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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 JOneS mneumonic?
White scar fibrosis
Autoimmune pericarditis 6-8 wks post MI
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
Stable angina

2. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Decreases LV dilation by decreasing volume
Coxsackie A or B
Yellow pallor neutrophils

3. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Loeffler syndrome
Sudden cardiac death
20 min

4. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Posterior wall of LV - posterior septum - papillary muscles
RBC damaged while crossing the calcified valve causing schistocytes
Erythematous nontender lesions on palms and soles.

5. What increases the risk for chronic rheumatic heart disease?
Circumflex
Restrictive cardiomyopathy
Small vegetations along the line of closure
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

6. What is the basic principle of CHF?
When a bacterial protein resembles a protein in human tissue
Squatting - expiration
Pump failure
Right to left

7. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Myofiber hypertrophy with disarray
R-->L
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

8. What is Dressler syndrome? When does it occur?
Migratory polyarthritis
Autoimmune pericarditis 6-8 wks post MI
R-->L
Tuberous sclerosis

9. What structures are susceptible to rupture post MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Infectious
Papillary muscle - free wall - IV septum
When a bacterial protein resembles a protein in human tissue

10. When does the heart have dark discoloration post MI?
Friction rub and chest pain
Valve scarring that arises as a consequence of rheumatic fever
Concentric LV hypertophy
4-24 hours

11. What causes the split S2 in ASD?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Increased blood in right heart delays closure of P valve
Troponin I
RHF

12. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Cyanosis - RV hypertrophy - polycythemia - clubbing
Janeway lesions
Stable and unstable prinzmetal
RHF

13. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Kawasaki disease
Dressler syndrome
Reperfusion injury
PDA

14. Dilated cardiomyopathy is a late complication of what illness?
1-3 days
Myocarditis
Osler nodes (ouch - ouch Osler)
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

15. What does rupture of a papillary muscle cause?
Volume overload and LHF
Gelatinous - abundant ground substance
Positive blood cultures anemia of chronic disease
Mitral insufficiency

16. What type of vegetations does Strep viridans cause?
First 4 hours
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Small - nondestructive vegetations (subacute endocarditis)
Migratory polyarthritis

17. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Congestive heart failure
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Coexisting mitral stenosis and fusion of commisures exist

18. What causes a mid - systolic click followed by a regurgitation murmur?
VSD
Annular - non pruritic rash w/erythematous borders trunks and limbs
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Mitral valve prolapse

19. What causes angina and syncope in aortic stenosis?

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20. What % of MIs involve the LAD?
45%
Anitschow cell
Trisomy 21
LAD

21. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
IV drug users
Gelatinous - abundant ground substance
Opening snap followed by diastolic rumble

22. What is the murmur of mitral regurg?
VSD
Holosystolic blowing murmur
Ventricle
S viridans

23. What is the rate of congenital heart defects?
Ventricle
Sterile vegetations on mitral valve along lines of closure
Systolic ejection click followed by crescendo - decrescendo murmur
1%

24. What congenital heart defect is associated with fetal alcohol syndrome?
Breast and lung carcinoma - melanoma - lymphoma
VSD
Months out fibrosis
PDA

25. What is the characteristic murmurr of mitral stenosis?
Bacterial endocarditis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Opening snap followed by diastolic rumble
Systemic venous congestion

26. What is the major cause of MI?
Stable angina
NG or Ca channel blocker
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Stretched muscle loses contractility

27. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
LHF
Coronary artery vasospasm - emboli - vasculitis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Nonbacterial thrombotic endocarditis (marantic endocarditis)

28. Is injury due angina reversible or irreversible?
Cardiogenic shock - CHF - arrhythmia
Rhadbomyoma - benign
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Reversible

29. What typically causes hypertrophic cardiomyopathy?
Mitral insufficiency
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
AD mutation in sarcomere proteins
Myxoma - benign

30. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Pericarditits
Pedunculated mass in the LA that causes syncope due to obstruction of MV
CHF

31. Vegetations on surface and undersurface of mitral valve.
Stable angina
S epidermidis
ST- segment depression
Libman - Sacks endocarditis

32. How does Eisenmeger syndrome occur?
Autoimmune pericarditis 6-8 wks post MI
Infantile coarctation of the aorta PDA
Rhabdomyoma
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

33. What causes the nutmeg color in nutmeg liver?
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
Heart transplant
Congested central veins
Chronic rheumatic heart disease

34. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Membrane damage
Cyanosis - RV hypertrophy - polycythemia - clubbing
Libman - Sacks endocarditis

35. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Aschoff bodies
PGE
Mitral mitral+aortic

36. What does a biopsy of hypertrophic cardiomyopathy look like?
Adult coarctation of the aorta
Myofiber hypertrophy with disarray
Group A beta - hemolytic streptococci
Backward LHF pulm htn and RHF - afib and associated mural thombis

37. What effect does aortic regurg have on the pulse pressure? Why?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
PDA
Surgical closure small defects may close spontaneously
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

38. What type of endocarditis is associated with SLE?
Posterior wall of LV - posterior septum - papillary muscles
Libman - Sacks endocarditis
Split S2 on auscultation
Mitral regurg

39. What is the most common cause of dilated cardiomyopathy? What are other causes?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Reversible
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Holosystolic blowing murmur

40. What is the tx for LHF?
4-24 hours
Osler nodes (ouch - ouch Osler)
Spontaneous
ACE inhibitor

41. What are the complications of aortic stenosis?
Large vegetations of S aureus
Prinzmetal angina
ST- segment depression
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

42. How does subendocardial MI/ischemia present on EKG?
Contraction band necrosis - reperfusion injury
Gelatinous - abundant ground substance
ST- segment depression
Mid - systolic click followed by regurgitation murmur

43. What is the most common primary cardiac tumor in children? Is it malignant or benign?
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
Ventricles cannot pump
Mitral regurg
Rhadbomyoma - benign

44. What does chronic ischemic heart disease progress to?
Kawasaki disease
CHF
Small vegetations along the line of closure
Large vegetations of S aureus

45. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Fibrinous pericarditis
Chest pain <20 min brought on by exertion or emotional stress

46. What is the leading cause of death in the US?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Migratory polyarthritis
Ischemic heart disease
Holosystolic blowing murmur

47. What is a water - hammer pulse?
Louder - increased systemic resistence decreases LV emptying
Low voltage EKG w/diminished QRS amplitude
Bounding pulse
Small vegetations along the line of closure

48. What is the 1day-1wk -1mo mneumonic for MI?
Infectious endocarditis - arrythmias - severe mitral regurg no
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Stable and unstable prinzmetal
Mitral regurg

49. What is the tx for VSD?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mitral and tricuspid regurg - arrhythmia
Surgical closure small defects may close spontaneously
Asymptomatic

50. Erythematous nontender lesions on palms and soles.
Loss of LV fx
Janeway lesions
Stable angina
Increased blood in right heart delays closure of P valve