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Flashcards in Cardiac Deck (194)
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1
Q

What causes Printzmetal Angina? What drug is used to Dx Prinzmetal’s Angina?

A

coronary artery vasospasm

Ergonovine

2
Q

Would Printzmetal Angina cause ST elevation or ST depression?

A

ST elevation

3
Q

Which protein is the gold standard for MI?

A

Troponin I

4
Q

How long does it take for Troponin I levels to rise?

A

2-4 hours

5
Q

How long does it take for Troponin I to peak?

A

24 hours

6
Q

Which protein is the transient marker for MI?

A

CK-MB

7
Q

How long is the myocardium dark following M.I.?

A

4-24 hours

8
Q

What is the microscopic change one day post-MI?

A

coagulative necrosis

9
Q

What is the microscopic change one week post-MI?

A

invasion of neutrophils and then macrophages

10
Q

What vessel feeds the papillary muscle?

A

RCA

11
Q

What is the complication of neutrophils invading the myocardium post-MI?

A

fibrinous pericarditis

12
Q

How does fibrinous pericarditis present?

A

friction rub

13
Q

What is the complication of macrophages invading the myocardium post-MI?

A

wall rupture

14
Q

What type of tissue invades one month post-MI?

A

granulation tissue

15
Q

What is the gross change months after an MI?

A

white scar

16
Q

What is the complication of a white scar in the myocardium?

A

Aneurysm

17
Q

What mediates Dressler syndrome? How many weeks post-MI does it take for this to occur?

A

autoimmune reaction to PERICARDIAL membrane

6-8 weeks

18
Q

How is Dressler Syndrome treated?

A

colchicine

19
Q

What are VSDs associated with?

A

fetal alcohol

20
Q

What is Eisenmenger Syndrome?

A

VSD–> L to R –> Pulm. HTN–> R to L

21
Q

What type of speciific heart defect is associated with Downs Syndrome?

A

Ostium Primum ASD

22
Q

Why does an ASD produce a split S2?

A

more blood in left heart delays closure

23
Q

What is the important and potentially fatal complication of an ostium primum?

A

paradoxical emboli

24
Q

What is the most common cause of a PDA?

A

congenital rubella

25
Q

Does a PDA result in a right-to-left or a left-to-right shunt?

A

left to right

26
Q

What is the treatment of a PDA? Why?

A

indomethacin

decreases PGE synthesis

27
Q

What are the four characteristics of Tetralogy of Fallot?

A

Persistent PDA

RVH

Over-riding aorta

VSD

28
Q

Does tetralogy of fallot cause a right-to-left or a left-to-right?

A

right-to-left

29
Q

What is Transposition of the Great Arteries associated with?

A

maternal diabetes

30
Q

What maintains a PDA?

A

PGE

31
Q

What is a Truncus Arteriosus?

A

single vessel arising from both ventricles

32
Q

Tricuspid atresia results in the development of what structure?

A

ASD

33
Q

Where does an infantile Aortic Coarctation often present?

A

distal to aortic arch

proximal to PDA

34
Q

What disease is Coarctation of the Aorta associated with?

A

Turner Syndrome

35
Q

How does adult Coarctation of the Aorta present?

A

strong UE pulses and low LE pulses

36
Q

What is the finding of Coarctation of the Aorta on Imaging? What causes this?

A

notched ribs

development of collateral circulation

37
Q

What valvular issue does Adult Coarctation of the Aorta present with?

A

bicuspid aortic valve

38
Q

What group of Strep cause rheumatic fever?

A

Group A

39
Q

What is the hemolysis pattern of Strep that causes Rheumatic Fever ?

A

β-hemolytic

40
Q

How long after an infection can Rheumatic Fever present?

A

2-3 weeks

41
Q

What is the constituent of Strep that causes Rheumatic Fever molecular mimmicry?

A

M-protein

42
Q

What are the two titers that may be present if a patient has been previously diagnosed with Group A β-hemolytic Strep?

A

anti-ASO

anti-DNase B

43
Q

What criteria are used to Dx Group B β-hemolytic Strep infection?

A

Jones Criteria

44
Q

What is the J of the JONES criteria?

A

joints (Migratory polyartiritis)

45
Q

What is the O of the JONES criteria? What specific condition?

A

O = heart shape = pancarditis

46
Q

What is the N of the JONES criteria?

A

N = (subcutaneous) Nodules

47
Q

What is the E of the JONES criteria?

A

Erythema Marginatum

48
Q

What is the S of the JONES criteria?

A

Syndenham Chorea

49
Q

What is Migratory Polyarteritis?

A

swelling/pain in one joint that moves to involve another joint

50
Q

What two valves are involved during Rheumatic Fever? Which more often?

A

aortic and mitral

Mitral = More often

51
Q

What type of abnormality takes place at the mitral valve early during Rheumatic Fever?

A

mitral regurgitation

52
Q

What is the most common cause of death in the acute phase of Rheumatic Fever?

A

myocarditis

53
Q

What is the histological finding of Myocarditis during Rheumatic Fever?

A

Aschoff Bodies

54
Q

What three cells compose the Aschoff Bodies during Rheumatic Fever?

A

Reactive Histiocytes

Giant cells

fibrinoid material

55
Q

What is Erythema Marginatum?

A

annular rash with erythematous border

56
Q

What happens to the mitral valve anatomy during chronic rheumatic fever?

A

thickening of chordae tendinae

57
Q

What happens to the aortic valve during chronic rheumatic fever?

A

fusion of commissures (bicuspid aortic valve)

58
Q

Ejection Click is a pathological finding of what cardiac abnormality?

A

Aortic Stenosis

59
Q

What are the three major complications of Aortic Stenosis?

A
  1. LVH
  2. Angina/Syncope upon exercise
  3. Micropathic Hemolytic Anemia
60
Q

What causes Aortic Regurgitation?

A

aortic root dilation

61
Q

What is the cause of Mitral Valve Prolapse ?

A

myxoid degeneration

62
Q

What are the two potential causes of Myxoid Degeneration?

A

ED or Marfan

63
Q

What is heard on auscultation during Mitral Valve Prolapse?

A

mid-systolic click

64
Q

Does a Mitral Valve Prolapse become louder or softer during squatting?

A

softer

65
Q

What is heard on auscultation during Mitral Valve Prolapse?

A

holosystolic click

66
Q

Does a Mitral Valve Regurgitation become louder or softer during squatting? Why?

A

louder

squatting causes increased systemic pressure that cause LV to pump more blood through mitral valve

67
Q

What is heard during auscultation during mitral valve stenosis?

A

opening snap

68
Q

What are the three complications of Mitral Valve Stenosis?

A

pulmonary congestion

pulmonary HTN

atrial fibrillation

69
Q

What bacteria is the most common cause of endocarditis/?

A

Strep. viridans

70
Q

Strep. viridans can infect with type of valve? Why?

A

previously damaged valve

bacteria attach to exposed collagen

71
Q

What is the most common cause of endocarditis in IV drug users?

A

S. aureus

72
Q

What valve is most commonly infected by S. aureus?

A

Tricuspid

73
Q

What does S. aureus do to heart valves?

A

destroy

74
Q

What species of bacteria most often infects prosthetic heart valves?

A

S. epidermidis

75
Q

What bug strongly hints at Colorectal Carcinoma?

A

Strep. bovis

76
Q

What group of bacteria is responsible for endocarditis with a negative blood cultures?

A

HACEK

77
Q

What is H of HACEK?

A

Haemophilus

78
Q

What is A of HACEK?

A

Actinobacillus

79
Q

What is C of HACEK?

A

Cardiobacterium

80
Q

What is E of HACEK?

A

Eikenella

81
Q

What is K of HACEK?

A

Kingella

82
Q

What two locations do Janeway lesions manifest? What disease are they indicative of?

A

palms and soles

endocarditis

83
Q

What two locations do Osler nodes lesions manifest? What disease are they indicative of?

A

fingers and toes

Endocarditis

84
Q

Where do splinter hemorrhages manifest?

A

nail-bed

85
Q

Where do Roth Spots manifest? What disease are they indicative of?

A

Retina

endocarditis

86
Q

What disease can endocarditis precipitate the formation of?

A

anemia of chronic disease

87
Q

What type of echo is used for endocarditis?

A

transesophageal echo

88
Q

What two diseases are sterile vegetations indicative of?

A

hyper-coaguable state

Adenocarcinoma

89
Q

What valve is most commonly infected by sterile vegetations? What is the result?

A

mitral

mitral regurgitation

90
Q

What endocarditis disease is produce during SLE? Which valve? What does this result in?

A

Libman-Sachs endocarditis

mitral

regurgitation

91
Q

Does a dilated cardiomyopathy result in systolic or diastolic function?

A

sytolic

92
Q

What two valves are most often affected during dilated cardiomyopathy? What does this lead to?

A

mitral and tricuspid

regurgitation

93
Q

What two viruses can cause a dilative cardiomyopathy?

A

Coxsackie A and B

94
Q

What type of immune cell invades the heart during a coxsackie virus infection? What layer?

A

Lymphocytes

myocardium

95
Q

What drug can cause a dilative cardiomyopathy?

A

Doxorubicin

96
Q

What specific disease can hemochromatosis cause in the heart?

A

dilative cardiomyopathy

97
Q

A mutation in genes for what protein can cause a hypertrophic cardiomyopathy? What is the mode of inheritance?

A

sarcomere

autosomal dominant

98
Q

What is the mode of inheritance for the most common genetic form of hypertrophic cardiomyopathy?

A

autosomdal dominant

99
Q

Would a hypertrophic cardiomyopathy lead to a systolic or diastolic dysfunction?

A

diastolic

100
Q

What type of stenosis can a patient with hypertrophic cardiomyopathy present with? Why?

A

aortic stenosis

ventricular septum hypertrophy

101
Q

What are the four causes of a restrictive cardiomyopathy?

A

amyloidosis

sarcoidosis

endocardial fibroelastosis

Loeffler Syndrome

102
Q

What are the three findings of Loeffler Syndrome?

A

endoMYOcardial fibrosis

Eosinophilic infiltrate

eosinophilia

103
Q

What is the classic finding of restrictive cardiomyopathy?

A

low-amplitude EKG

104
Q

What is a myxoma? What is the specific location as to where a myxoma often arises?

A

benign pedunculated mass

usually in left atria

105
Q

What type of tumor is a myxoma?

A

mesenchymal

106
Q

What valve does a myxoma often occlude?

A

mitral

107
Q

What is a rhabdomyoma?

A

benign hamartoma of cardiac muscle

108
Q

What patient population does a myxoma arise?

A

adult

109
Q

What patient population does a rhabdomyoma arise?

A

children

110
Q

What other disease is a rhabdomyoma associated with?

A

tuberous sclerosis

111
Q

Where in the heart does a rhabdomyoma often arise?

A

ventricle

112
Q

Which four cancer can metastisize to the heart?

A

breast, lung, lymphoma, melanoma

113
Q

What layer of the heart do metastatic tumors like to lodge? What can this lead to?

A

pericardium

pericardial effusion

114
Q

Does Temporal Arteritis more commonly effect males or females? Over what age?

A

females

50

115
Q

What causes Unstable Angina?

A

rupture of a coronary artery with incomplete occlusion

116
Q

When does unstable angina occur?

A

at rest

117
Q

Is prinzmetal angina a reversible or irreversible injury?

A

reversible

118
Q

What does Prinzmetal Angina do on the EKG?

A

ST elevation

119
Q

What are the two treatments of Prinzmetal Angina?

A

GTN or CCBs

120
Q

Does GTN relieve the symptoms of myocardial infarction?

A

no

121
Q

What parts of the heart are often spared during Myocardial Infarction?

A

RV and both atria

122
Q

How long is Troponin I detectable?

A

7-10 days

123
Q

Reperfusion of irreversibly damaged myocytes leads to influx of what ion? Causing?

A

calcium

contraction band necrosis

124
Q

What is the microscopic change of the myocardium months after injury?

A

fibrosis

125
Q

What is the key complication of the macrophage phase of post-MI immune response?

A

rupture

126
Q

What must occur for pericarditis to occur post-MI?

A

transmural infarction

127
Q

How long post-MI does Dressler Syndrome arise?

A

6-8 weeks

128
Q

What type of collagen would be present in a healed MI?

A

type one

129
Q

What is the most common cause of right-sided HF?

A

left-sided HF

130
Q

What are the three manifestations of right-sided HF?

A

JVD

nutmeg liver

peripheral edema

131
Q

What are the two findings of Eisenmenger syndrome on physical exam and labs?

A

clubbing of fingers

polycythemia

132
Q

Why does S2 split during an ASD?

A

delayed closure of pulmonic valve due to increased blood volume

133
Q

Explain the process of why a person with Tetralogy of Fallot squat?

A

increase pressure on left heart to shunt blood to right heart and improve blood flow to lungs

134
Q

What drug is used to treat TGA? Why?

A

misoprostol

maintain PDA

135
Q

What is truncus arteriosus ?

A

single vessel arising from ventricles

136
Q

What are the two forms of Coarctation of the Aorta?

A

infantile and adult

137
Q

Infantile Coarctation of the Aorta is associated with what other finding?

A

PDA

138
Q

Where does Adult Coarctation of Aorta occur?

A

distal to aortic arch

139
Q

How long will each joint be affected during Migratory Polyarthritis?

A

2-3 days

140
Q

Of the JONES criteria, which is the only symptom that will not resolve with time?

A

valvular issue

141
Q

What specific cell type is found during myocarditis of rheumatic fever? What type of cell is this?

A

Anitschkow

reactive histiocyte

142
Q

What process causes the friction of Acute Rheumatic Fever?

A

pericarditis

143
Q

Repeated exposure to Group A β-hemolytic Strep. can cause what long term heart problem?

A

mitral stenosis

144
Q

What type of aortic valve has a higher liklihood of developing aortic stenosis?

A

bicuspid aortic valve

145
Q

What will be heard on auscultation during Aortic Regurgitation ?

A

early, blowing diastolic murmur

146
Q

What are three common presenting symptoms for a patient with aortic regurgitation?

A

wide pulse pressure

pulsating nail bed

bobbing head

147
Q

What would be heard during auscultation for mitral valve regurgitation?

A

holosystolic ‘blowing’ murmur

148
Q

Would mitral valve regurgitation become louder or softer during expiration? Why?

A

louder

more blood enters LA and LV to be pumped

149
Q

Below what vessel do the vaso vasorum cease to exist? What can this lead to?

A

renal arteries

AAA

150
Q

Would a right sided murmur become louder or softer upon inspiration?

A

louder

151
Q

What is Kussmaul’s sign?

A

rise in JVD upon inspiration

152
Q

Which β-blocker can exacerbate Prinzmetal Angina?

A

Propranalol

153
Q

What are Janeway Lesions/Osler Nodes/Splinter Hemorrhages composed of?

A

Septic Embloi

154
Q

Do Janeway lesions hurt?

A

no

155
Q

Do Osler nodes hurt?

A

yes

156
Q

Other than a fever and murmur, what disease can all forms of endocarditis produce?

A

Anemia of Chronic Disease

157
Q

What process occurs during Libman-Sacks Endocrditis?

A

mitral regurgitation

158
Q

What is the major form of endocarditis that can produce vegetations on the surface and underside of the mitral valve?

A

Libman Sacks Endocarditis

159
Q

What is the mode of inheritance for a genetic mutation that could lead to dilated cardiomyopathy?

A

autosomal dominant

160
Q

Other than doxorubicin, what drug is known to cause a dilative cardiomyopathy?

A

alcohol

161
Q

What heart pathology can pregnancy cause?

A

dilated cardiomyopathy

162
Q

Myofiber Disarray is indicative of what disease?

A

hypertrophic cardiomyopathy

163
Q

Endocardial Fibroelastosis primarily effects what age group?

A

children

164
Q

What is the most common primary cardiac tumor in adults?

A

Myxoma

165
Q

What is the most common presentation for a myxoma?

A

syncope

166
Q

What vessel supplies the papillary muscles of the LV?

A

right coronary artery

167
Q

How long does it take CK-MB to rise after an infarction?

A

4-6 hours

168
Q

How long does it takes CK-MB to peak after an infarction?

A

24 hours

169
Q

How long does it takes CK-MB to return to normal levels after an infarction?

A

72 hours

170
Q

Does a Mitral Valve Regurgitation become louder or softer during inspiration? Why?

A

louder

more blood enters left atria

171
Q

Which angina show STE? Which angina shows STDs?

A

STDs = stable or unstable

STEs = prinzmetal

172
Q

What part of the body is cyanotic in a kid with a PDA?

A

lower extremities

173
Q

What presents with a bounding pulse, aortic stenosis or aortic regurgitation?

A

regurgitation

174
Q

Does aortic regurgitation result in eccentric or concentric hypertrophy?

A

eccentric

175
Q

Does aortic stenosis result in eccentric or concentric hypertrophy?

A

concentric

176
Q

Is stable angina a reversible or irreversible injury?

A

reversible

177
Q

Would Stable Angina cause ST elevation or ST depression?

A

depression

178
Q

Would Unstable Angina cause ST elevation or ST depression?

A

depression

179
Q

What two drugs are used to treat Prinzmetal Angina?

A

nitro and CCBs

180
Q

What time frame of chest pain differentiate angina from M.I.?

A

twenty minutes

181
Q

What is removed from the cell during coagulative necrosis?

A

nuclei

182
Q

For how long following ischemia will no changes be seen in microscopy or gross changes?

A

four hours

183
Q

What color is the heart on gross examination when neutrophils are present?

A

yellow

184
Q

What specific days for neutrophil infiltration post-MI?

A

1-3

185
Q

What specific days for macrophage infiltration post-MI?

A

4-7

186
Q

What is the most common type of ASD?

A

ostium secundum

187
Q

Is PDA symptomatic at birth?

A

no

188
Q

During what kind of heart inflammation do Anitschkow cells arise?

A

Myocarditis

189
Q

Is mitral regurgitation caused by acute or chronic rheumatic fever?

A

acute

190
Q

Is mitral stenosis caused by acute or chronic rheumatic fever?

A

chronic

191
Q

Does S. viridans destroy valves?

A

no

192
Q

Does S. aureus destroy valves?

A

yes

193
Q

What type of cardiomyopathy could pregnancy produce?

A

dilated

194
Q

What is the most common tumor of the heart?

A

metastasis