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Cardiac

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What is the tx for LHF?
ACE inhibitor
Congestive heart failure
Prophylactic abx during dental procedures
ST- segment depression

2. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Concentric LV hypertophy
Circumflex
Anterior wall of LV and anterior septum

3. What is the rate of congenital heart defects?
1%
Hemosiderin laden macrophages
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Contraction band necrosis - reperfusion injury

4. How does dilated cardiomyopathy cause LHF?
Right side - serotonin and other secretory products detoxified in the lung
Stretched muscle loses contractility
Cyanosis - RV hypertrophy - polycythemia - clubbing
>70%

5. What coronary arterysupplies the lateral wall of the LV?
Chronic ischemic heart disease
Circumflex
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Fibrosis and dystrophic calcification

6. L- to - R shunt switching to R- to - L shunt.
Heart can't fill
Squatting - expiration
Eisenmenger syndrome
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

7. What is endocardial fibroelastosis? In what population is it found?
Infantile coarctation of the aorta PDA
Thickening of chrodae tendinae and cusps - mitral stenosis
Infantile coarctation of the aorta
Dense layer of elastic and fibrotic tissue in the endocardium - children

8. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
>60 years - bicuspid aortic valve
Tuberous sclerosis
Maternal diabetes
Months out fibrosis

9. What effect does mitral stenosis have on the heart chambers?
LA dilation
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Yellow pallor macrophages
Tricuspid

10. What are the major criteria of the Jones criteria?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Opening snap followed by diastolic rumble
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

11. What causes the dependent pitting edema in RHF?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Stable angina
Increased hydrostatic pressure
Mitral stenosis

12. What genetic conditions predispose a pt to mitral valve prolapse?
Adult coarctation of the aorta
Tricuspid
Ehlers - Danlow and Marfan syndrome
Group A beta - hemolytic streptococci

13. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
ST- segment depression
Valve replacement once LV dysfx develops
4-24 hours

14. Holosystolic blowing murmur that increases w/expiration?
Asymptomatic
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Mitral regurg
Breast and lung carcinoma - melanoma - lymphoma

15. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
3-8 wks
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

16. When does the heart have dark discoloration post MI?
Group A beta - hemolytic streptococci
4-24 hours
PDA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

17. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Ostium primum
Myofiber hypertrophy with disarray
Doxorubicin - cocaine

18. What does Libman - Sacks endocarditis cause?
Migratory polyarthritis
Eisenmenger syndrome
Mitral regurg
Mitral stenosis

19. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Nitroglycerin
Elevated ASO anti - DNase B titers
Heart can't fill

20. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Mitral regurg
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Blood vessels coming in from normal tissue

21. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Papillary muscle - free wall - IV septum
R-->L
Mid - systolic click followed by regurgitation murmur

22. What is migratory polyarthritis?
Yellow pallor neutrophils
Hypertrophic cardiomyopathy
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Day 1-7

23. What are the four defects in tetralogy of fallot?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Mitral valve prolapse
AD mutation in sarcomere proteins
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

24. Is injury due angina reversible or irreversible?
Mid - systolic click followed by regurgitation murmur
Holosystolic blowing murmur
Pericardial effusion due to pericardial involvement
Reversible

25. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Ostium primum
Reperfusion injury
Slow HR - decreasing O2 demand and risk for arrhythmia

26. When is an MI patent at highest risk for fibrionous pericarditis?
Mitral regurgitation due to vegetations
1-3 days out
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Type I

27. Which angina(s) show ST elevation on EKG? ST depression?
Within the first day
Holosystolic machine like murmur
Prinzmetal stable and unstable
Right side - serotonin and other secretory products detoxified in the lung

28. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Mitral mitral+aortic
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Minimizes ischemia

29. What does granulation tissue contain?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Adult coarctation of the aorta
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Plump fibroblasts - collagen - blood vessels

30. EKG for stable angina?
ST- segment depression
Dense layer of elastic and fibrotic tissue in the endocardium - children
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

31. What type of tumor is a rhabdomyoma?
Harmartoma
3-8 wks
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Loss of fx

32. What are the minor critera of the Jones criteria?
PDA
Nonspecific - eg fever and elevated ESR
LHF
Mitral mitral+aortic

33. What is the most common congenital heart defect?
Split S2 on auscultation
Large - destructive vegetations
RBC damaged while crossing the calcified valve causing schistocytes
VSD

34. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
S aureus
ST- segment depression
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

35. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Stable and unstable prinzmetal
Osler nodes (ouch - ouch Osler)
Mitral stenosis

36. What % of MIs involve the LAD?
45%
ST- segment depression
Dark discoloration coagulative necrosis
Harmartoma

37. What is the main cause of MV regurg? What are other causes?
Mitral valve prolapse
Nonbacterial thrombotic endocarditis (marantic endocarditis)
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
ST- segment depression

38. What murmur ccan be heard in PDA?
4-7 days
Holosystolic machine like murmur
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

39. What are heart failure cells?
Contraction band necrosis
Left -->right
Pulsating nail bed
Hemosiderin laden macrophages

40. What is the most common valve infected by S aureus?
Tricuspid
Rhabdomyoma
Myocardium
Red border granulation tissue

41. How does hypertension cause LHF?

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42. When do CK- MB levels rise - peak - and return to normal?
Left -->right
Tetralogy of fallot
4-6 hours - 24 hours - 72 hours
3-8 wks

43. Large vegetations on tricuspid valve?
Ventricle
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
S aureus
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

44. What is the tx for VSD?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Surgical closure small defects may close spontaneously
Ehlers - Danlow and Marfan syndrome
Streptococcus bovis/

45. What causes angina and syncope in aortic stenosis?

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46. What vavular defect results from acute rheumatic fever?
Bacterial endocarditis
Heart can't fill
Mitral valve prolapse
Mitral regurgitation due to vegetations

47. What type of vegetations does Strep viridans cause?
Nitroglycerin
20 min
Small - nondestructive vegetations (subacute endocarditis)
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

48. What does nonbacterial thrombotic endocarditis cause?
Coexisting mitral stenosis and fusion of commisures exist
Mitral regurgitation due to vegetations
Yellow pallor neutrophils
Mitral regurg

49. Erythematous nontender lesions on palms and soles.
Endocardial fibroelastosis
Janeway lesions
Gelatinous - abundant ground substance
Dilation of all four chambers of the heart

50. What are complications of dilated cardiomyopathy?
S epidermidis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Mitral and tricuspid regurg - arrhythmia
Rhadbomyoma - benign

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