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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 sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Granulation tissue
Coxsackie A or B
Pericarditits

2. What characterizes acute rheumatic fever endocarditiis?
2-3 weeks
Metastasis
Small vegetations along the line of closure
Aneurysm - mural thrombus - Dressler syndrome

3. What are the laboratory findings of bacterial endocarditis?
Asymptomatic
Coxsackie A or B
Turner syndrome
Positive blood cultures anemia of chronic disease

4. Myofiber hypertrophy with disarray.
Aortic regurg
Fibrinous pericarditis
Metastasis
Hypertrophic cardiomyopathy

5. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Months out fibrosis
VSD
Aschoff bodies

6. What is systolic dysfx?
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
Ventricles cannot pump
Squatting - expiration
Group A beta - hemolytic streptococci

7. What drug relieves stable angina?
Nitroglycerin
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
ASD - R-->L
Months out fibrosis

8. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Chest pain <20 min brought on by exertion or emotional stress
PDA
Bounding pulse
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

9. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Left -->right
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Type I

10. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Months out fibrosis
Hypertrophic cardiomyopathy

11. What are the clinical features of RHF due to?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Decreased forward perfusion pulmonary congestion
Red border granulation tissue
Systemic venous congestion

12. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
LAD
Preductal - post aortic arch
Reperfusion injury

13. How do ACE inhibitors tx MI?
Left -->right
LAD
Sudden cardiac death
Decreases LV dilation by decreasing volume

14. Holosystolic blowing murmur that increases w/expiration?
Bacterial endocarditis
Squatting - increased systemic resistence decreases LV emptying
Hypertrophic cardiomyopathy
Mitral regurg

15. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Contraction band necrosis - reperfusion injury
Infectious endocarditis
Volume overload and LHF

16. What is an Aschoff body?
Mitral mitral+aortic
Erythematous nontender lesions on palms and soles.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
ST- segment elevation

17. What is an Anitschow cell?
Pts w/previously damaged valves
Reactive histiocyte with caterpillar nucleus
Rhadbomyoma - benign
LAD

18. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Transesophageal echo
RCA
Day 1-7

19. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Left -->right
Backward LHF pulm htn and RHF - afib and associated mural thombis
Janeway lesions

20. What % stenosis causes stable angina?
Mitral valve prolapse
Sterile vegetations on surface and undersurface on mitral valve
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
>70%

21. What is Loeffler syndrome?
Trisomy 21
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Systolic ejection click followed by crescendo - decrescendo murmur

22. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Right to left
S aureus
Loeffler syndrome
Infectious endocarditis - arrythmias - severe mitral regurg no

23. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pericarditits
Dressler syndrome
Coronary artery vasospasm - emboli - vasculitis

24. What are heart failure cells?
Open blocked vessels
Reactive histiocyte with caterpillar nucleus
PDA
Hemosiderin laden macrophages

25. What causes acute endocarditis?
2-3 weeks
Mitral regurg
Large vegetations of S aureus
Decreased forward perfusion pulmonary congestion

26. What is a common complication of cardiac metastasis?
Ostium primum
Plump fibroblasts - collagen - blood vessels
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Pericardial effusion due to pericardial involvement

27. What is the most common valve infected by S aureus?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Inability to fill ventricles
Colon cancer
Tricuspid

28. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Left -->right
Chronic rheumatic heart disease
Open blocked vessels

29. What are other (not atherosclerotic) causes of MI?
Contraction band necrosis - reperfusion injury
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Myocarditis
Coronary artery vasospasm - emboli - vasculitis

30. What typically causes hypertrophic cardiomyopathy?
Mitral valve prolapse
AD mutation in sarcomere proteins
RBC damaged while crossing the calcified valve causing schistocytes
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

31. When would arrhythmia occur after MI?
Within the first day
IV drug users
Rhabdomyoma
Kawasaki disease

32. What complication occurs 1-3 days post MI?
Minimizes ischemia
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mid - systolic click followed by regurgitation murmur
Fibrinous pericarditis

33. What are the sx of pericardiits?
Turner syndrome
2-4 hours - 24 hours - 7-10 days
Friction rub and chest pain
Minimizes ischemia

34. How does hypertension cause LHF?

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35. Why are cardiac enzymes elevated after an MI?
Pericarditits
R-->L
Membrane damage
Myocarditis

36. Which congenital heart defect is associated with congenital rubella?
VSD
Pts w/previously damaged valves
PDA
Rhadbomyoma - benign

37. With what congenital heart defect is ADULT coarctation of the aorta associated?
Myofiber hypertrophy with disarray
Bounding pulse
Bicuspid aortic valve
Prinzmetal

38. What is the gold standard blood marker for MI?
LA
Troponin I
4-24 hours
Reactive histiocyte with caterpillar nucleus

39. Which coronary artery supplies the posterior wall of the LV and posterior septum?
LHF
Yellow pallor neutrophils
2-3%
RCA

40. How does Eisenmeger syndrome occur?
Increased hydrostatic pressure
Congestive heart failure
Aortic regurg
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

41. What is the classic EKG finding of restrictive cardiomyopathy?
LA dilation
Low voltage EKG w/diminished QRS amplitude
S aureus
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

42. What effect does aortic stenosis have on the chambers of the heart?
Rupture of free wall - IV septum - or papillary muscle
Concentric LV hypertophy
Group A beta - hemolytic streptococci
4-24 hours

43. Tender lesions on fingers or toes.
Dark discoloration coagulative necrosis
Osler nodes (ouch - ouch Osler)
Tetralogy of fallot
Libman - Sacks endocarditis

44. What causes wear and tear aortic stenosis?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
3-8 wks
Fibrosis and dystrophic calcification
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

45. How do beta blockers tx MI?
Heart transplant
Contraction band necrosis - reperfusion injury
Slow HR - decreasing O2 demand and risk for arrhythmia
Anterior wall of LV and anterior septum

46. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
20 min
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
PDA

47. What is endocardial fibroelastosis? In what population is it found?
Streptococcus viridans
Dense layer of elastic and fibrotic tissue in the endocardium - children
Migratory polyarthritis
Holosystolic blowing murmur

48. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Infantile coarctation of the aorta PDA
Regurg vs stenosis
Paradoxical emboli
Transesophageal echo

49. How does reperfusion injury occur?
45%
Sterile vegetations on surface and undersurface on mitral valve
ST- segment depression
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

50. What complications occur within 4 hrs post MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Holosystolic blowing murmur
Cardiogenic shock - CHF - arrhythmia
Increased blood in right heart delays closure of P valve