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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 type of shunt results in cyanosis at birth?
Right to left
Tricuspid
Myocarditis
Ventricle

2. Dense layer of elastic and fibrotic tissue in the endocardium.
Valve replacement
Acute inflammation
Atherosclerosis of coronary arteries
Endocardial fibroelastosis

3. What does rupture of a papillary muscle cause?
Yellow pallor macrophages
Nonspecific - eg fever and elevated ESR
Mitral insufficiency
Sterile vegetations on surface and undersurface on mitral valve

4. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Mitral stenosis
Hypertrophic cardiomyopathy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

5. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Contraction band necrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

6. What causes notching of the ribs in adult coarctation of the aorta?
Endocardial fibroelastosis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Regurg vs stenosis
Intercostal arteries enlarged due to collateral circulation

7. How do you tx prinzmetal angina?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Spontaneous
NG or Ca channel blocker
Red border granulation tissue

8. What tests show prior group A beta - hemolytic strep infection?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Stable angina
Dilation of all four chambers of the heart
Elevated ASO anti - DNase B titers

9. How does contraction band necrosis occur?
Erythematous nontender lesions on palms and soles.
Decrease preload -->lowers myocardial stress
ASD - R-->L
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

10. What is the cause of the red border around granulation tissue?
Infantile coarctation of the aorta PDA
Blood vessels coming in from normal tissue
Prinzmetal angina - cocaine
ASD - R-->L

11. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Myocarditis

12. What is the leading cause of death in the US?
Ischemic heart disease
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

13. What does rupture of the LV free wall cause?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Cardiac tamponade
Rhabdomyoma
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

14. What are the causes of restrictive cardiomyopathy in adults?
Tender lesions on fingers or toes.
Pts w/previously damaged valves
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
4-7 days macrophage infiltration

15. What are the sx of aortic regurg?
>70%
LAD
Volume overload and LHF
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

16. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Wear and tear
Decrease preload -->lowers myocardial stress
Contraction band necrosis

17. What does chronic ischemic heart disease progress to?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Dense layer of elastic and fibrotic tissue in the endocardium - children
Open blocked vessels
CHF

18. What two things cause coronary artery vasospasm?
4-6 hours - 24 hours - 72 hours
Open blocked vessels
Prinzmetal angina - cocaine
SLE

19. What is a common complication of cardiac metastasis?
Ostium secundum (90%)
Red border granulation tissue
Pericardial effusion due to pericardial involvement
Positive blood cultures anemia of chronic disease

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

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21. What is the JOneS mneumonic?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
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
1%

22. What causes prinzmetal angina?
Pts w/previously damaged valves
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
Breast and lung carcinoma - melanoma - lymphoma
Coronary artery vasospasm

23. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Loeffler syndrome
Prinzmetal
Mitral insufficiency

24. What type of vegetations form in nonbacterial thrombotic endocarditis?
PGE
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Sterile vegetations on mitral valve along lines of closure
ST- segment depression

25. What heart sound manifest with an ASD?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Blood vessels coming in from normal tissue
Troponin I
Split S2 on auscultation

26. What is the most common cause of endocarditis in IV drug users?
Increased hydrostatic pressure
Asymptomatic
S aureus
Large vegetations of S aureus

27. What is the most common cause of aortic stenosis?
Infectious endocarditis - arrythmias - severe mitral regurg no
Wear and tear
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
ASD - R-->L

28. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Tetralogy of fallot
Bacterial endocarditis
Myxoma - benign
Ischemic heart disease

29. What is a Quincke pulse?
Pulsating nail bed
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
2-3%
When a bacterial protein resembles a protein in human tissue

30. What causes angina and syncope in aortic stenosis?

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31. What causes mitral valve prolapse?
1%
Myxoid degeneration
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Left -->right

32. What are the HACEK organisms? With what condition are they associated?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
4-24 hours
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
S aureus

33. What are the sx of right - to - left shunt?
LAD
Cyanosis - RV hypertrophy - polycythemia - clubbing
Nonspecific - eg fever and elevated ESR
Streptococcus bovis/

34. What imaging test is useful for detecting lesions on valves?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Transesophageal echo
Erythematous nontender lesions on palms and soles.
Dressler syndrome

35. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Membrane damage
Pericarditits

36. What does a biopsy of hypertrophic cardiomyopathy look like?
Intercostal arteries enlarged due to collateral circulation
Tricuspid
Myofiber hypertrophy with disarray
Left -->right

37. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Holosystolic blowing murmur
45%
Turner syndrome
20 min

38. How does MI cause LHF?
Mitral stenosis
Papillary muscle - free wall - IV septum
Libman - Sacks endocarditis
Loss of LV fx

39. How does adult coarctation of the aorta present?
LA
Maternal diabetes
Myxoid degeneration
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

40. Which angina is relieved by Ca channel blockers?
LV dilation and eccentric hypertrophy
Prinzmetal
Reversible
Troponin I

41. What is the major cause of MI?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Prinzmetal stable and unstable
Mitral regurg

42. What increases the volume of mitral regurg murmur?
Janeway lesions
Myofiber hypertrophy with disarray
Indomethacin - decreases PGE
Squatting - expiration

43. What are Osler nodes?
4-7 days macrophage infiltration
Tender lesions on fingers or toes.
SLE
Stable and unstable prinzmetal

44. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
Concentric LV hypertophy
Myocarditis
CK- MB

45. What is the basic principle of CHF?
Colon cancer
Pump failure
Backward LHF pulm htn and RHF - afib and associated mural thombis
Dilation of all four chambers of the heart

46. What is dilated cardiomyopathy?
Transposition of the great vessels
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Nitroglycerin
Dilation of all four chambers of the heart

47. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
IV drug users
RCA
Mitral and tricuspid regurg - arrhythmia

48. What maintains patency of the PDA?
Small vegetations along the line of closure
PGE
Autoimmune pericarditis 6-8 wks post MI
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

49. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Prinzmetal angina
Myocarditis in acute rheumatic heart fever
Mitral regurgitation due to vegetations

50. What are the causes of LHF?
Split S2 on auscultation
Dark discoloration coagulative necrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Stable and unstable prinzmetal