

27. Vegetations on surface and undersurface of mitral valve.
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
4-7 days
Tricuspid
Libman - Sacks endocarditis

28. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
RCA
Nitroglycerin
Infantile coarctation of the aorta

29. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Migratory polyarthritis
CK- MB
4-7 days macrophage infiltration
Endocardial fibroelastosis

30. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Holosystolic blowing murmur
Plump fibroblasts - collagen - blood vessels
Hypertophy of RV atrophy of LV

31. With what congenital heart defect is ADULT coarctation of the aorta associated?
Volume overload and LHF
Maternal diabetes
Bicuspid aortic valve
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

32. What causes mitral valve prolapse?
Myxoid degeneration
Limits thrombosis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Dark discoloration coagulative necrosis

33. What are the sx/complications of myocarditis?
Pericardial effusion due to pericardial involvement
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Aschoff bodies
Sudden cardiac death

34. What gross and microscopic changes occur 1-3 weeks after an MI?
1%
Red border granulation tissue
L->R
PDA

35. Infects predamaged valves after transient bacteremia?
Loss of LV fx
Doxorubicin - cocaine
Shunt
S viridans

36. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Coexisting mitral stenosis and fusion of commisures exist
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
RCA
PDA

37. What is migratory polyarthritis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Left -->right
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
PDA

38. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Mitral regurg
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
ST- segment depression
Degree of pulmonary artery stenosis

39. What artery is the 2nd most often occluded in an MI?
Inability to fill ventricles
RCA
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Mitral mitral+aortic

40. What is the murmur of mitral valve prolapse?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
NG or Ca channel blocker
Mid - systolic click followed by regurgitation murmur
Boot shaped heart

41. Turner syndrome is associated with which congenital heart defect?
Infectious endocarditis - arrythmias - severe mitral regurg no
Split S2 on auscultation
Pulsating nail bed
Infantile coarctation of the aorta

42. What makes the MV prolapse murmur louder? Why?
Atherosclerosis of coronary arteries
1-3 days out
Squatting - increased systemic resistence decreases LV emptying
SLE

43. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Maternal diabetes
Intercostal arteries enlarged due to collateral circulation
Stable angina
20 min

44. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
S aureus
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

45. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Maternal diabetes

46. Tx for PDA?
First 4 hours
Indomethacin - decreases PGE
Pancarditis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

47. What is systolic dysfx?
LA dilation
Ventricles cannot pump
Coexisting mitral stenosis and fusion of commisures exist
Heart can't fill

48. Why are cardiac enzymes elevated after an MI?
Pulsating nail bed
Membrane damage
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
NG or Ca channel blocker

49. Poor myocardial fx due to chronic ischemic damage?
Boot shaped heart
Mitral regurgitation due to vegetations
Rupture of free wall - IV septum - or papillary muscle
Chronic ischemic heart disease

50. What type of shunt dose PDA cause?
Pericarditits
Hypertophy of RV atrophy of LV
Left -->right
Gelatinous - abundant ground substance