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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 type of collagen is involved in fibrosis?
PDA
Type I
1-3 days
Dense layer of elastic and fibrotic tissue in the endocardium - children

2. What is the leading cause of death in the US?
Left -->right
Ischemic heart disease
Coxsackie A or B
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

3. What are Janeway lesions?
RCA
Pericardial effusion due to pericardial involvement
S viridans
Erythematous nontender lesions on palms and soles.

4. What causes the split S2 in ASD?
Surgical closure small defects may close spontaneously
Increased blood in right heart delays closure of P valve
Cyanosis - RV hypertrophy - polycythemia - clubbing
20 min

5. Tender lesions on fingers or toes.
Chronic ischemic heart disease
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
RBC damaged while crossing the calcified valve causing schistocytes
Osler nodes (ouch - ouch Osler)

6. What type of tumor is a rhabdomyoma?
Atherosclerosis of coronary arteries
Harmartoma
Chronic ischemic heart disease
Prinzmetal stable and unstable

7. Which vasculitis can cause MI?
Kawasaki disease
Congestive heart failure
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Positive blood cultures anemia of chronic disease

8. What are the clinical features of RHF?
R-->L
Congenital rubella
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
S aureus

9. What effect does chronic rheumatic heart disease have the mitral valve?
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
Thickening of chrodae tendinae and cusps - mitral stenosis
Elevated ASO anti - DNase B titers
Dark discoloration coagulative necrosis

10. What does a biopsy of hypertrophic cardiomyopathy look like?
Valve scarring that arises as a consequence of rheumatic fever
Opening snap followed by diastolic rumble
Turner syndrome
Myofiber hypertrophy with disarray

11. Tx for PDA?
4-7 days
Valve replacement
Indomethacin - decreases PGE
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

12. Sudden death in a young athlete.
PDA
Hypertrophic cardiomyopathy
Chronic rheumatic heart disease
Gelatinous - abundant ground substance

13. What are heart failure cells?
Trisomy 21
Hemosiderin laden macrophages
Circumflex
Day 1-7

14. What causes an early - blowing diastolic murmur?
Myocarditis in acute rheumatic heart fever
ST- segment elevation
Spontaneous
Aortic regurg

15. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Chronic ischemic heart disease
Dressler syndrome
Myocarditis

16. In which chamber of the heart are cardiac myxomas found?
LA
Elevated ASO anti - DNase B titers
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Myocarditis

17. What is a water - hammer pulse?
Bounding pulse
Transposition of the great vessels
Squatting - increased systemic resistence decreases LV emptying
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

18. What is the tx for VSD?
LV dilation and eccentric hypertrophy
Surgical closure small defects may close spontaneously
Maternal diabetes
Bicuspid aortic valve

19. What are the complications of mitral valve prolapse? Are they common?
Metastasis
When a bacterial protein resembles a protein in human tissue
Squatting - expiration
Infectious endocarditis - arrythmias - severe mitral regurg no

20. What are the complications that occur months after an MI?
Increased hydrostatic pressure
Valve replacement AFTER the onset of complications
Aneurysm - mural thrombus - Dressler syndrome
PGE

21. What does nonbacterial thrombotic endocarditis cause?
ST- segment depression
Mitral regurg
Indomethacin - decreases PGE
Acute inflammation

22. What is the cause of the red border around granulation tissue?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Blood vessels coming in from normal tissue
Mitral mitral+aortic
VSD

23. What effect does aortic regurg have on the pulse pressure? Why?
Red border granulation tissue
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
Endocarditis of prosthetic valves
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

24. What are the major criteria of the Jones criteria?
Myocarditis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Subendocardial
LAD

25. What causes angina and syncope in aortic stenosis?

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26. What are the clinical features of LHF due to?
Decrease preload -->lowers myocardial stress
Decreased forward perfusion pulmonary congestion
LHF
Ischemic heart disease

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

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28. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Months out fibrosis
Mitral valve prolapse
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Loeffler syndrome

29. When does the heart have a yellow pallor post MI?
LAD
Day 1-7
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
LAD

30. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Hypercoagulable state or underlying adenocarcinoma
Ostium primum
Infectious endocarditis - arrythmias - severe mitral regurg no
PDA

31. What are the sx of right - to - left shunt?
Yellow pallor macrophages
Louder - increased systemic resistence decreases LV emptying
Cyanosis - RV hypertrophy - polycythemia - clubbing
Fibrosis and dystrophic calcification

32. What is an Anitschow cell?
AD mutation in sarcomere proteins
Spontaneous
Reactive histiocyte with caterpillar nucleus
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

33. What type of valvular vegetations does S aureus cause?
Stable and unstable prinzmetal
Large - destructive vegetations
45%
Prophylactic abx during dental procedures

34. What two things cause coronary artery vasospasm?
Left -->right
Prinzmetal angina - cocaine
Yellow pallor neutrophils
Pedunculated mass in the LA that causes syncope due to obstruction of MV

35. Large vegetations on tricuspid valve?
S aureus
Infantile coarctation of the aorta PDA
Coxsackie A or B
VSD

36. Pericarditis 6-8 wks post MI.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Coxsackie A or B
Dressler syndrome
Nitroglycerin

37. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
ASD - R-->L
PDA

38. What causes heart failure cells?
PDA
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Paradoxical emboli
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

39. In transposition of the great vessels - What is required for survival? How is this achieved?
Low voltage EKG w/diminished QRS amplitude
ACE inhibitor
Right to left
Shunt - PGE to maintain PDA until surgical repair can be performed

40. What is the murmur of mitral valve prolapse?
Nitroglycerin
Congested central veins
Mid - systolic click followed by regurgitation murmur
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

41. What are the HACEK organisms? With what condition are they associated?
ST- segment depression
Coxsackie A or B
Chronic ischemic heart disease
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

42. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Turner syndrome
VSD
>60 years - bicuspid aortic valve
Bicuspid aortic valve

43. What is the characteristic finding on CXR in tetralogy of fallot?
Myxoid degeneration
Boot shaped heart
Months out fibrosis
ACE inhibitor

44. Why would cardiac enzymes continue to increase after the initial MI?
Decreased forward perfusion pulmonary congestion
Reperfusion injury
Maternal diabetes
Split S2 on auscultation

45. What is the tx for aortic stenosis?
Stable and unstable prinzmetal
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Myocarditis
Valve replacement AFTER the onset of complications

46. What bug causes acute rheumatic fever?
Membrane damage
Group A beta - hemolytic streptococci
Endocardial fibroelastosis
Dilated

47. What are the laboratory findings of bacterial endocarditis?
Endocarditis of prosthetic valves
PDA
Decreased forward perfusion pulmonary congestion
Positive blood cultures anemia of chronic disease

48. When is an MI pt at greatest risk for cardiogenic shock?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Ventricles cannot pump
First 4 hours
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

49. What are the complications of mitral stenosis?
Red border granulation tissue
Day 1-7
VSD
Backward LHF pulm htn and RHF - afib and associated mural thombis

50. What are the two effects of ATII?
Troponin I
Pericardial effusion due to pericardial involvement
Reversible
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

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