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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 clinical features of endocarditis? What causes each feature?
Mitral regurg
Reperfusion injury
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
Erythematous nontender lesions on palms and soles.

2. At what point in development do congenital heart defects arise?
ASD - R-->L
Migratory polyarthritis
PDA
3-8 wks

3. What type of collagen is involved in fibrosis?
Metastasis
Ventricle
VSD
Type I

4. What coronary artery supplies the mitral valve papillary muscles?
Surgical closure small defects may close spontaneously
Mitral regurg
RCA
Louder - increased systemic resistence decreases LV emptying

5. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Osler nodes (ouch - ouch Osler)
Degree of pulmonary artery stenosis
S viridans

6. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Inability to fill ventricles
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Split S2 on auscultation
Tuberous sclerosis

7. What is the gold standard blood marker for MI?
Troponin I
ACE inhibitor
Increased blood in right heart delays closure of P valve
Bacterial endocarditis

8. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Aneurysm - mural thrombus - Dressler syndrome
Congested central veins
Kawasaki disease

9. In which chamber of the heart are rhabdomyomas found?
Coxsackie A or B
Mitral regurg
Fetal alcohol syndrome
Ventricle

10. What is the JOneS mneumonic?
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
R-->L
When a bacterial protein resembles a protein in human tissue
Coexisting mitral stenosis and fusion of commisures exist

11. What are the clinical features of RHF?
Squatting - expiration
Systemic venous congestion
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Elevated ASO anti - DNase B titers

12. What causes acute endocarditis?
PDA
PGE
Cardiogenic shock - CHF - arrhythmia
Large vegetations of S aureus

13. What valves are involved in rhuematic endocarditis?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Sterile vegetations on mitral valve along lines of closure
Mitral mitral+aortic
S aureus

14. What is the tx for dilated cardiomyopathy?
Heart transplant
Nonspecific - eg fever and elevated ESR
PDA
Pulsating nail bed

15. Which congenital heart defect is associated with maternal diabetes?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Transposition of the great vessels
LAD
Limits thrombosis

16. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Rhabdomyoma
Mid - systolic click followed by regurgitation murmur

17. Vegetations on surface and undersurface of mitral valve.
Split S2 on auscultation
Ischemic heart disease
Libman - Sacks endocarditis
Right -->left

18. What is the rate of mitral valve prolapse in the US?
Large vegetations of S aureus
20 min
2-3%
Reperfusion injury

19. How does fibrinolysis/angioplasty tx MI?
Harmartoma
Open blocked vessels
Valve replacement once LV dysfx develops
ST- segment depression

20. What maintains patency of the PDA?
Indomethacin - decreases PGE
PGE
PDA
Bicuspid aortic valve

21. What are the two effects of ATII?
Split S2 on auscultation
Low voltage EKG w/diminished QRS amplitude
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Transesophageal echo

22. What areas of the heart does the LAD supply?
Aortic regurg
Anterior wall of LV and anterior septum
Small vegetations along the line of closure
4-24 hours

23. What vavular defect results from acute rheumatic fever?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Chronic ischemic heart disease
ST- segment depression
Mitral regurgitation due to vegetations

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

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25. What gross and microscopic changes occur 4-24 hours after an MI?
Louder - increased systemic resistence decreases LV emptying
PDA
Fibrinous pericarditis
Dark discoloration coagulative necrosis

26. What % of MIs involve the LAD?
AD mutation in sarcomere proteins
Tetralogy of fallot
>70%
45%

27. What is the characteristic murmurr of mitral stenosis?
Aneurysm - mural thrombus - Dressler syndrome
Hypertrophic cardiomyopathy
Opening snap followed by diastolic rumble
Subendocardial

28. What artery is the 2nd most often occluded in an MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nonbacterial thrombotic endocarditis (marantic endocarditis)
RCA
Endocardial fibroelastosis

29. Ostium primum ASD is associated with what congenital disorder?
Stable and unstable prinzmetal
ACE inhibitor
Open blocked vessels
Trisomy 21

30. Is scar tissue or myocardium stronger?
Spontaneous
Myocardium
Right -->left
Ventricles cannot pump

31. What is the most common type of ASD? What %?
Ostium secundum (90%)
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Myocarditis
Holosystolic machine like murmur

32. What complication occurs 1-3 days post MI?
Cardiogenic shock - CHF - arrhythmia
LAD
Fibrinous pericarditis
CHF

33. What are heart failure cells?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Reperfusion injury
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Hemosiderin laden macrophages

34. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Dilated
Hypertrophic cardiomyopathy
Myxoma - benign
LAD

35. What effect does aortic regurg have on the pulse pressure? Why?
Systolic dysfx leading to biventricular CHF
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
PDA
Valve scarring that arises as a consequence of rheumatic fever

36. What causes prinzmetal angina?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Coronary artery vasospasm
Membrane damage
45%

37. What are complications of dilated cardiomyopathy?
Cardiogenic shock - CHF - arrhythmia
Myxoma - benign
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral and tricuspid regurg - arrhythmia

38. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Ventricle
Aortic regurg
Tricuspid

39. What effect does mitral stenosis have on the heart chambers?
Colon cancer
Degree of pulmonary artery stenosis
LA dilation
Anitschow cell

40. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Myxoid degeneration
Fetal alcohol syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia

41. What typically causes hypertrophic cardiomyopathy?
Pts w/previously damaged valves
S aureus
2-3%
AD mutation in sarcomere proteins

42. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
Squatting - expiration
Loss of fx
Boot shaped heart

43. What does chronic ischemic heart disease progress to?
Low voltage EKG w/diminished QRS amplitude
Right -->left
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
CHF

44. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
3-8 wks
Ventricle
4-7 days macrophage infiltration

45. How does asprin/heparin tx MI?
L->R
1-3 days
Limits thrombosis
Myocarditis

46. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Eisenmenger syndrome
Loeffler syndrome
Mitral regurg

47. What is the basic principle of CHF?
Pump failure
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
LV dilation and eccentric hypertrophy
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

48. What is the classic EKG finding of restrictive cardiomyopathy?
Atherosclerosis of coronary arteries
Low voltage EKG w/diminished QRS amplitude
Fibrosis and dystrophic calcification
Mitral and tricuspid regurg - arrhythmia

49. What is diastolic dysfx?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Inability to fill ventricles
Dilation of all four chambers of the heart
Squatting - increased systemic resistence decreases LV emptying

50. What are the sx of cardiac myxoma?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Doxorubicin - cocaine
Endocardial fibroelastosis
Pedunculated mass in the LA that causes syncope due to obstruction of MV