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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 endocarditis is associated w/metastatic cancer and wasting conditions?
Within the first day
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pericarditits
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

2. What are other (not atherosclerotic) causes of MI?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Prinzmetal
Coronary artery vasospasm - emboli - vasculitis
Blood vessels coming in from normal tissue

3. How do beta blockers tx MI?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Large vegetations of S aureus
Decrease preload -->lowers myocardial stress
Slow HR - decreasing O2 demand and risk for arrhythmia

4. What valves are involved in rhuematic endocarditis?
Migratory polyarthritis
LAD
Trisomy 21
Mitral mitral+aortic

5. When is an MI patent at highest risk for fibrionous pericarditis?
4-7 days macrophage infiltration
1-3 days out
PDA
Nitroglycerin

6. What vavular defect results from acute rheumatic fever?
Colon cancer
Fibrinous pericarditis
Prinzmetal stable and unstable
Mitral regurgitation due to vegetations

7. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Valve replacement AFTER the onset of complications
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Nonspecific - eg fever and elevated ESR

8. What are the Jones criteria?
Wear and tear
Yellow pallor macrophages
IV drug users
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

9. What does nonbacterial thrombotic endocarditis cause?
Stable and unstable prinzmetal
Valve replacement
Squatting - expiration
Mitral regurg

10. What is systolic dysfx?
Ventricles cannot pump
Dilated
LAD
Coronary artery vasospasm - emboli - vasculitis

11. What is an important complication of ASD?
Erythematous nontender lesions on palms and soles.
Paradoxical emboli
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Papillary muscle - free wall - IV septum

12. In transposition of the great vessels - What is required for survival? How is this achieved?
Turner syndrome
Shunt - PGE to maintain PDA until surgical repair can be performed
Right side - serotonin and other secretory products detoxified in the lung
Transposition of the great vessels

13. What causes an early - blowing diastolic murmur?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Aortic regurg
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Atherosclerosis of coronary arteries

14. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Increased blood in right heart delays closure of P valve
Reperfusion injury
Squatting - expiration
Cardiac tamponade

15. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Annular - non pruritic rash w/erythematous borders trunks and limbs
Autoimmune pericarditis 6-8 wks post MI
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

16. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Adult coarctation of the aorta
PDA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

17. What coronary artery supplies the mitral valve papillary muscles?
Increased hydrostatic pressure
Myxoma - benign
Libman - Sacks endocarditis
RCA

18. What are the HACEK organisms? With what condition are they associated?
Circumflex
>60 years - bicuspid aortic valve
Cardiac tamponade
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

19. With what disease is Libman - Sacks endocarditis associated?
SLE
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Plump fibroblasts - collagen - blood vessels
Turner syndrome

20. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Sudden cardiac death
Rupture of free wall - IV septum - or papillary muscle
RBC damaged while crossing the calcified valve causing schistocytes
Colon cancer

21. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Aortic regurg
Months out fibrosis
Tender lesions on fingers or toes.
Streptococcus bovis/

22. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Tender lesions on fingers or toes.
Hypercoagulable state or underlying adenocarcinoma
Myofiber hypertrophy with disarray

23. What does rupture of the LV free wall cause?
Decrease preload -->lowers myocardial stress
Cardiac tamponade
Trisomy 21
Pericarditits

24. What cardiac disease is associated with tuberous sclerosis?
Migratory polyarthritis
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
Rhabdomyoma
Turner syndrome

25. What is the rate of mitral valve prolapse in the US?
Posterior wall of LV - posterior septum - papillary muscles
Open blocked vessels
NG or Ca channel blocker
2-3%

26. What artery is the 2nd most often occluded in an MI?
4-7 days macrophage infiltration
RCA
Rupture of free wall - IV septum - or papillary muscle
Blood vessels coming in from normal tissue

27. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
SLE
Reactive histiocyte with caterpillar nucleus
Stable and unstable prinzmetal
LV dilation and eccentric hypertrophy

28. What complications occur 4-7 days post MI?
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
Rupture of free wall - IV septum - or papillary muscle
Bicuspid aortic valve
Inability to maintain systemic pressure w/lack of O2 to vital organs

29. Why are cardiac enzymes elevated after an MI?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Membrane damage
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
PDA

30. Tx for PDA?
Membrane damage
L->R
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Indomethacin - decreases PGE

31. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LAD
Anterior wall of LV and anterior septum
Small vegetations along the line of closure

32. What are the complications of mitral stenosis?
L->R
Streptococcus bovis/
Backward LHF pulm htn and RHF - afib and associated mural thombis
4-24 hours

33. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Dark discoloration coagulative necrosis
Granulation tissue
CHF
RCA

34. What are the major criteria of the Jones criteria?
Dilation of all four chambers of the heart
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Stable angina
Systemic venous congestion

35. What are the causes of restrictive cardiomyopathy in adults?
Small - nondestructive vegetations (subacute endocarditis)
Autoimmune pericarditis 6-8 wks post MI
Squat in response to cyanotic spell
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

36. Which vasculitis can cause MI?
CHF
Kawasaki disease
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Coronary artery vasospasm - emboli - vasculitis

37. What causes a mid - systolic click followed by a regurgitation murmur?
Increased hydrostatic pressure
Stable and unstable prinzmetal
20 min
Mitral valve prolapse

38. What murmur ccan be heard in PDA?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Holosystolic machine like murmur
Doxorubicin - cocaine

39. What is the leading cause of death in the US?
4-7 days macrophage infiltration
Adult coarctation of the aorta
Ischemic heart disease
Mitral stenosis

40. What shunt does tetralogy of fallot produce?
Granulation tissue
Acute inflammation
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Right -->left

41. What are the causes of LHF?
Squatting - increased systemic resistence decreases LV emptying
Mitral regurgitation due to vegetations
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Volume overload and LHF

42. What gross and microscopic changes occur 4-7 days after an MI?
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
Ventricle
Asymptomatic
Yellow pallor macrophages

43. What is the main cause of MV regurg? What are other causes?
Janeway lesions
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
AD mutation in sarcomere proteins
RCA

44. What causes prinzmetal angina?
Hypertrophic cardiomyopathy
First 4 hours
RHF
Coronary artery vasospasm

45. How long after pharyngitis does acute rheumatic fever occur?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Papillary muscle - free wall - IV septum
Right -->left
2-3 weeks

46. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Cardiogenic shock - CHF - arrhythmia
2-4 hours - 24 hours - 7-10 days
Anitschow cell
Asymptomatic

47. What drugs can cause dilated cardiomyopathy?
Opening snap followed by diastolic rumble
Transposition of the great vessels
Restrictive cardiomyopathy
Doxorubicin - cocaine

48. What is the characteristic murmurr of mitral stenosis?
Mid - systolic click followed by regurgitation murmur
Opening snap followed by diastolic rumble
CK- MB
Day 1-7

49. What is diastolic dysfx?
Dilation of all four chambers of the heart
Inability to fill ventricles
Ostium secundum (90%)
Loeffler syndrome

50. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Opening snap followed by diastolic rumble
Chronic ischemic heart disease
When a bacterial protein resembles a protein in human tissue