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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 is the most common form of cardiomyopathy?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Systemic venous congestion
Dilated
Prophylactic abx during dental procedures

2. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Decreases LV dilation by decreasing volume
Dilated
Stretched muscle loses contractility

3. What is Dressler syndrome? When does it occur?
Pericarditits
Contraction band necrosis
Autoimmune pericarditis 6-8 wks post MI
Infantile coarctation of the aorta PDA

4. What is the gross and microscopic appearance of cardiac myxomas?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
IV drug users
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Gelatinous - abundant ground substance

5. What does rupture of the LV free wall cause?
Cardiac tamponade
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Trisomy 21
Papillary muscle - free wall - IV septum

6. How do beta blockers tx MI?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
3-8 wks
Slow HR - decreasing O2 demand and risk for arrhythmia

7. What % of MIs involve the LAD?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Fetal alcohol syndrome
Janeway lesions
45%

8. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Loeffler syndrome
Mitral and tricuspid regurg - arrhythmia
ST- segment depression
Months out fibrosis

9. What is a Quincke pulse?
Pulsating nail bed
Tetralogy of fallot
ST- segment depression
R-->L

10. What are the forward and backward sx of LHF?
Papillary muscle - free wall - IV septum
Plump fibroblasts - collagen - blood vessels
Mitral valve prolapse
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

11. What coronary arterysupplies the lateral wall of the LV?
ST- segment depression
Ostium secundum (90%)
Circumflex
Infectious endocarditis - arrythmias - severe mitral regurg no

12. Dilated cardiomyopathy is a late complication of what illness?
Months out fibrosis
Myocarditis
Fetal alcohol syndrome
Ventricle

13. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Pump failure
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
PDA

14. What are the sx of right - to - left shunt?
CK- MB
Mitral mitral+aortic
Cyanosis - RV hypertrophy - polycythemia - clubbing
PDA

15. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Heart transplant
Pericarditits
IV drug users

16. What valves are involved in rhuematic endocarditis?
S aureus
Mitral mitral+aortic
LAD
Large vegetations of S aureus

17. Infects predamaged valves after transient bacteremia?
First 4 hours
Pericardial effusion due to pericardial involvement
S viridans
4-7 days macrophage infiltration

18. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Endocardial fibroelastosis
Pericardial effusion due to pericardial involvement
Decreases LV dilation by decreasing volume

19. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Large vegetations of S aureus
>60 years - bicuspid aortic valve
Regurg vs stenosis
Osler nodes (ouch - ouch Osler)

20. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Loss of fx
Asymptomatic

21. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Contraction band necrosis
1%

22. What murmur ccan be heard in PDA?
Nonspecific - eg fever and elevated ESR
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Holosystolic machine like murmur
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

23. Which chambers of the heart are generally spared in an MI?
Endocardial fibroelastosis (rare)
Atria and RV
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Papillary muscle - free wall - IV septum

24. Is injury due angina reversible or irreversible?
Stretched muscle loses contractility
NG or Ca channel blocker
Subendocardial
Reversible

25. When is an MI pt at greatest risk for cardiogenic shock?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
First 4 hours
2-3%
Coronary artery vasospasm

26. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Kawasaki disease
Aschoff bodies
Aortic regurg
Positive blood cultures anemia of chronic disease

27. What creates the immune reaction in acute rhuematic fever?

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28. How does reperfusion injury occur?
Anterior wall of LV and anterior septum
Eisenmenger syndrome
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Group A beta - hemolytic streptococci

29. Systolic ejection click followed by crescendo - decrescendo murmur.
Backward LHF pulm htn and RHF - afib and associated mural thombis
Membrane damage
CHF
Aortic stenosis

30. What imaging test is useful for detecting lesions on valves?
Tender lesions on fingers or toes.
ST- segment depression
SLE
Transesophageal echo

31. What is the classic EKG finding of restrictive cardiomyopathy?
Blood vessels coming in from normal tissue
Fetal alcohol syndrome
Low voltage EKG w/diminished QRS amplitude
Preductal - post aortic arch

32. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
>70%
Libman - Sacks endocarditis
Aneurysm - mural thrombus - Dressler syndrome

33. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Mitral regurg
NG or Ca channel blocker
Stretched muscle loses contractility

34. How does restrictive cardiomyopathy cause LHF?

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35. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Valve replacement AFTER the onset of complications
Aortic stenosis
When a bacterial protein resembles a protein in human tissue

36. How does Eisenmeger syndrome occur?
Ostium secundum (90%)
Anterior wall of LV and anterior septum
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
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

37. What is typically the mechanims of sudden cardiac death?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Increased hydrostatic pressure
Ventricular arrhythmia
Aneurysm - mural thrombus - Dressler syndrome

38. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Membrane damage
Aortic regurg

39. What is the 1day-1wk -1mo mneumonic for MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Open blocked vessels
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

40. What is the most common tumor of the heart?
R-->L
Nonspecific - eg fever and elevated ESR
Metastasis
Troponin I

41. What effect does mitral stenosis have on the heart chambers?
Autoimmune pericarditis 6-8 wks post MI
Turner syndrome
Dilated
LA dilation

42. What does chronic ischemic heart disease progress to?
CHF
Janeway lesions
Posterior wall of LV - posterior septum - papillary muscles
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

43. What is the characteristic murmur of aortic stenosis?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Mitral valve prolapse
Myocardium
Systolic ejection click followed by crescendo - decrescendo murmur

44. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Myocarditis
Thickening of chrodae tendinae and cusps - mitral stenosis
20 min
Aortic regurg

45. At what point in development do congenital heart defects arise?
Inability to fill ventricles
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
Endocarditis of prosthetic valves
3-8 wks

46. What are the causes of LHF?
LAD
Infectious
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Rhadbomyoma - benign

47. What are the complications of mitral stenosis?
Endocardial fibroelastosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

48. Pericarditis 6-8 wks post MI.
Myxoid degeneration
Dressler syndrome
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
Boot shaped heart

49. What causes the split S2 in ASD?
Coexisting mitral stenosis and fusion of commisures exist
Sudden cardiac death
>60 years - bicuspid aortic valve
Increased blood in right heart delays closure of P valve

50. Which angina(s) show ST elevation on EKG? ST depression?
White scar fibrosis
4-6 hours - 24 hours - 72 hours
Split S2 on auscultation
Prinzmetal stable and unstable