Quiz 2

Question 1

Three major categories of cardiomyopathies?

Answer 1

Dilated (90%), Hypertrophic, & Restrictive

Question 2

Most common cause of non-ischemic dilated cardiomyopathy (DCM) in the US:

Answer 2

chronic alcoholism (Thiamine & carnitine deficiency, as well as alcohol toxicity to tissues)

Question 3

Dilated cardiomyopathy is characterized by enlargement of which chamber(s)?

Answer 3

All four - becomes rounder, basketball shaped

Question 4

Hypertrophic cardiomyopathy primarily affects which chamber(s)?
Due to?

Answer 4

Left ventricle (classically the ventricular septum)
Genetic [NOT d/t HTN]

Question 5

The most common cause(s) of restrictive cardiomyopathy?

Answer 5

amyloidosis & hemochromatosis

Question 6

Restrictive cardiomyopathy is caused by:

Answer 6

infiltration of normal tissue, which results in impaired motion and abnormal contraction and relaxation

Question 7

Endocarditis is:

What area is affected most? Side?

Answer 7

inflammation of the valve leaflets, potentially also lining of atria and ventricles. Leads to vegetations.
Tends to begin at area of greatest pressure = lines of closure.
L>R
Atrial side of AV valves / Vent side of semilunar valves

Question 8

Most common cause of infectious endocarditis?

Answer 8

BACTERIA (staph aureus - 30-50% of community acquired cases, and 60-80% of nosocomial cases [MRSA])

Question 9

Marantic endocarditis is:

Answer 9

non-bacterial thrombotic endocarditis, deposition of small, pink, embolizing, sterile vegetations on valve leaflets [marantikos = wasting away]; d/t hypercoagulable state known as Trousseau’s syndrome.

Question 10

Portals of entry of endocarditis include:

Answer 10

IV drug use
poor dental health, recent procedure, infection
GU infections or instrumentation (catheter)
skin infections (impetigo)
pulmonary infection

Question 11

Acute vs. sub-acute endocarditis:

Answer 11

Acute - rapidly developing, destructive, usually d/t infection, 50% mortality within days, abscess in ring of tissue below leaflets common.
Subacute - slower development, less severe, typically d/t previous valvular damage, infection by less virulent organism, likely recovery, vegetations that embolize common.

Question 12

Microemboli in the fingernail beds are called:
In the skin:
In the retina:

Answer 12

Splinter hemorrhages
Petechiae
Roth’s spots

Question 13

Risk factors for endocarditis:

Answer 13

IV drug use
alcoholism
artificial valves / vascular grafts
immunocompromised (steroids, RA drugs, etc)
in-dwelling catheters

Question 14

Most common cause of infectious endocarditis in native valves, perhaps damaged, & main cause of subacute endocarditis?

Answer 14

Strep viridans (alpha hemolytic)

Question 15

Organism associated with endocarditis in pts with prosthetic valves:

Answer 15

Staph epidermidis

Question 16

Organism associated with IV drug users endocarditis:

Answer 16

Staph aureus

Question 17

Organism associated with alcoholics with endocarditis:

Answer 17

anaerobes & oral cavity bacteria

Question 18

Organism associated with endocarditis after procedures (cytoscopy, prostatectomy, indwelling catheters):

Answer 18

E coli & other gram negative

Question 19

Organism associated with endocarditis in pts with carcinoma of the colon:

Answer 19

strep bovis (so if found => colonoscopy needed to r/o CA)

Question 20

Endocarditis associated with SLE is called:

Answer 20

Libman-Sacks endocarditis (flat spreading vegetations on mitral valve surface & chordae tendineae)

Question 21

Myocarditis results from:

Answer 21

infection of the heart
autoimmune phenomena:
   Rheumatic heart dz (common worldwide, less in US - abx)
   collagen vascular dzs - SLE, RA
drugs
transplant rejection

Question 22

Most common infectious agent of myocarditis:

Answer 22

Coxsackie virus

Others include Lyme’s, CMV, HIV, typhus, Chaga’s, meningococcus, toxoplasmosis, trichinosis, etc

Question 23

Compare valvular stenosis & insufficiency:

Answer 23

Valvular stenosis is a failure to open completely, impeding forward flow.
Valvular insufficiency is a failure to close completely, allowing reverse flow (regurg)

Question 24

The most frequent valvular abnormalities that account for 2/3 of all valvular dz:

Answer 24

acquired stenosis of the aortic and mitral valves

Question 25

Most common valvular disease:

Answer 25

Aortic Stenosis
(there is debate that MVP is more common)
Left sided valvular dz more common than right

Question 26

myxomatous degeneration:

Answer 26

• pathological weakening of the connective tissue, most often used to describe MVP
• one of the most common forms of valvular heart dz
• the most common cause of pure mitral valve insufficiency.

Question 27

Possible complications of MVP:

Answer 27

infective endocarditis
mitral insufficiency
stroke / systemic infarct - from emboli
arrhythmia - atrial or ventricular

Question 28

Rheumatic fever often follows:

Answer 28

group A beta-hemolytic streptococcus [strep pyogenes] pharyngitis (strep throat)

NOT skin infections of strep, like impetigo

Question 29

Why are antibiotics used so often in strep throat infections?

Answer 29

to shorten the course, diminish infectivity, & diminished sequelae (RF).

• Abx do not shorten the course of RF.
• Untreated pts may remain infected with strep for weeks after symptoms resolve.

Question 30

Aschoff bodies are pathognomonic for?

What are they?

Answer 30

Rheumatic heart dz (but may show up in RF, not restricted to the heart)

granulomatous structures consisting of fibrinous material, lymphocytes, plasma cells, and macrophages surrounding necrotic centers.

Question 31

Post-strep RF is likely d/t an autoimmune response caused by:

Answer 31

anti-streptococcal M protein antibodies that cross-react with cardiac myosin

Question 32

Tumor review

Answer 32

benign - doesn’t change cell type, 70% of heart tumors
malignant - neoplastic changes, 30% of heart tumors
staging - magnitude of original lesion + spread
grading - histological, grade of cellular differentiation

Question 33

Most common cause of pericarditis:

Answer 33

idiopathic [post-viral syndrome = unknown etiology]

others include infectious (TB), inflammatory, autoimmune, drugs, trauma.

Question 34

Dressler’s syndrome:

Answer 34

autoimmune pericarditis

2-3 wk post MI

Question 35

Post-MI pericarditis:

Answer 35

inflammatory cells recruited to site of necrosis

Question 36

The bread-and-butter appearance of the heart is classic for:

Answer 36

Fibrinous pericarditis

Question 37

Five characterizations of pericarditis:

Answer 37

Serous - transudative, normally minimal fluid
Fibrinous - fibrin, bread & butter appearance
Hemorrhagic - blood, beefy appearance
Purulent - pus
Caseous - necrosing, granulomatous, think TB

Question 38

Most common heart tumor:

Features:

Answer 38

atrial myxoma (benign)
hypocellular myxoid mass
polygonal/elongated cells
mono- or multinucleate
finely vacuolated eosinophilic cytoplasm

Question 39

Most common pediatric heart tumor:

Features:

Answer 39

cardiac rhabdomyoma
benign, but position can lead to arrhythmia/obstruction
spontaneous regression

Question 40

Malignancy with greatest propensity to metastasize to the heart:

Answer 40

melanoma