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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 causes unstable angina?
Anitschow cell
PGE
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Elevated ASO anti - DNase B titers

2. What causes angina and syncope in aortic stenosis?

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3. At what point in development do congenital heart defects arise?
Restrictive cardiomyopathy
Prophylactic abx during dental procedures
3-8 wks
Sterile vegetations on mitral valve along lines of closure

4. Why would cardiac enzymes continue to increase after the initial MI?
R-->L
Reperfusion injury
Loss of fx
Ehlers - Danlow and Marfan syndrome

5. What always follows necrosis?
Mitral regurg
Restrictive cardiomyopathy
Acute inflammation
L->R

6. What is the JOneS mneumonic?
1-3 days out
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
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Tetralogy of fallot

7. What type of shunt dose PDA cause?
Loss of fx
Mitral regurg
Left -->right
Aortic stenosis

8. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Chronic rheumatic heart disease
Janeway lesions
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
Reperfusion injury

9. What are the causes of LHF?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
RHF
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

10. When do macrophagess infiltrate the myocardium post MI?
Dark discoloration coagulative necrosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
4-7 days
Aschoff bodies

11. In what pt population does S aureus commonly cause valvular disease?
Migratory polyarthritis
IV drug users
Kawasaki disease
Libman - Sacks endocarditis

12. When would arrhythmia occur after MI?
Within the first day
Paradoxical emboli
Dark discoloration coagulative necrosis
Left -->right

13. What type of valvular vegetations does S aureus cause?
S aureus
ST- segment depression
Large - destructive vegetations
Endocardial fibroelastosis

14. In which chamber of the heart are rhabdomyomas found?
RBC damaged while crossing the calcified valve causing schistocytes
Infantile coarctation of the aorta
Streptococcus bovis/
Ventricle

15. What does Libman - Sacks endocarditis cause?
IV drug users
Months out fibrosis
Mitral regurg
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

16. Opening snap followed by diastolic rumble.
Ehlers - Danlow and Marfan syndrome
Dilated
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Mitral stenosis

17. What are other (not atherosclerotic) causes of MI?
Positive blood cultures anemia of chronic disease
R-->L
Dark discoloration coagulative necrosis
Coronary artery vasospasm - emboli - vasculitis

18. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
4-24 hours
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Increased hydrostatic pressure
1%

19. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Months out fibrosis
Mitral mitral+aortic
Surgical closure small defects may close spontaneously

20. What causes the dependent pitting edema in RHF?
AD mutation in sarcomere proteins
Stretched muscle loses contractility
Increased hydrostatic pressure
Troponin I

21. What are the HACEK organisms? With what condition are they associated?
Blood vessels coming in from normal tissue
Day 1-7
Months out fibrosis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

22. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Yellow pallor macrophages
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

23. What two things happen when a blocked vessel is opened after an MI?
Wear and tear
Contraction band necrosis - reperfusion injury
Hemosiderin laden macrophages
Mitral valve prolapse

24. What type of vegetations does Strep viridans cause?
Ventricular arrhythmia
Pump failure
RBC damaged while crossing the calcified valve causing schistocytes
Small - nondestructive vegetations (subacute endocarditis)

25. How does MI cause LHF?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Fibrosis and dystrophic calcification
Posterior wall of LV - posterior septum - papillary muscles
Loss of LV fx

26. What is the most common cause of death during the acute phase of rheumatic fever?
Valve replacement AFTER the onset of complications
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Myocarditis
Osler nodes (ouch - ouch Osler)

27. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Autoimmune pericarditis 6-8 wks post MI
Loeffler syndrome
Elevated ASO anti - DNase B titers

28. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Aneurysm - mural thrombus - Dressler syndrome
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Blood vessels coming in from normal tissue

29. L- to - R shunt switching to R- to - L shunt.
Eisenmenger syndrome
Mitral regurg
NG or Ca channel blocker
Opening snap followed by diastolic rumble

30. In which pts does S viridans cause endocarditits?
Aortic regurg
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Asymptomatic
Pts w/previously damaged valves

31. What congenital heart defect presents later in life with lower extremity cyanosis?
Osler nodes (ouch - ouch Osler)
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Left -->right
PDA

32. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Asymptomatic
Surgical closure small defects may close spontaneously
Mitral regurg

33. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Coexisting mitral stenosis and fusion of commisures exist
Membrane damage
LA dilation
Sudden cardiac death

34. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Stable and unstable prinzmetal
Tricuspid
Reactive histiocyte with caterpillar nucleus

35. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Tuberous sclerosis

36. What is the most common type of endocarditis?
Janeway lesions
Bicuspid aortic valve
Infectious
Slow HR - decreasing O2 demand and risk for arrhythmia

37. Is scar tissue or myocardium stronger?
Right -->left
Myocardium
Loeffler syndrome
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

38. EKG for stable angina?
Spontaneous
ST- segment depression
Months out fibrosis
Aortic stenosis

39. What typically causes hypertrophic cardiomyopathy?
Right to left
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
AD mutation in sarcomere proteins

40. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Systemic venous congestion
Myocarditis
2-3 weeks

41. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Chronic rheumatic heart disease
Prinzmetal angina
Heart can't fill

42. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Ehlers - Danlow and Marfan syndrome
Surgical closure small defects may close spontaneously
Positive blood cultures anemia of chronic disease
Aortic regurg

43. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Hypertrophic cardiomyopathy
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
20 min

44. Is injury due angina reversible or irreversible?
Reversible
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Sterile vegetations on surface and undersurface on mitral valve
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

45. What makes the MV prolapse murmur louder? Why?
Prinzmetal angina - cocaine
Atherosclerosis of coronary arteries
Coexisting mitral stenosis and fusion of commisures exist
Squatting - increased systemic resistence decreases LV emptying

46. What disesase has Aschoff bodies?
Mitral regurg
Myocarditis in acute rheumatic heart fever
Valve replacement once LV dysfx develops
Bicuspid aortic valve

47. What causes mitral valve prolapse?
Ostium secundum (90%)
Right to left
Myxoid degeneration
Pump failure

48. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Myxoid degeneration
When a bacterial protein resembles a protein in human tissue
Autoimmune pericarditis 6-8 wks post MI
Months out fibrosis

49. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Yellow pallor macrophages
Valve scarring that arises as a consequence of rheumatic fever
Opening snap followed by diastolic rumble

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

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