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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?
Circumflex
Atria and RV
Turner syndrome
Subendocardial

2. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Sudden cardiac death
Infectious endocarditis
Reperfusion injury

3. What is the rate of mitral valve prolapse in the US?
Annular - non pruritic rash w/erythematous borders trunks and limbs
2-3%
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Congenital rubella

4. What are heart failure cells?
Acute inflammation
Hemosiderin laden macrophages
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Holosystolic machine like murmur

5. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

6. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Gelatinous - abundant ground substance
S viridans
Positive blood cultures anemia of chronic disease

7. What complications occur 4-7 days post MI?
Intercostal arteries enlarged due to collateral circulation
Infectious endocarditis
Rupture of free wall - IV septum - or papillary muscle
PDA

8. What is the tx for dilated cardiomyopathy?
Sterile vegetations on mitral valve along lines of closure
Fibrinous pericarditis
First 4 hours
Heart transplant

9. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Infantile coarctation of the aorta
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
ST- segment depression
Months out fibrosis

10. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Contraction band necrosis - reperfusion injury
Prinzmetal stable and unstable
Small - nondestructive vegetations (subacute endocarditis)

11. What is the most common tumor of the heart?
R-->L
Loss of fx
Metastasis
RBC damaged while crossing the calcified valve causing schistocytes

12. How does hypertension cause LHF?

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13. What areas of the heart does the RCA supply?
Congested central veins
Posterior wall of LV - posterior septum - papillary muscles
Group A beta - hemolytic streptococci
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

14. In what pt population does S aureus commonly cause valvular disease?
Regurg vs stenosis
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
IV drug users
Holosystolic machine like murmur

15. What is diastolic dysfx?
Spontaneous
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Inability to fill ventricles
Osler nodes (ouch - ouch Osler)

16. What is the characteristic finding on CXR in tetralogy of fallot?
1-3 days out
Myocarditis in acute rheumatic heart fever
Bacterial endocarditis
Boot shaped heart

17. How long after pharyngitis does acute rheumatic fever occur?
Acute inflammation
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
2-3 weeks
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

18. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Valve replacement AFTER the onset of complications
4-7 days macrophage infiltration
Left -->right
Gelatinous - abundant ground substance

19. What type of valvular vegetations does S aureus cause?
VSD
Large - destructive vegetations
Chronic rheumatic heart disease
Pericardial effusion due to pericardial involvement

20. How does asprin/heparin tx MI?
Limits thrombosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Shunt - PGE to maintain PDA until surgical repair can be performed
Circumflex

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

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22. Are most congenital heart defects spontaneous or inherited?
Squatting - expiration
Ehlers - Danlow and Marfan syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia
Spontaneous

23. What is the most common cause of death during the acute phase of rheumatic fever?
2-4 hours - 24 hours - 7-10 days
Posterior wall of LV - posterior septum - papillary muscles
Myocarditis
Group A beta - hemolytic streptococci

24. How does aortic regurg affect the heart chambers?
Cyanosis - RV hypertrophy - polycythemia - clubbing
LV dilation and eccentric hypertrophy
Loss of LV fx
Valve replacement once LV dysfx develops

25. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Tender lesions on fingers or toes.
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Fetal alcohol syndrome
>60 years - bicuspid aortic valve

26. What is the most common cause of RHF? What are others?
Endocarditis of prosthetic valves
Mitral regurgitation due to vegetations
Colon cancer
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

27. What are the tx for MI?
Valve replacement
Intercostal arteries enlarged due to collateral circulation
PDA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

28. When does the heart have a yellow pallor post MI?
Autoimmune pericarditis 6-8 wks post MI
Day 1-7
Mitral valve prolapse
Coexisting mitral stenosis and fusion of commisures exist

29. What gross and microscopic changes occur 1-3 weeks after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Prophylactic abx during dental procedures
Red border granulation tissue
Mitral regurg

30. What artery is the 2nd most often occluded in an MI?
Mitral mitral+aortic
Streptococcus viridans
VSD
RCA

31. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Squat in response to cyanotic spell
Dark discoloration coagulative necrosis
Bicuspid aortic valve

32. When does the heart have dark discoloration post MI?
Within the first day
Reperfusion injury
Months out fibrosis
4-24 hours

33. Tx for PDA?
Rhabdomyoma
When a bacterial protein resembles a protein in human tissue
Transposition of the great vessels
Indomethacin - decreases PGE

34. Why would cardiac enzymes continue to increase after the initial MI?
1-3 days out
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Reperfusion injury
Adult coarctation of the aorta

35. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
MI
Months out fibrosis
LA

36. Which angina(s) show ST elevation on EKG? ST depression?
Pulsating nail bed
Shunt
Prinzmetal stable and unstable
Bounding pulse

37. How does O2 tx MI?
Minimizes ischemia
Anitschow cell
Sterile vegetations on mitral valve along lines of closure
Loss of fx

38. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Subendocardial
Paradoxical emboli
ASD - R-->L

39. What does chronic ischemic heart disease progress to?
Restrictive cardiomyopathy
White scar fibrosis
Months out fibrosis
CHF

40. With what disease is transposition of the great vessels associated?
Maternal diabetes
Prinzmetal angina
Anitschow cell
3-8 wks

41. What type of vegetations does Strep viridans cause?
Mitral regurg
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Small - nondestructive vegetations (subacute endocarditis)
S aureus

42. What is eythema marginatum? What parts of the body does it commonly involve?
Small - nondestructive vegetations (subacute endocarditis)
2-4 hours - 24 hours - 7-10 days
Contraction band necrosis - reperfusion injury
Annular - non pruritic rash w/erythematous borders trunks and limbs

43. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Hypertrophic cardiomyopathy
Loss of fx
Sudden cardiac death
PDA

44. What complications occur within 4 hrs post MI?
Ventricular arrhythmia
Cardiogenic shock - CHF - arrhythmia
4-7 days macrophage infiltration
Louder - increased systemic resistence decreases LV emptying

45. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Prinzmetal angina - cocaine
Tuberous sclerosis

46. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Systemic venous congestion
Rhadbomyoma - benign
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Minimizes ischemia

47. 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.
Prophylactic abx during dental procedures
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Wear and tear
Stable angina

48. What does nonbacterial thrombotic endocarditis cause?
Membrane damage
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral regurg
20 min

49. What is the most common type of ASD? What %?
Prinzmetal
Ostium secundum (90%)
Myxoid degeneration
Migratory polyarthritis

50. What causes unstable angina?
Minimizes ischemia
Regurg vs stenosis
Chronic ischemic heart disease
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery