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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 does rupture of the LV free wall cause?
Anterior wall of LV and anterior septum
Right side - serotonin and other secretory products detoxified in the lung
IV drug users
Cardiac tamponade

2. How does Eisenmeger syndrome occur?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
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
Slow HR - decreasing O2 demand and risk for arrhythmia
S epidermidis

3. What is the tx for LHF?
Type I
ACE inhibitor
NG or Ca channel blocker
LAD

4. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Months out fibrosis
Tender lesions on fingers or toes.
Ostium primum

5. What causes acute endocarditis?
Endocardial fibroelastosis (rare)
Large vegetations of S aureus
Eisenmenger syndrome
Anitschow cell

6. What coronary artery supplies the mitral valve papillary muscles?
RCA
Surgical closure small defects may close spontaneously
Contraction band necrosis
Migratory polyarthritis

7. Erythematous nontender lesions on palms and soles.
Myxoid degeneration
4-6 hours - 24 hours - 72 hours
Dilated
Janeway lesions

8. What is the definition of ischemia?
Infantile coarctation of the aorta
Prophylactic abx during dental procedures
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Decrease in blood flow to an organ

9. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LAD
Annular - non pruritic rash w/erythematous borders trunks and limbs

10. How does restrictive cardiomyopathy cause LHF?

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11. What causes a mid - systolic click followed by a regurgitation murmur?
Stable and unstable prinzmetal
CK- MB
Membrane damage
Mitral valve prolapse

12. What effect does mitral stenosis have on the heart chambers?
LA dilation
Aortic stenosis
S viridans
Ischemic heart disease

13. How do you prevent S viridans endocarditis?
LAD
Prophylactic abx during dental procedures
Cardiogenic shock - CHF - arrhythmia
Plump fibroblasts - collagen - blood vessels

14. What is the tx for VSD?
Mitral regurg
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Dressler syndrome
Surgical closure small defects may close spontaneously

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

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16. What is the major cause of MI?
1-3 days out
Heart transplant
S aureus
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

17. How does stable angina present?
Holosystolic machine like murmur
Chest pain <20 min brought on by exertion or emotional stress
LAD
ASD - R-->L

18. What is the most common cause of mitral stenosis?
PDA
Chronic rheumatic heart disease
Increased blood in right heart delays closure of P valve
Ostium secundum (90%)

19. What genetic conditions predispose a pt to mitral valve prolapse?
Pericarditits
Stable and unstable prinzmetal
Louder - increased systemic resistence decreases LV emptying
Ehlers - Danlow and Marfan syndrome

20. What are the cancers that most commonly metastasize to the heart?
Yellow pallor macrophages
White scar fibrosis
4-7 days
Breast and lung carcinoma - melanoma - lymphoma

21. What drug relieves stable angina?
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
Nitroglycerin
Rhabdomyoma
Loeffler syndrome

22. What are the forward and backward sx of LHF?
Right side - serotonin and other secretory products detoxified in the lung
PDA
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
Rupture of free wall - IV septum - or papillary muscle

23. What creates the immune reaction in acute rhuematic fever?

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24. What increases the volume of mitral regurg murmur?
Heart transplant
NG or Ca channel blocker
Metastasis
Squatting - expiration

25. How does asprin/heparin tx MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
White scar fibrosis
Limits thrombosis

26. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Hypertrophic cardiomyopathy

27. What is the only Jones criteria that doesn't resolve with time?
Hypertrophic cardiomyopathy
Plump fibroblasts - collagen - blood vessels
Pancarditis
Fetal alcohol syndrome

28. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Fibrinous pericarditis
Ostium primum
NG or Ca channel blocker

29. What congenital heart defect is associated with fetal alcohol syndrome?
Coxsackie A or B
Elevated ASO anti - DNase B titers
Stable angina
VSD

30. What are the complications that occur months after an MI?
Valve replacement once LV dysfx develops
Aneurysm - mural thrombus - Dressler syndrome
Myocarditis in acute rheumatic heart fever
Decreased forward perfusion pulmonary congestion

31. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Increased blood in right heart delays closure of P valve
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
20 min

32. What is eythema marginatum? What parts of the body does it commonly involve?
Ventricles cannot pump
Annular - non pruritic rash w/erythematous borders trunks and limbs
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Elevated ASO anti - DNase B titers

33. What is dilated cardiomyopathy?
Mitral regurgitation due to vegetations
3-8 wks
VSD
Dilation of all four chambers of the heart

34. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Streptococcus viridans
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Subendocardial

35. Which chambers of the heart are generally spared in an MI?
Eisenmenger syndrome
Elevated ASO anti - DNase B titers
Atria and RV
Heart transplant

36. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Colon cancer
Prophylactic abx during dental procedures
Aneurysm - mural thrombus - Dressler syndrome
Degree of pulmonary artery stenosis

37. What complications occur within 4 hrs post MI?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Cardiogenic shock - CHF - arrhythmia
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Months out fibrosis

38. What causes an early - blowing diastolic murmur?
Aortic 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
SLE
Intercostal arteries enlarged due to collateral circulation

39. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Myxoma - benign
Colon cancer
Large vegetations of S aureus
Prinzmetal

40. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
RCA
Fibrosis and dystrophic calcification
Colon cancer

41. What are the sx of right - to - left shunt?
ACE inhibitor
Cyanosis - RV hypertrophy - polycythemia - clubbing
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
Kawasaki disease

42. What is the 1day-1wk -1mo mneumonic for MI?
S aureus
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Nonbacterial thrombotic endocarditis (marantic endocarditis)

43. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Autoimmune pericarditis 6-8 wks post MI
20 min
Reperfusion injury
Congested central veins

44. What is the rate of congenital heart defects?
Libman - Sacks endocarditis
Positive blood cultures anemia of chronic disease
Hypercoagulable state or underlying adenocarcinoma
1%

45. What is endocardial fibroelastosis? In what population is it found?
Coronary artery vasospasm - emboli - vasculitis
Louder - increased systemic resistence decreases LV emptying
Dense layer of elastic and fibrotic tissue in the endocardium - children
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

46. What effect does chronic rheumatic heart disease have the mitral valve?
Aschoff bodies
Thickening of chrodae tendinae and cusps - mitral stenosis
R-->L
Eisenmenger syndrome

47. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Loss of LV fx
Mitral regurg
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Stable and unstable prinzmetal

48. What is the gold standard blood marker for MI?
LA dilation
Day 1-7
PGE
Troponin I

49. What are the complications of aortic stenosis?
Asymptomatic
Mitral insufficiency
Infantile coarctation of the aorta PDA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

50. What are the minor critera of the Jones criteria?
Valve replacement AFTER the onset of complications
Nonspecific - eg fever and elevated ESR
Systemic venous congestion
4-7 days

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