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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 does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
Coronary artery vasospasm
Decrease preload -->lowers myocardial stress
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

2. What artery is the 2nd most often occluded in an MI?
Doxorubicin - cocaine
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
RCA
Valve scarring that arises as a consequence of rheumatic fever

3. What effect does dilated cardiomyopathy have on the heart?
Endocardial fibroelastosis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aschoff bodies
Systolic dysfx leading to biventricular CHF

4. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Concentric LV hypertophy
Boot shaped heart
Yellow pallor neutrophils

5. What type of ASD is associated w/Down syndrome?
Infectious
Friction rub and chest pain
Congenital rubella
Ostium primum

6. What is the major cause of MI?
Large vegetations of S aureus
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
2-3 weeks
Coronary artery vasospasm - emboli - vasculitis

7. What type of shunt does ASD cause?
Ostium primum
Aschoff bodies
Left -->right
Janeway lesions

8. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Trisomy 21
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Aortic regurg

9. What is endocardial fibroelastosis? In what population is it found?
VSD
Dense layer of elastic and fibrotic tissue in the endocardium - children
S aureus
Paradoxical emboli

10. What valves are involved in rhuematic endocarditis?
Systolic dysfx leading to biventricular CHF
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral mitral+aortic
Large vegetations of S aureus

11. What are the clinical features of endocarditis? What causes each feature?
S aureus
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
Stable and unstable prinzmetal
Small vegetations along the line of closure

12. What type of vegetations form in nonbacterial thrombotic endocarditis?
ST- segment elevation
Sterile vegetations on mitral valve along lines of closure
Systemic venous congestion
Ventricular arrhythmia

13. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Pericarditits
Congenital rubella
Mitral mitral+aortic

14. What is Loeffler syndrome?
Streptococcus viridans
Months out fibrosis
Adult coarctation of the aorta
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

15. What heart sound manifest with an ASD?
Myocarditis in acute rheumatic heart fever
Split S2 on auscultation
Shunt - PGE to maintain PDA until surgical repair can be performed
VSD

16. What valves are most commonly involved in chronic rheumatic heart disease?
Aneurysm - mural thrombus - Dressler syndrome
Systolic dysfx leading to biventricular CHF
Mitral mitral+aortic
Aortic stenosis

17. What is migratory polyarthritis?
Regurg vs stenosis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
3-8 wks
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

18. Which artery is most often occluded in an MI?
LAD
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Prinzmetal angina
Anitschow cell

19. What is the leading cause of death in the US?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Ischemic heart disease
Adult coarctation of the aorta
Limits thrombosis

20. In which chamber of the heart are cardiac myxomas found?
Ehlers - Danlow and Marfan syndrome
Left -->right
Inability to fill ventricles
LA

21. What causes an early - blowing diastolic murmur?
Split S2 on auscultation
Congestive heart failure
Aortic regurg
CHF

22. Which angina is relieved by Ca channel blockers?
Acute inflammation
Squatting - increased systemic resistence decreases LV emptying
Months out fibrosis
Prinzmetal

23. What is an Anitschow cell?
Pump failure
Bacterial endocarditis
Granulation tissue
Reactive histiocyte with caterpillar nucleus

24. What coronary arterysupplies the lateral wall of the LV?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Circumflex
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

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

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26. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Pts w/previously damaged valves
Nitroglycerin
Gelatinous - abundant ground substance
Squat in response to cyanotic spell

27. How does fibrinolysis/angioplasty tx MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Spontaneous
Mitral mitral+aortic
Open blocked vessels

28. With what congenital heart defect is ADULT coarctation of the aorta associated?
RCA
Thickening of chrodae tendinae and cusps - mitral stenosis
Bicuspid aortic valve
Increased blood in right heart delays closure of P valve

29. What does rupture of the LV free wall cause?
Red border granulation tissue
Cardiac tamponade
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Bacterial endocarditis

30. What is the rate of congenital heart defects?
VSD
Decrease in blood flow to an organ
PDA
1%

31. What complications occur within 4 hrs post MI?
Coronary artery vasospasm
RBC damaged while crossing the calcified valve causing schistocytes
Cardiogenic shock - CHF - arrhythmia
Infectious endocarditis

32. What effect does aortic stenosis have on the chambers of the heart?
Yellow pallor neutrophils
Concentric LV hypertophy
Decreases LV dilation by decreasing volume
Months out fibrosis

33. How does MI cause LHF?
Ehlers - Danlow and Marfan syndrome
Months out fibrosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Loss of LV fx

34. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Mitral regurg
Backward LHF pulm htn and RHF - afib and associated mural thombis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

35. What is the most common congenital heart defect?
Aneurysm - mural thrombus - Dressler syndrome
Mitral regurgitation due to vegetations
Months out fibrosis
VSD

36. What are the clinical features of RHF due to?
Systemic venous congestion
Preductal - post aortic arch
LA
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

37. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Colon cancer
Pericarditits
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

38. What disesase has Aschoff bodies?
Subendocardial
Aortic regurg
Myocarditis in acute rheumatic heart fever
Intercostal arteries enlarged due to collateral circulation

39. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Rupture of free wall - IV septum - or papillary muscle
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Coxsackie A or B

40. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Ehlers - Danlow and Marfan syndrome
LA
Prinzmetal angina
Atherosclerosis of coronary arteries

41. What type of shunt dose PDA cause?
2-3%
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Migratory polyarthritis
Left -->right

42. How does transmural MI/ischemia present on EKG?
4-24 hours
Nonbacterial thrombotic endocarditis (marantic endocarditis)
ST- segment elevation
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

43. What is molecular mimicry?
L->R
When a bacterial protein resembles a protein in human tissue
Subendocardial
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

44. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Minimizes ischemia
ASD - R-->L
RHF
Asymptomatic

45. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
PDA
Holosystolic machine like murmur
Left -->right

46. When would arrhythmia occur after MI?
Loss of fx
Within the first day
Anterior wall of LV and anterior septum
Nitroglycerin

47. With what disease is transposition of the great vessels associated?
Mid - systolic click followed by regurgitation murmur
CHF
Maternal diabetes
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

48. What % stenosis causes stable angina?
Membrane damage
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Indomethacin - decreases PGE
>70%

49. What murmur ccan be heard in PDA?
Myocarditis
Holosystolic machine like murmur
Pump failure
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

50. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Trisomy 21
PDA
Group A beta - hemolytic streptococci
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations