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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 complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Aortic regurg
Aschoff bodies
Reversible

2. What is molecular mimicry?
NG or Ca channel blocker
When a bacterial protein resembles a protein in human tissue
PGE
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

3. What are the forward and backward sx of LHF?
2-3%
Chronic rheumatic heart disease
Blood vessels coming in from normal tissue
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

4. What is the major cause of MI?
Shunt
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Coexisting mitral stenosis and fusion of commisures exist

5. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Myxoid degeneration
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Months out fibrosis

6. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Aneurysm - mural thrombus - Dressler syndrome
Endocarditis of prosthetic valves
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

7. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
LA dilation
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Subendocardial

8. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Stretched muscle loses contractility
Turner syndrome
Streptococcus viridans

9. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Erythematous nontender lesions on palms and soles.
MI
LV dilation and eccentric hypertrophy
L->R

10. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Pericarditits
Squat in response to cyanotic spell
Contraction band necrosis
ACE inhibitor

11. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Infectious
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Small - nondestructive vegetations (subacute endocarditis)

12. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Low voltage EKG w/diminished QRS amplitude
RBC damaged while crossing the calcified valve causing schistocytes
Migratory polyarthritis

13. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Prinzmetal
ST- segment elevation
Type I

14. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Wear and tear
Loss of fx
Congestive heart failure
RHF

15. With what disease is Libman - Sacks endocarditis associated?
Circumflex
SLE
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Prinzmetal stable and unstable

16. How does adult coarctation of the aorta present?
Aortic regurg
R-->L
Dense layer of elastic and fibrotic tissue in the endocardium - children
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

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

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18. What complications occur 4-7 days post MI?
RCA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Sterile vegetations on surface and undersurface on mitral valve
Rupture of free wall - IV septum - or papillary muscle

19. How does squating decrease hypoxemia in tetralogy of fallot?
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
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Within the first day
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

20. With what disease is infantile coarctation of the aorta associated?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Stable angina
Turner syndrome
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

21. What are the cancers that most commonly metastasize to the heart?
Coronary artery vasospasm - emboli - vasculitis
Contraction band necrosis
Breast and lung carcinoma - melanoma - lymphoma
Posterior wall of LV - posterior septum - papillary muscles

22. What are the four defects in tetralogy of fallot?
Valve scarring that arises as a consequence of rheumatic fever
Transesophageal echo
When a bacterial protein resembles a protein in human tissue
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

23. What are the sx of PDA at birth?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Asymptomatic
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Nonbacterial thrombotic endocarditis (marantic endocarditis)

24. What is an Anitschow cell?
Eisenmenger syndrome
Reactive histiocyte with caterpillar nucleus
Mitral regurg
Systemic venous congestion

25. What is the effect of mitral regurg on the heart?
Reactive histiocyte with caterpillar nucleus
Slow HR - decreasing O2 demand and risk for arrhythmia
Volume overload and LHF
CK- MB

26. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Reactive histiocyte with caterpillar nucleus
Months out fibrosis
CHF
RBC damaged while crossing the calcified valve causing schistocytes

27. What are Janeway lesions?
Gelatinous - abundant ground substance
Reactive histiocyte with caterpillar nucleus
Erythematous nontender lesions on palms and soles.
Dilated

28. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Large - destructive vegetations
Turner syndrome
Colon cancer
Infectious endocarditis

29. What congenital heart defect is associated with fetal alcohol syndrome?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Loeffler syndrome
Low voltage EKG w/diminished QRS amplitude
VSD

30. What type of valvular vegetations does S aureus cause?
Circumflex
Large - destructive vegetations
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Erythematous nontender lesions on palms and soles.

31. What iis the tx for aortic regurg?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Valve replacement once LV dysfx develops
Months out fibrosis
Anterior wall of LV and anterior septum

32. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Squatting - increased systemic resistence decreases LV emptying
Mitral and tricuspid regurg - arrhythmia
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

33. What areas of the heart does the RCA supply?
Mitral insufficiency
Posterior wall of LV - posterior septum - papillary muscles
Mitral valve prolapse
Fetal alcohol syndrome

34. Large vegetations on tricuspid valve?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Prinzmetal stable and unstable
S aureus
Minimizes ischemia

35. What is the most common valve infected by S aureus?
PDA
Mitral regurg
Tricuspid
Ehlers - Danlow and Marfan syndrome

36. What is typically the mechanims of sudden cardiac death?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Ventricular arrhythmia
Months out fibrosis

37. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Mid - systolic click followed by regurgitation murmur
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Friction rub and chest pain

38. What is the cause of restrictive cardiomyopathy in children?
Dark discoloration coagulative necrosis
Squatting - expiration
Endocardial fibroelastosis (rare)
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

39. What typically causes hypertrophic cardiomyopathy?
ASD - R-->L
AD mutation in sarcomere proteins
Membrane damage
Small vegetations along the line of closure

40. Erythematous nontender lesions on palms and soles.
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Volume overload and LHF
Janeway lesions
Endocarditis of prosthetic valves

41. Which chambers of the heart are generally spared in an MI?
RHF
Atria and RV
Decreases LV dilation by decreasing volume
Pericarditits

42. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
Contraction band necrosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Decreases LV dilation by decreasing volume

43. What is the etiology of S viridans endocarditis?
4-7 days
Reperfusion injury
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Reperfusion injury

44. What is the most common cause of endocarditis in IV drug users?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
LV dilation and eccentric hypertrophy
S aureus
Months out fibrosis

45. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
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
Myocardium
Infantile coarctation of the aorta PDA

46. What tests show prior group A beta - hemolytic strep infection?
Rupture of free wall - IV septum - or papillary muscle
Sterile vegetations on surface and undersurface on mitral valve
Elevated ASO anti - DNase B titers
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

47. What is the most common congenital heart defect?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Reactive histiocyte with caterpillar nucleus
Pts w/previously damaged valves
VSD

48. What is the most common cause of myocarditis?
RHF
Coxsackie A or B
Systemic venous congestion
Systolic ejection click followed by crescendo - decrescendo murmur

49. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Small vegetations along the line of closure
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Restrictive cardiomyopathy

50. Which angina is relieved by Ca channel blockers?
Bicuspid aortic valve
Loeffler syndrome
Papillary muscle - free wall - IV septum
Prinzmetal