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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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1. What valves are involved in rhuematic endocarditis?
L->R
Mitral valve prolapse
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Mitral mitral+aortic

2. What does rupture of the LV free wall cause?
Cardiac tamponade
Aneurysm - mural thrombus - Dressler syndrome
Hypertrophic cardiomyopathy
Right -->left

3. What is the most common cause of dilated cardiomyopathy? What are other causes?
Small vegetations along the line of closure
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
45%
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

4. What coronary artery supplies the mitral valve papillary muscles?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Anitschow cell
RCA

5. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Streptococcus bovis/
Paradoxical emboli
Congenital rubella

6. What is cardiogenic shock?
2-3%
Volume overload and LHF
Prinzmetal angina
Inability to maintain systemic pressure w/lack of O2 to vital organs

7. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Pump failure
VSD
Regurg vs stenosis

8. What type of endocarditis is associated with SLE?
Aneurysm - mural thrombus - Dressler syndrome
Type I
Libman - Sacks endocarditis
Months out fibrosis

9. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Contraction band necrosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

10. When is an MI patent at highest risk for fibrionous pericarditis?
Stretched muscle loses contractility
Valve replacement once LV dysfx develops
Turner syndrome
1-3 days out

11. What is the classic EKG finding of restrictive cardiomyopathy?
Reperfusion injury
Dilation of all four chambers of the heart
Low voltage EKG w/diminished QRS amplitude
Right -->left

12. What effect does mitral stenosis have on the heart chambers?
Minimizes ischemia
S aureus
LA dilation
Prophylactic abx during dental procedures

13. What are Janeway lesions?
MI
45%
Erythematous nontender lesions on palms and soles.
Loss of LV fx

14. Are most congenital heart defects spontaneous or inherited?
Group A beta - hemolytic streptococci
Infantile coarctation of the aorta PDA
Type I
Spontaneous

15. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Hypertophy of RV atrophy of LV
Volume overload and LHF
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

16. What is diastolic dysfx?
Mitral regurg
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
45%
Inability to fill ventricles

17. How does aortic regurg affect the heart chambers?
Red border granulation tissue
LV dilation and eccentric hypertrophy
Rhabdomyoma
1%

18. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Contraction band necrosis
Months out fibrosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

19. What complications occur within 4 hrs post MI?
Harmartoma
Heart transplant
Cardiogenic shock - CHF - arrhythmia
SLE

20. What are the clinical features of RHF due to?
Chronic rheumatic heart disease
Doxorubicin - cocaine
Systemic venous congestion
Posterior wall of LV - posterior septum - papillary muscles

21. When does the heart have a yellow pallor post MI?
Holosystolic blowing murmur
Rhabdomyoma
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Day 1-7

22. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Yellow pallor neutrophils
Rhadbomyoma - benign
Anitschow cell

23. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
RHF
Dressler syndrome
PDA

24. What are the HACEK organisms? With what condition are they associated?
LAD
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Bounding pulse
LAD

25. How do nitrates tx MI?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Decrease preload -->lowers myocardial stress
Infectious endocarditis
Tender lesions on fingers or toes.

26. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Bicuspid aortic valve
Erythematous nontender lesions on palms and soles.
RBC damaged while crossing the calcified valve causing schistocytes
Colon cancer

27. What congenital heart defect presents later in life with lower extremity cyanosis?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
PDA
Loss of fx

28. What is the murmur of mitral valve prolapse?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral mitral+aortic
Janeway lesions
Mid - systolic click followed by regurgitation murmur

29. How does O2 tx MI?
Months out fibrosis
LAD
Minimizes ischemia
Cardiac tamponade

30. How does hypertension cause LHF?

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31. How do you tx prinzmetal angina?
Squatting - expiration
Chest pain <20 min brought on by exertion or emotional stress
NG or Ca channel blocker
Squat in response to cyanotic spell

32. Which vasculitis can cause MI?
Prinzmetal angina
Holosystolic machine like murmur
Heart transplant
Kawasaki disease

33. What is the most common cause of death during the acute phase of rheumatic fever?
Plump fibroblasts - collagen - blood vessels
Mitral regurg
2-4 hours - 24 hours - 7-10 days
Myocarditis

34. What is the leading cause of death in the US?
Loeffler syndrome
Ischemic heart disease
ST- segment depression
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

35. What type of tumor is a rhabdomyoma?
Low voltage EKG w/diminished QRS amplitude
Harmartoma
Osler nodes (ouch - ouch Osler)
Loeffler syndrome

36. What conditions can cause nonbacterial thrombotic endocarditis?
Myocarditis in acute rheumatic heart fever
Hypercoagulable state or underlying adenocarcinoma
Mitral mitral+aortic
Transposition of the great vessels

37. What type of ischemia does stable angina cause?
Turner syndrome
Subendocardial
Pump failure
Hemosiderin laden macrophages

38. What is the foundation of a scar?
Systemic venous congestion
Libman - Sacks endocarditis
Dark discoloration coagulative necrosis
Granulation tissue

39. What causes the dependent pitting edema in RHF?
RBC damaged while crossing the calcified valve causing schistocytes
Increased hydrostatic pressure
Turner syndrome
LV dilation and eccentric hypertrophy

40. How do beta blockers tx MI?
Congestive heart failure
Slow HR - decreasing O2 demand and risk for arrhythmia
Granulation tissue
PDA

41. What imaging test is useful for detecting lesions on valves?
Subendocardial
Transesophageal echo
Coronary artery vasospasm
PDA

42. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Type I
Red border granulation tissue
PDA

43. What is the rate of congenital heart defects?
Mitral regurg
Months out fibrosis
1%
Large - destructive vegetations

44. What is the major cause of MI?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Congestive heart failure
Months out fibrosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

45. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Anitschow cell
Dark discoloration coagulative necrosis
ST- segment elevation

46. How does Eisenmeger syndrome occur?
Blood vessels coming in from normal tissue
Nonspecific - eg fever and elevated ESR
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
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

47. What is dilated cardiomyopathy?
Limits thrombosis
Libman - Sacks endocarditis
White scar fibrosis
Dilation of all four chambers of the heart

48. What is a Quincke pulse?
VSD
Pulsating nail bed
Aortic regurg
Chronic ischemic heart disease

49. What murmur ccan be heard in PDA?
Degree of pulmonary artery stenosis
Spontaneous
Holosystolic machine like murmur
Anterior wall of LV and anterior septum

50. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
20 min
LAD
Infantile coarctation of the aorta PDA