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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. With what disease is infantile coarctation of the aorta associated?
Right to left
Open blocked vessels
Turner syndrome
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

2. What is a water - hammer pulse?
Trisomy 21
Mid - systolic click followed by regurgitation murmur
Bounding pulse
Blood vessels coming in from normal tissue

3. What type of shunt does truncus arteriosus cause?
Anterior wall of LV and anterior septum
Months out fibrosis
PDA
R-->L

4. What is the etiology of S viridans endocarditis?
Ventricles cannot pump
Ostium primum
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Migratory polyarthritis

5. What is migratory polyarthritis?
Myocarditis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Prinzmetal angina
Tuberous sclerosis

6. What is the most common type of endocarditis?
Infectious
Asymptomatic
Dressler syndrome
Circumflex

7. What type of valvular vegetations does S aureus cause?
ACE inhibitor
Mitral regurg
Large - destructive vegetations
Louder - increased systemic resistence decreases LV emptying

8. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
2-3%
Left -->right
Mitral regurg

9. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Endocarditis of prosthetic valves
Streptococcus bovis/
Pancarditis

10. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Backward LHF pulm htn and RHF - afib and associated mural thombis
S viridans
Dilation of all four chambers of the heart
Myxoma - benign

11. What does rupture of a papillary muscle cause?
Migratory polyarthritis
Mitral insufficiency
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Fetal alcohol syndrome

12. What are the sx/complications of myocarditis?
Myofiber hypertrophy with disarray
Infectious endocarditis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

13. What is molecular mimicry?
Mitral mitral+aortic
Dressler syndrome
Mitral and tricuspid regurg - arrhythmia
When a bacterial protein resembles a protein in human tissue

14. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Months out fibrosis
Turner syndrome
Congestive heart failure

15. What maintains patency of the PDA?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
PGE
Holosystolic machine like murmur
Metastasis

16. What are the cancers that most commonly metastasize to the heart?
Anitschow cell
Breast and lung carcinoma - melanoma - lymphoma
Tender lesions on fingers or toes.
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

17. What causes the dependent pitting edema in RHF?
Large vegetations of S aureus
Contraction band necrosis
Decrease in blood flow to an organ
Increased hydrostatic pressure

18. L- to - R shunt switching to R- to - L shunt.
ASD - R-->L
Thickening of chrodae tendinae and cusps - mitral stenosis
Eisenmenger syndrome
Metastasis

19. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
LA dilation
Mitral mitral+aortic
Prophylactic abx during dental procedures

20. What % of MIs involve the LAD?
4-7 days
Prinzmetal angina
45%
Pericardial effusion due to pericardial involvement

21. What type of ASD is associated w/Down syndrome?
Streptococcus viridans
Ostium primum
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Squatting - expiration

22. In which chamber of the heart are cardiac myxomas found?
LA
Decrease in blood flow to an organ
Valve replacement
Anterior wall of LV and anterior septum

23. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Libman - Sacks endocarditis
Autoimmune pericarditis 6-8 wks post MI
4-7 days macrophage infiltration
Myxoma - benign

24. When do neutrophils infiltrate the myocardium post MI?
Hypercoagulable state or underlying adenocarcinoma
Dark discoloration coagulative necrosis
Yellow pallor macrophages
1-3 days

25. What coronary arterysupplies the lateral wall of the LV?
Left -->right
Circumflex
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Open blocked vessels

26. What generally causes ischemic heart disease?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Atherosclerosis of coronary arteries
Months out fibrosis

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

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28. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
R-->L
Nonspecific - eg fever and elevated ESR
Yellow pallor neutrophils

29. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Troponin I
NG or Ca channel blocker
Ostium primum

30. With what disease is Libman - Sacks endocarditis associated?
Dark discoloration coagulative necrosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
2-4 hours - 24 hours - 7-10 days
SLE

31. What is the most common cause of myocarditis?
2-3%
Coxsackie A or B
Split S2 on auscultation
Prinzmetal angina - cocaine

32. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Asymptomatic
Ventricle
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

33. Which congenital heart defect is associated with congenital rubella?
Ostium secundum (90%)
Holosystolic machine like murmur
Minimizes ischemia
PDA

34. What is the characteristic murmur of aortic stenosis?
Ischemic heart disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Systolic ejection click followed by crescendo - decrescendo murmur
45%

35. What is the basic principle of CHF?
Squatting - expiration
Pump failure
Dark discoloration coagulative necrosis
2-3 weeks

36. What is the foundation of a scar?
Granulation tissue
Valve scarring that arises as a consequence of rheumatic fever
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Fibrinous pericarditis

37. Which coronary artery supplies the anterior wall and anterior septum?
Red border granulation tissue
Chest pain <20 min brought on by exertion or emotional stress
LAD
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

38. What is the most comon cause of aortic regurg? What are the other causes?
Coronary artery vasospasm - emboli - vasculitis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Valve scarring that arises as a consequence of rheumatic fever
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

39. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Shunt
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Heart can't fill
2-3 weeks

40. Myofiber hypertrophy with disarray.
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
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Atherosclerosis of coronary arteries
Hypertrophic cardiomyopathy

41. How does subendocardial MI/ischemia present on EKG?
RHF
ST- segment depression
Pericarditits
Tetralogy of fallot

42. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Congenital rubella
Pump failure

43. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Sudden cardiac death
Infectious
Ventricles cannot pump

44. What gross and microscopic changes occur 1-3 weeks after an MI?
Prinzmetal angina - cocaine
Red border granulation tissue
Maternal diabetes
LAD

45. What are the Jones criteria?
Hemosiderin laden macrophages
Aortic regurg
1-3 days
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

46. What type of shunt results in cyanosis at birth?
Large vegetations of S aureus
Concentric LV hypertophy
Right to left
Months out fibrosis

47. What type of endocarditis is associated with SLE?
Mitral mitral+aortic
Yellow pallor macrophages
Libman - Sacks endocarditis
Pericarditits

48. What are complications of dilated cardiomyopathy?
Degree of pulmonary artery stenosis
Aortic stenosis
Mitral valve prolapse
Mitral and tricuspid regurg - arrhythmia

49. What gross and microscopic changes occur 4-24 hours after an MI?
Ischemic heart disease
Nonspecific - eg fever and elevated ESR
Dark discoloration coagulative necrosis
Pulsating nail bed

50. What are the complications of mitral stenosis?
Metastasis
Nitroglycerin
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Backward LHF pulm htn and RHF - afib and associated mural thombis