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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. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Eisenmenger syndrome
45%
Contraction band necrosis

2. What is the characteristic murmurr of mitral stenosis?
Osler nodes (ouch - ouch Osler)
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
Opening snap followed by diastolic rumble
Pedunculated mass in the LA that causes syncope due to obstruction of MV

3. Holosystolic blowing murmur that increases w/expiration?
1-3 days out
Mitral regurg
Prinzmetal angina
Type I

4. What is the only Jones criteria that doesn't resolve with time?
ST- segment depression
Pancarditis
Endocarditis of prosthetic valves
Posterior wall of LV - posterior septum - papillary muscles

5. How does contraction band necrosis occur?
Cardiac tamponade
4-24 hours
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Turner syndrome

6. What does chronic ischemic heart disease progress to?
Harmartoma
Aschoff bodies
CHF
Subendocardial

7. What are the sx/complications of myocarditis?
4-6 hours - 24 hours - 72 hours
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Myxoma - benign
>70%

8. Which congenital heart defect is associated with congenital rubella?
PDA
Pancarditis
Pericarditits
Yellow pallor macrophages

9. Tx for PDA?
Myxoid degeneration
Indomethacin - decreases PGE
Anterior wall of LV and anterior septum
Shunt - PGE to maintain PDA until surgical repair can be performed

10. When is an MI patent at highest risk for fibrionous pericarditis?
Plump fibroblasts - collagen - blood vessels
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
1-3 days out

11. What does a biopsy of hypertrophic cardiomyopathy look like?
Opening snap followed by diastolic rumble
Myofiber hypertrophy with disarray
Myocarditis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

12. How does aortic regurg affect the heart chambers?
Left -->right
Tetralogy of fallot
LV dilation and eccentric hypertrophy
Slow HR - decreasing O2 demand and risk for arrhythmia

13. What drug relieves stable angina?
Mitral stenosis
Stable and unstable prinzmetal
Dressler syndrome
Nitroglycerin

14. What is the gold standard blood marker for MI?
Pump failure
Myofiber hypertrophy with disarray
Troponin I
Ventricle

15. What cardiac enzyme is useful for detecting reinfarction?
Anitschow cell
CK- MB
ST- segment elevation
Dressler syndrome

16. What are the two effects of ATII?
Prinzmetal angina
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

17. What are the clinical features of endocarditis? What causes each feature?
Troponin I
Indomethacin - decreases PGE
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
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

18. What iis the tx for aortic regurg?
Months out fibrosis
Dressler syndrome
Valve replacement once LV dysfx develops
Right side - serotonin and other secretory products detoxified in the lung

19. What is the characteristic murmur of aortic stenosis?
Pericarditits
Stable and unstable prinzmetal
Systolic ejection click followed by crescendo - decrescendo murmur
Concentric LV hypertophy

20. What causes the dependent pitting edema in RHF?
S aureus
Prinzmetal stable and unstable
Slow HR - decreasing O2 demand and risk for arrhythmia
Increased hydrostatic pressure

21. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Atherosclerosis of coronary arteries
ST- segment depression
Congested central veins

22. What is a Quincke pulse?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
2-3 weeks
Pulsating nail bed
Thickening of chrodae tendinae and cusps - mitral stenosis

23. What is typically the mechanims of sudden cardiac death?
Breast and lung carcinoma - melanoma - lymphoma
LAD
Ventricular arrhythmia
Libman - Sacks endocarditis

24. How does reperfusion injury occur?
Minimizes ischemia
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Myocardium
Loeffler syndrome

25. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Infantile coarctation of the aorta
Coxsackie A or B

26. What are the sx of aortic regurg?
Opening snap followed by diastolic rumble
ST- segment depression
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Rupture of free wall - IV septum - or papillary muscle

27. Large vegetations on tricuspid valve?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Loeffler syndrome
ST- segment depression
S aureus

28. 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
Right to left
AD mutation in sarcomere proteins
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

29. What is the most common tumor of the heart?
Open blocked vessels
Metastasis
Libman - Sacks endocarditis
CHF

30. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Nitroglycerin
Decrease in blood flow to an organ
Reperfusion injury
Day 1-7

31. How do beta blockers tx MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Streptococcus viridans
Metastasis
Slow HR - decreasing O2 demand and risk for arrhythmia

32. What effect does transposition of the great vessels have on the ventricles?
ACE inhibitor
Chronic ischemic heart disease
Mitral insufficiency
Hypertophy of RV atrophy of LV

33. Vegetations on surface and undersurface of mitral valve.
LAD
Libman - Sacks endocarditis
Hypertophy of RV atrophy of LV
Myocarditis

34. What is Loeffler syndrome?
Congested central veins
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Right -->left
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

35. What is the definition of ischemia?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Myofiber hypertrophy with disarray
Decrease in blood flow to an organ
Left -->right

36. How does restrictive cardiomyopathy cause LHF?

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37. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Coronary artery vasospasm
Months out fibrosis
Cyanosis - RV hypertrophy - polycythemia - clubbing

38. With what endocarditis is S epidermidis associated?
Congestive heart failure
Group A beta - hemolytic streptococci
Endocarditis of prosthetic valves
VSD

39. At what point in development do congenital heart defects arise?
3-8 wks
ACE inhibitor
Dense layer of elastic and fibrotic tissue in the endocardium - children
Months out fibrosis

40. What is a water - hammer pulse?
Bounding pulse
Opening snap followed by diastolic rumble
Atherosclerosis of coronary arteries
Adult coarctation of the aorta

41. Sudden death in a young athlete.
Mitral regurg
>70%
Hypertrophic cardiomyopathy
VSD

42. What are the complications of mitral valve prolapse? Are they common?
Positive blood cultures anemia of chronic disease
1%
Infectious endocarditis - arrythmias - severe mitral regurg no
S aureus

43. What type of shunt results in cyanosis at birth?
Right to left
Contraction band necrosis
Fetal alcohol syndrome
Coronary artery vasospasm

44. What are the complications of aortic stenosis?
MI
Ventricular arrhythmia
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
ST- segment depression

45. What typically causes hypertrophic cardiomyopathy?
CK- MB
AD mutation in sarcomere proteins
Prinzmetal angina
LAD

46. What gross and microscopic changes occur 4-24 hours after an MI?
Dilation of all four chambers of the heart
45%
Concentric LV hypertophy
Dark discoloration coagulative necrosis

47. What causes a mid - systolic click followed by a regurgitation murmur?
Bounding pulse
Mitral valve prolapse
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Cardiogenic shock - CHF - arrhythmia

48. When would arrhythmia occur after MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Paradoxical emboli
Decrease in blood flow to an organ
Within the first day

49. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Endocardial fibroelastosis (rare)
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

50. Erythematous nontender lesions on palms and soles.
Decrease preload -->lowers myocardial stress
Dilated
Maternal diabetes
Janeway lesions