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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 are the sx of PDA at birth?
Ostium primum
Asymptomatic
RCA
Myocardium

2. What % of MIs involve the LAD?
45%
Colon cancer
Janeway lesions
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

3. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Osler nodes (ouch - ouch Osler)
LAD
Fibrosis and dystrophic calcification

4. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Decreases LV dilation by decreasing volume
Valve scarring that arises as a consequence of rheumatic fever
Chronic ischemic heart disease

5. Which artery is most often occluded in an MI?
Valve replacement AFTER the onset of complications
LAD
Wear and tear
Holosystolic blowing murmur

6. What is an important complication of ASD?
Small vegetations along the line of closure
Paradoxical emboli
First 4 hours
Volume overload and LHF

7. What type of shunt results in cyanosis at birth?
Pulsating nail bed
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Right to left
PDA

8. What is endocardial fibroelastosis? In what population is it found?
Mitral regurg
Dense layer of elastic and fibrotic tissue in the endocardium - children
1-3 days out
2-3 weeks

9. What is the tx for dilated cardiomyopathy?
Loss of fx
Circumflex
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Heart transplant

10. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1%
Yellow pallor neutrophils

11. What is the most common type of endocarditis?
Pump failure
Inability to maintain systemic pressure w/lack of O2 to vital organs
Infectious
ST- segment depression

12. What gross and microscopic changes occur 4-7 days after an MI?
Nitroglycerin
Yellow pallor macrophages
Prinzmetal angina
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

13. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Transesophageal echo
Degree of pulmonary artery stenosis
LA dilation
Chest pain <20 min brought on by exertion or emotional stress

14. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Wear and tear
Stable angina
LHF

15. Lower extremity cyanosis later in life - holostystolic machine like murmur.
1-3 days out
PDA
Fetal alcohol syndrome
Degree of pulmonary artery stenosis

16. What type of shunt does transposition of the great vessels cause?
4-24 hours
R-->L
Asymptomatic
Prinzmetal stable and unstable

17. What increases the volume of mitral regurg murmur?
MI
Blood vessels coming in from normal tissue
Small - nondestructive vegetations (subacute endocarditis)
Squatting - expiration

18. What is the basic principle of CHF?
2-3 weeks
Fetal alcohol syndrome
Pump failure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

19. What effect does chronic rheumatic heart disease have the mitral valve?
>70%
Thickening of chrodae tendinae and cusps - mitral stenosis
Restrictive cardiomyopathy
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

20. What is the most common valve infected by S aureus?
2-3 weeks
Tricuspid
Ventricles cannot pump
Paradoxical emboli

21. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Endocarditis of prosthetic valves
L->R
Valve scarring that arises as a consequence of rheumatic fever

22. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Sudden cardiac death
VSD
Right to left

23. What causes mitral valve prolapse?
Myxoid degeneration
S aureus
Valve replacement AFTER the onset of complications
Volume overload and LHF

24. How does stable angina present?
Ostium primum
Decrease in blood flow to an organ
Chest pain <20 min brought on by exertion or emotional stress
Gelatinous - abundant ground substance

25. With what virus is PDA associated?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Congenital rubella
Shunt - PGE to maintain PDA until surgical repair can be performed

26. What is typically the mechanims of sudden cardiac death?
Surgical closure small defects may close spontaneously
Ventricular arrhythmia
Kawasaki disease
Heart can't fill

27. What is the most common cause of aortic stenosis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Dark discoloration coagulative necrosis
Wear and tear
Infectious

28. What makes the MV prolapse murmur louder? Why?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Squatting - increased systemic resistence decreases LV emptying
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Infectious

29. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Yellow pallor macrophages
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Cyanosis - RV hypertrophy - polycythemia - clubbing

30. What are the sx/complications of myocarditis?
Adult coarctation of the aorta
CHF
R-->L
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

31. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Open blocked vessels
Aschoff bodies
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Congenital rubella

32. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1-3 days
Valve replacement once LV dysfx develops
Split S2 on auscultation

33. How do you prevent S viridans endocarditis?
Hemosiderin laden macrophages
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
Coexisting mitral stenosis and fusion of commisures exist
Prophylactic abx during dental procedures

34. With what disease is Libman - Sacks endocarditis associated?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Libman - Sacks endocarditis
SLE
LA dilation

35. With what developmental disorder is VSD associated?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
NG or Ca channel blocker
Fetal alcohol syndrome
Mitral mitral+aortic

36. Which congenital heart defect is associated with congenital rubella?
Myofiber hypertrophy with disarray
Friction rub and chest pain
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
PDA

37. How does hypertension cause LHF?

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38. What is the most common type of ASD? What %?
Systolic ejection click followed by crescendo - decrescendo murmur
Ostium secundum (90%)
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Concentric LV hypertophy

39. What does a biopsy of hypertrophic cardiomyopathy look like?
Loeffler syndrome
Myofiber hypertrophy with disarray
Holosystolic blowing murmur
Right to left

40. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Squatting - expiration
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Infantile coarctation of the aorta PDA

41. How do ACE inhibitors tx MI?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Systolic ejection click followed by crescendo - decrescendo murmur
Aschoff bodies
Decreases LV dilation by decreasing volume

42. Is injury due angina reversible or irreversible?
Membrane damage
3-8 wks
Reversible
Aortic stenosis

43. Why are cardiac enzymes elevated after an MI?
Hemosiderin laden macrophages
Systolic ejection click followed by crescendo - decrescendo murmur
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Membrane damage

44. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Valve replacement
1-3 days out
AD mutation in sarcomere proteins

45. What type of shunt does a VSD cause?
L->R
Posterior wall of LV - posterior septum - papillary muscles
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Heart transplant

46. What is the foundation of a scar?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Rhabdomyoma
Dark discoloration coagulative necrosis
Granulation tissue

47. Large vegetations on tricuspid valve?
Paradoxical emboli
Prinzmetal angina - cocaine
S aureus
Opening snap followed by diastolic rumble

48. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1-3 days
Pulsating nail bed

49. What % stenosis causes stable angina?
S aureus
>70%
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Sudden cardiac death

50. Lower extremity cyanosis in infants? In adults?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Tender lesions on fingers or toes.
Thickening of chrodae tendinae and cusps - mitral stenosis
Infantile coarctation of the aorta PDA