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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. Infects predamaged valves after transient bacteremia?
Atherosclerosis of coronary arteries
Mitral stenosis
S viridans
Slow HR - decreasing O2 demand and risk for arrhythmia

2. What is the gold standard blood marker for MI?
Troponin I
R-->L
Hypertrophic cardiomyopathy
1-3 days

3. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
CK- MB
Myocarditis
Thickening of chrodae tendinae and cusps - mitral stenosis

4. What is a common complication of cardiac metastasis?
Systolic ejection click followed by crescendo - decrescendo murmur
Pericardial effusion due to pericardial involvement
Coxsackie A or B
PDA

5. What is the rate of mitral valve prolapse in the US?
Mitral mitral+aortic
Tender lesions on fingers or toes.
Reactive histiocyte with caterpillar nucleus
2-3%

6. What effect does chronic rheumatic heart disease have the mitral valve?
Colon cancer
Reversible
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Thickening of chrodae tendinae and cusps - mitral stenosis

7. How do you tx prinzmetal angina?
Indomethacin - decreases PGE
NG or Ca channel blocker
LA
L->R

8. What congenital heart defect does indomethacin tx?
Dilated
Libman - Sacks endocarditis
Tetralogy of fallot
PDA

9. How does adult coarctation of the aorta present?
Rhabdomyoma
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Osler nodes (ouch - ouch Osler)
LHF

10. What type of shunt does ASD cause?
Aortic stenosis
Left -->right
Mitral and tricuspid regurg - arrhythmia
Myocardium

11. What causes microangiopathic hemolytic anemia in aortic stenosis?
Months out fibrosis
Valve scarring that arises as a consequence of rheumatic fever
RBC damaged while crossing the calcified valve causing schistocytes
Papillary muscle - free wall - IV septum

12. Are most congenital heart defects spontaneous or inherited?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Spontaneous
Systolic dysfx leading to biventricular CHF
Stretched muscle loses contractility

13. How does squating decrease hypoxemia in tetralogy of fallot?
ST- segment depression
Group A beta - hemolytic streptococci
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Left -->right

14. What does granulation tissue contain?
AD mutation in sarcomere proteins
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Plump fibroblasts - collagen - blood vessels
Pulsating nail bed

15. What is the most common cause of endocarditis in IV drug users?
S aureus
Shunt - PGE to maintain PDA until surgical repair can be performed
Myocarditis in acute rheumatic heart fever
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

16. What is the characteristic murmur of aortic stenosis?
PDA
LV dilation and eccentric hypertrophy
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Systolic ejection click followed by crescendo - decrescendo murmur

17. What does a biopsy of hypertrophic cardiomyopathy look like?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Myofiber hypertrophy with disarray
Nitroglycerin
Limits thrombosis

18. What is dilated cardiomyopathy?
1-3 days
IV drug users
Dilation of all four chambers of the heart
Cardiogenic shock - CHF - arrhythmia

19. What is the definition of ischemia?
Decrease in blood flow to an organ
Regurg vs stenosis
Aortic regurg
Coexisting mitral stenosis and fusion of commisures exist

20. What compensatory mechanism do tetralogy of fallot pts learn?
Cardiac tamponade
Decreased forward perfusion pulmonary congestion
Squat in response to cyanotic spell
Atria and RV

21. What causes the dependent pitting edema in RHF?
Group A beta - hemolytic streptococci
CHF
Prinzmetal angina - cocaine
Increased hydrostatic pressure

22. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Anitschow cell
Coronary artery vasospasm
Migratory polyarthritis

23. Myofiber hypertrophy with disarray.
Prinzmetal stable and unstable
Right to left
Hypertrophic cardiomyopathy
Rhadbomyoma - benign

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

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25. What maintains patency of the PDA?
1%
ST- segment elevation
Stretched muscle loses contractility
PGE

26. Opening snap followed by diastolic rumble.
Mitral stenosis
Contraction band necrosis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Contraction band necrosis - reperfusion injury

27. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
1-3 days out
Indomethacin - decreases PGE
Shunt - PGE to maintain PDA until surgical repair can be performed
ASD - R-->L

28. What type of valvular vegetations does S aureus cause?
Rhabdomyoma
Large - destructive vegetations
Stable angina
Aschoff bodies

29. What causes acute endocarditis?
Large vegetations of S aureus
Kawasaki disease
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
R-->L

30. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Streptococcus viridans
Infectious
Endocarditis of prosthetic valves

31. What type of collagen is involved in fibrosis?
Type I
>70%
Plump fibroblasts - collagen - blood vessels
Gelatinous - abundant ground substance

32. When do macrophagess infiltrate the myocardium post MI?
Intercostal arteries enlarged due to collateral circulation
4-7 days
Coronary artery vasospasm - emboli - vasculitis
Myxoid degeneration

33. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Chronic ischemic heart disease
Tuberous sclerosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Aortic stenosis

34. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Shunt - PGE to maintain PDA until surgical repair can be performed
Dense layer of elastic and fibrotic tissue in the endocardium - children
PDA

35. How does fibrinolysis/angioplasty tx MI?
Systolic dysfx leading to biventricular CHF
Inability to fill ventricles
Preductal - post aortic arch
Open blocked vessels

36. What is the foundation of a scar?
Breast and lung carcinoma - melanoma - lymphoma
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
Granulation tissue
Reactive histiocyte with caterpillar nucleus

37. How does O2 tx MI?
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
Blood vessels coming in from normal tissue
Minimizes ischemia
Coexisting mitral stenosis and fusion of commisures exist

38. When does the heart have a yellow pallor post MI?
RBC damaged while crossing the calcified valve causing schistocytes
Heart can't fill
Day 1-7
Regurg vs stenosis

39. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Acute inflammation
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Pts w/previously damaged valves

40. What is the most common cause of myocarditis?
Months out fibrosis
R-->L
Harmartoma
Coxsackie A or B

41. What endocarditis is commonly found in patients with colon cancer?
Day 1-7
Streptococcus bovis/
Erythematous nontender lesions on palms and soles.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

42. What murmur ccan be heard in PDA?
RBC damaged while crossing the calcified valve causing schistocytes
Holosystolic machine like murmur
Tetralogy of fallot
Red border granulation tissue

43. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Atria and RV
Migratory polyarthritis
4-7 days macrophage infiltration
Ostium primum

44. What tests show prior group A beta - hemolytic strep infection?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Nitroglycerin
Cyanosis - RV hypertrophy - polycythemia - clubbing
Elevated ASO anti - DNase B titers

45. What is a water - hammer pulse?
Infantile coarctation of the aorta PDA
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
LAD
Bounding pulse

46. What valves are most commonly involved in chronic rheumatic heart disease?
Pancarditis
Tricuspid
Mitral mitral+aortic
Squat in response to cyanotic spell

47. What is the most common form of cardiomyopathy?
Months out fibrosis
3-8 wks
Holosystolic blowing murmur
Dilated

48. Which congenital heart defect is associated with maternal diabetes?
LAD
Transposition of the great vessels
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Low voltage EKG w/diminished QRS amplitude

49. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Heart can't fill
RCA
4-6 hours - 24 hours - 72 hours
Mitral valve prolapse

50. With what condition are rhabdomyomas associated?
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
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Tuberous sclerosis
Nonspecific - eg fever and elevated ESR