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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 heart sound manifest with an ASD?
Split S2 on auscultation
Decreases LV dilation by decreasing volume
Preductal - post aortic arch
Bicuspid aortic valve

2. What is a common complication of cardiac metastasis?
Transposition of the great vessels
ST- segment depression
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Pericardial effusion due to pericardial involvement

3. What causes prinzmetal angina?
Rhadbomyoma - benign
Inability to fill ventricles
PGE
Coronary artery vasospasm

4. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Transposition of the great vessels
Elevated ASO anti - DNase B titers
Anterior wall of LV and anterior septum

5. Which vasculitis can cause MI?
Kawasaki disease
CK- MB
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
>70%

6. What causes the nutmeg color in nutmeg liver?
Aschoff bodies
Valve scarring that arises as a consequence of rheumatic fever
Large - destructive vegetations
Congested central veins

7. When do neutrophils infiltrate the myocardium post MI?
Boot shaped heart
Pump failure
1-3 days
Eisenmenger syndrome

8. What are the complications that occur months after an MI?
LAD
Streptococcus viridans
Cardiogenic shock - CHF - arrhythmia
Aneurysm - mural thrombus - Dressler syndrome

9. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Surgical closure small defects may close spontaneously
Sudden cardiac death
Restrictive cardiomyopathy
Within the first day

10. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Hypercoagulable state or underlying adenocarcinoma
Kawasaki disease
Mitral insufficiency

11. What endocarditis is commonly found in patients with colon cancer?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Streptococcus bovis/
Aortic regurg
Colon cancer

12. What is migratory polyarthritis?
Right side - serotonin and other secretory products detoxified in the lung
Group A beta - hemolytic streptococci
Friction rub and chest pain
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

13. What effect does squatting have on the murmur of mitral valve prolapse? Why?
ACE inhibitor
Louder - increased systemic resistence decreases LV emptying
Cardiogenic shock - CHF - arrhythmia
Reperfusion injury

14. What does rupture of the LV free wall cause?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mitral regurg
Mitral insufficiency
Cardiac tamponade

15. EKG for stable angina?
Ostium secundum (90%)
ST- segment depression
Hypertophy of RV atrophy of LV
LAD

16. Which angina is relieved by Ca channel blockers?
Heart can't fill
Congestive heart failure
Granulation tissue
Prinzmetal

17. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Intercostal arteries enlarged due to collateral circulation
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Systolic ejection click followed by crescendo - decrescendo murmur

18. What causes mitral valve prolapse?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
PDA
Myxoid degeneration
Dressler syndrome

19. Systolic ejection click followed by crescendo - decrescendo murmur.
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
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
Low voltage EKG w/diminished QRS amplitude
Aortic stenosis

20. With what disease is transposition of the great vessels associated?
NG or Ca channel blocker
Maternal diabetes
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Janeway lesions

21. When does the heart have a yellow pallor post MI?
Day 1-7
Myxoma - benign
Anterior wall of LV and anterior septum
Restrictive cardiomyopathy

22. How does transmural MI/ischemia present on EKG?
Split S2 on auscultation
Ostium secundum (90%)
Breast and lung carcinoma - melanoma - lymphoma
ST- segment elevation

23. What are the tx for MI?
Systolic dysfx leading to biventricular CHF
Volume overload and LHF
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pancarditis

24. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral regurg
Limits thrombosis

25. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Prinzmetal stable and unstable
Positive blood cultures anemia of chronic disease
Bounding pulse

26. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Myocardium
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Valve replacement once LV dysfx develops

27. What are the sx of aortic regurg?
Large vegetations of S aureus
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Ehlers - Danlow and Marfan syndrome

28. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
1-3 days
Mitral regurg
Type I

29. What are the major criteria of the Jones criteria?
Nonspecific - eg fever and elevated ESR
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Coexisting mitral stenosis and fusion of commisures exist
Large - destructive vegetations

30. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Surgical closure small defects may close spontaneously
PDA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

31. How does subendocardial MI/ischemia present on EKG?
Infectious
Mitral valve prolapse
ST- segment depression
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

32. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Turner syndrome
Systolic dysfx leading to biventricular CHF

33. What does rupture of the IV septum cause?
Tetralogy of fallot
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Aneurysm - mural thrombus - Dressler syndrome
Shunt

34. What is the cause of the red border around granulation tissue?
Ehlers - Danlow and Marfan syndrome
Squat in response to cyanotic spell
Blood vessels coming in from normal tissue
Ostium primum

35. 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
Autoimmune pericarditis 6-8 wks post MI
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

36. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Pancarditis
Fibrinous pericarditis
Right side - serotonin and other secretory products detoxified in the lung
Nonbacterial thrombotic endocarditis (marantic endocarditis)

37. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Prinzmetal angina - cocaine
IV drug users
Autoimmune pericarditis 6-8 wks post MI

38. Friction rub and chest pain.
Infantile coarctation of the aorta
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
Infectious endocarditis
Pericarditits

39. What is the gold standard blood marker for MI?
Troponin I
Gelatinous - abundant ground substance
Right -->left
Chronic ischemic heart disease

40. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Anitschow cell
Squatting - increased systemic resistence decreases LV emptying
Rhadbomyoma - benign

41. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
ST- segment depression
LAD
Infectious endocarditis - arrythmias - severe mitral regurg no

42. How does asprin/heparin tx MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Inability to maintain systemic pressure w/lack of O2 to vital organs
Surgical closure small defects may close spontaneously
Limits thrombosis

43. What type of collagen is involved in fibrosis?
Adult coarctation of the aorta
Type I
Anitschow cell
Months out fibrosis

44. What is the characteristic murmurr of mitral stenosis?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
MI
Large - destructive vegetations
Opening snap followed by diastolic rumble

45. What always follows necrosis?
Mitral regurgitation due to vegetations
Acute inflammation
Indomethacin - decreases PGE
45%

46. L- to - R shunt switching to R- to - L shunt.
Bicuspid aortic valve
Eisenmenger syndrome
Loss of LV fx
3-8 wks

47. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Coexisting mitral stenosis and fusion of commisures exist
Contraction band necrosis
S viridans

48. How does ischemia cause LHF?
IV drug users
Mitral regurg
Loss of fx
Coronary artery vasospasm - emboli - vasculitis

49. How does Eisenmeger syndrome occur?
Slow HR - decreasing O2 demand and risk for arrhythmia
Nonspecific - eg fever and elevated ESR
4-6 hours - 24 hours - 72 hours
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

50. What are the causes of restrictive cardiomyopathy in adults?
Pericarditits
PDA
Chest pain <20 min brought on by exertion or emotional stress
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

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