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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 clinical features of endocarditis? What causes each feature?
Mitral mitral+aortic
LV dilation and eccentric hypertrophy
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
Valve replacement

2. What is chronic rheumatic heart disease?
Decrease preload -->lowers myocardial stress
Decreases LV dilation by decreasing volume
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Valve scarring that arises as a consequence of rheumatic fever

3. Boot - shaped heart on x- ray?
Mitral stenosis
Tetralogy of fallot
Friction rub and chest pain
VSD

4. What is Loeffler syndrome?
Maternal diabetes
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Stretched muscle loses contractility
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

5. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Atherosclerosis of coronary arteries
LAD
Nitroglycerin
Rhabdomyoma

6. What murmur ccan be heard in PDA?
Spontaneous
Holosystolic machine like murmur
Hemosiderin laden macrophages
Hypercoagulable state or underlying adenocarcinoma

7. What are the Jones criteria?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Transposition of the great vessels
Heart transplant
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

8. What are Osler nodes?
Reactive histiocyte with caterpillar nucleus
Loss of fx
Tender lesions on fingers or toes.
>60 years - bicuspid aortic valve

9. What valves are involved in rhuematic endocarditis?
Reactive histiocyte with caterpillar nucleus
Mitral mitral+aortic
Valve scarring that arises as a consequence of rheumatic fever
Positive blood cultures anemia of chronic disease

10. What are the clinical features of RHF?
Plump fibroblasts - collagen - blood vessels
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

11. What cardiac disease is associated with tuberous sclerosis?
Ehlers - Danlow and Marfan syndrome
S aureus
Hemosiderin laden macrophages
Rhabdomyoma

12. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Acute inflammation
Sudden cardiac death
Endocardial fibroelastosis (rare)

13. What are the cancers that most commonly metastasize to the heart?
Decrease preload -->lowers myocardial stress
Breast and lung carcinoma - melanoma - lymphoma
1%
Fibrosis and dystrophic calcification

14. What type of shunt does truncus arteriosus cause?
Infantile coarctation of the aorta
Endocarditis of prosthetic valves
R-->L
Circumflex

15. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Infectious endocarditis - arrythmias - severe mitral regurg no
ASD - R-->L
Ostium primum

16. L- to - R shunt switching to R- to - L shunt.
Increased hydrostatic pressure
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Eisenmenger syndrome
Preductal - post aortic arch

17. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Left -->right
Reversible
Chronic rheumatic heart disease

18. What makes the MV prolapse murmur louder? Why?
Ventricle
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Trisomy 21
Squatting - increased systemic resistence decreases LV emptying

19. What are the sx of cardiac myxoma?
Myocardium
Anterior wall of LV and anterior septum
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Backward LHF pulm htn and RHF - afib and associated mural thombis

20. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Ventricles cannot pump
Within the first day
First 4 hours

21. Tx for PDA?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Indomethacin - decreases PGE
Asymptomatic
2-3 weeks

22. What does a biopsy of hypertrophic cardiomyopathy look like?
Decreases LV dilation by decreasing volume
Cardiogenic shock - CHF - arrhythmia
Myofiber hypertrophy with disarray
Mitral valve prolapse

23. What is the definition of ischemia?
PDA
Decrease in blood flow to an organ
S epidermidis
>60 years - bicuspid aortic valve

24. What causes a mid - systolic click followed by a regurgitation murmur?
Minimizes ischemia
Erythematous nontender lesions on palms and soles.
Indomethacin - decreases PGE
Mitral valve prolapse

25. What areas of the heart does the RCA supply?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
3-8 wks
Posterior wall of LV - posterior septum - papillary muscles
Months out fibrosis

26. In which chamber of the heart are rhabdomyomas found?
Myocardium
Contraction band necrosis
LAD
Ventricle

27. What is a complication of chronic rheumatic heart disease?
Decrease preload -->lowers myocardial stress
Aschoff bodies
R-->L
Infectious endocarditis

28. What is molecular mimicry?
When a bacterial protein resembles a protein in human tissue
Holosystolic blowing murmur
Acute inflammation
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

29. Where is the coarctation in infantile coarctation of the aorta?
Ostium primum
Tetralogy of fallot
Preductal - post aortic arch
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

30. What cardiac enzyme is useful for detecting reinfarction?
Heart can't fill
CK- MB
Coxsackie A or B
Mitral valve prolapse

31. What coronary artery supplies the mitral valve papillary muscles?
RCA
Atria and RV
RBC damaged while crossing the calcified valve causing schistocytes
Mitral and tricuspid regurg - arrhythmia

32. What is the most common cause of mitral stenosis?
Restrictive cardiomyopathy
Chronic rheumatic heart disease
Harmartoma
Endocardial fibroelastosis

33. How does subendocardial MI/ischemia present on EKG?
Large - destructive vegetations
Prinzmetal stable and unstable
Cardiac tamponade
ST- segment depression

34. Dilated cardiomyopathy is a late complication of what illness?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Hypertophy of RV atrophy of LV
Myocarditis

35. What is the JOneS mneumonic?
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
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
Months out fibrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

36. What vavular defect results from acute rheumatic fever?
LAD
Mitral regurgitation due to vegetations
Myofiber hypertrophy with disarray
45%

37. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Asymptomatic
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Janeway lesions
Prinzmetal

38. What type of shunt does transposition of the great vessels cause?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Months out fibrosis
Pericardial effusion due to pericardial involvement
R-->L

39. How does Eisenmeger syndrome occur?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Breast and lung carcinoma - melanoma - lymphoma
Hypertrophic cardiomyopathy
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

40. What causes the nutmeg color in nutmeg liver?
Congested central veins
Transesophageal echo
Infectious endocarditis - arrythmias - severe mitral regurg no
Endocardial fibroelastosis

41. What is the gross and microscopic appearance of cardiac myxomas?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Gelatinous - abundant ground substance
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Systolic dysfx leading to biventricular CHF

42. Which congenital heart defect is associated with maternal diabetes?
L->R
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Transposition of the great vessels

43. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
When a bacterial protein resembles a protein in human tissue
Holosystolic blowing murmur
Myocardium

44. What does nonbacterial thrombotic endocarditis cause?
Plump fibroblasts - collagen - blood vessels
Mitral regurg
Hypertrophic cardiomyopathy
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

45. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Bacterial endocarditis
4-7 days macrophage infiltration
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Loss of fx

46. Friction rub and chest pain.
SLE
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Tender lesions on fingers or toes.
Pericarditits

47. What heart sound manifest with an ASD?
ACE inhibitor
Thickening of chrodae tendinae and cusps - mitral stenosis
Split S2 on auscultation
Aortic regurg

48. What is eythema marginatum? What parts of the body does it commonly involve?
Pts w/previously damaged valves
Tender lesions on fingers or toes.
Janeway lesions
Annular - non pruritic rash w/erythematous borders trunks and limbs

49. What is the most common cause of endocarditis in IV drug users?
R-->L
S aureus
Slow HR - decreasing O2 demand and risk for arrhythmia
Dilated

50. Vegetations on surface and undersurface of mitral valve.
Regurg vs stenosis
Indomethacin - decreases PGE
Libman - Sacks endocarditis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy