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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 is the tx for aortic stenosis?
LV dilation and eccentric hypertrophy
Mid - systolic click followed by regurgitation murmur
Turner syndrome
Valve replacement AFTER the onset of complications

2. What are the minor critera of the Jones criteria?
Metastasis
Nonspecific - eg fever and elevated ESR
Asymptomatic
Sterile vegetations on surface and undersurface on mitral valve

3. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Coexisting mitral stenosis and fusion of commisures exist
Regurg vs stenosis
Group A beta - hemolytic streptococci
RCA

4. What are the sx of hypertrophic cardiomyopathy?
Valve replacement AFTER the onset of complications
LHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

5. What is the basic principle of CHF?
Pump failure
Cyanosis - RV hypertrophy - polycythemia - clubbing
Nitroglycerin
R-->L

6. When is an MI patent at highest risk for fibrionous pericarditis?
Ventricular arrhythmia
1-3 days out
Volume overload and LHF
Anterior wall of LV and anterior septum

7. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Type I
Open blocked vessels
Plump fibroblasts - collagen - blood vessels
Migratory polyarthritis

8. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Metastasis
Squat in response to cyanotic spell
ST- segment depression

9. What is the most common cause of dilated cardiomyopathy? What are other causes?
Systemic venous congestion
Day 1-7
Turner syndrome
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

10. How does restrictive cardiomyopathy cause LHF?

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11. What causes prinzmetal angina?
Coronary artery vasospasm
Rhabdomyoma
Sudden cardiac death
Prinzmetal

12. 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.
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Stable angina
PGE

13. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Harmartoma
SLE
Shunt

14. When is an MI pt at greatest risk for cardiogenic shock?
LHF
First 4 hours
Shunt - PGE to maintain PDA until surgical repair can be performed
Right to left

15. What % of MIs involve the LAD?
PGE
1%
45%
>70%

16. What does rupture of the LV free wall cause?
Systolic ejection click followed by crescendo - decrescendo murmur
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Myocarditis in acute rheumatic heart fever
Cardiac tamponade

17. What tests show prior group A beta - hemolytic strep infection?
Degree of pulmonary artery stenosis
Dilated
Decrease in blood flow to an organ
Elevated ASO anti - DNase B titers

18. Poor myocardial fx due to chronic ischemic damage?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Chronic ischemic heart disease
Valve replacement AFTER the onset of complications
Autoimmune pericarditis 6-8 wks post MI

19. What complications occur 4-7 days post MI?
Regurg vs stenosis
Rupture of free wall - IV septum - or papillary muscle
Dark discoloration coagulative necrosis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

20. Which chambers of the heart are generally spared in an MI?
L->R
Atria and RV
Day 1-7
Low voltage EKG w/diminished QRS amplitude

21. What type of vegetations does Strep viridans cause?
ASD - R-->L
Endocarditis of prosthetic valves
Small - nondestructive vegetations (subacute endocarditis)
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

22. What is the most common tumor of the heart?
Prinzmetal
Breast and lung carcinoma - melanoma - lymphoma
S epidermidis
Metastasis

23. What are the causes of restrictive cardiomyopathy in adults?
Rhabdomyoma
Decrease preload -->lowers myocardial stress
Anterior wall of LV and anterior septum
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

24. What effect does aortic stenosis have on the chambers of the heart?
Mitral stenosis
Yellow pallor macrophages
Type I
Concentric LV hypertophy

25. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Nitroglycerin
Large vegetations of S aureus
Rhadbomyoma - benign
Acute inflammation

26. How does fibrinolysis/angioplasty tx MI?
Troponin I
Sterile vegetations on mitral valve along lines of closure
Open blocked vessels
Atherosclerosis of coronary arteries

27. What disesase has Aschoff bodies?
Endocardial fibroelastosis
Myocarditis in acute rheumatic heart fever
Heart can't fill
Reperfusion injury

28. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Pancarditis
Holosystolic machine like murmur
Myofiber hypertrophy with disarray

29. What does Libman - Sacks endocarditis cause?
Mitral regurg
Ostium secundum (90%)
Maternal diabetes
Reperfusion injury

30. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Mitral regurg
Myxoid degeneration
4-7 days macrophage infiltration

31. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
>60 years - bicuspid aortic valve
Decreased forward perfusion pulmonary congestion
ST- segment depression

32. Turner syndrome is associated with which congenital heart defect?
Red border granulation tissue
Infantile coarctation of the aorta
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
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

33. What type of ASD is associated w/Down syndrome?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Myocarditis
Ostium primum
Circumflex

34. How does subendocardial MI/ischemia present on EKG?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
ST- segment depression
Split S2 on auscultation
2-4 hours - 24 hours - 7-10 days

35. What maintains patency of the PDA?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Squatting - expiration
Autoimmune pericarditis 6-8 wks post MI
PGE

36. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Tuberous sclerosis
Cardiogenic shock - CHF - arrhythmia
Coronary artery vasospasm - emboli - vasculitis

37. What type of shunt does truncus arteriosus cause?
R-->L
Infantile coarctation of the aorta
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
L->R

38. What two things cause coronary artery vasospasm?
L->R
Cardiogenic shock - CHF - arrhythmia
Prinzmetal angina - cocaine
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

39. In which chamber of the heart are cardiac myxomas found?
2-3%
Mitral insufficiency
Low voltage EKG w/diminished QRS amplitude
LA

40. What is the most common congenital heart defect?
Anitschow cell
Thickening of chrodae tendinae and cusps - mitral stenosis
VSD
SLE

41. What is the major cause of MI?
PDA
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Sudden cardiac death
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

42. What congenital heart defect often is present with infantile coarctation of the aorta?
When a bacterial protein resembles a protein in human tissue
PDA
Atherosclerosis of coronary arteries
Holosystolic machine like murmur

43. In transposition of the great vessels - What is required for survival? How is this achieved?
Circumflex
Aschoff bodies
Shunt - PGE to maintain PDA until surgical repair can be performed
Small - nondestructive vegetations (subacute endocarditis)

44. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Red border granulation tissue
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Squatting - expiration
Circumflex

45. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Aschoff bodies
Nonspecific - eg fever and elevated ESR
ASD - R-->L
Asymptomatic

46. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
Janeway lesions
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
First 4 hours

47. What murmur ccan be heard in PDA?
Infectious
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Chest pain <20 min brought on by exertion or emotional stress
Holosystolic machine like murmur

48. What are heart failure cells?
Hemosiderin laden macrophages
Stretched muscle loses contractility
Maternal diabetes
20 min

49. What is chronic rheumatic heart disease?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Systemic venous congestion
Shunt - PGE to maintain PDA until surgical repair can be performed
Valve scarring that arises as a consequence of rheumatic fever

50. What are the sx/complications of myocarditis?
Right -->left
Atherosclerosis of coronary arteries
Contraction band necrosis - reperfusion injury
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy