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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 complication occurs 1-3 days post MI?
Split S2 on auscultation
Troponin I
Fibrinous pericarditis
Dense layer of elastic and fibrotic tissue in the endocardium - children

2. What is the definition of ischemia?
Decrease in blood flow to an organ
Atria and RV
Valve replacement once LV dysfx develops
Prinzmetal

3. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Hypercoagulable state or underlying adenocarcinoma
Decreases LV dilation by decreasing volume
Louder - increased systemic resistence decreases LV emptying
Sterile vegetations on surface and undersurface on mitral valve

4. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Prinzmetal angina
Right side - serotonin and other secretory products detoxified in the lung
PDA

5. What conditions can cause nonbacterial thrombotic endocarditis?
Valve replacement
Pulsating nail bed
Hypercoagulable state or underlying adenocarcinoma
Pericardial effusion due to pericardial involvement

6. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Backward LHF pulm htn and RHF - afib and associated mural thombis
2-3%
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

7. How does asprin/heparin tx MI?
Limits thrombosis
Prinzmetal
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
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 effect does chronic rheumatic heart disease have on the aortic valve?

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9. When do CK- MB levels rise - peak - and return to normal?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Libman - Sacks endocarditis
2-4 hours - 24 hours - 7-10 days
4-6 hours - 24 hours - 72 hours

10. What type of shunt does ASD cause?
Louder - increased systemic resistence decreases LV emptying
Left -->right
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
Systolic ejection click followed by crescendo - decrescendo murmur

11. Poor myocardial fx due to chronic ischemic damage?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Infantile coarctation of the aorta PDA
Chronic ischemic heart disease
Ventricular arrhythmia

12. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Contraction band necrosis - reperfusion injury
Nonspecific - eg fever and elevated ESR
4-7 days

13. What causes the nutmeg color in nutmeg liver?
Congested central veins
Indomethacin - decreases PGE
Mitral valve prolapse
2-3 weeks

14. What always follows necrosis?
Coronary artery vasospasm - emboli - vasculitis
Ostium primum
Acute inflammation
Myofiber hypertrophy with disarray

15. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Atria and RV
Type I
ASD - R-->L

16. What is the leading cause of death in the US?
Yellow pallor neutrophils
Ischemic heart disease
Pericarditits
4-7 days

17. What type of shunt results in cyanosis at birth?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Volume overload and LHF
Rhadbomyoma - benign
Right to left

18. When do troponin levels rise - peak - and return to normal?
Holosystolic machine like murmur
2-4 hours - 24 hours - 7-10 days
Type I
Sterile vegetations on surface and undersurface on mitral valve

19. What are the HACEK organisms? With what condition are they associated?
LHF
Cardiogenic shock - CHF - arrhythmia
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Infectious endocarditis

20. What causes the split S2 in ASD?
Right to left
Mitral valve prolapse
Increased blood in right heart delays closure of P valve
Anterior wall of LV and anterior septum

21. What type of collagen is involved in fibrosis?
Volume overload and LHF
Infantile coarctation of the aorta
Troponin I
Type I

22. What drugs can cause dilated cardiomyopathy?
Limits thrombosis
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
Doxorubicin - cocaine
Turner syndrome

23. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Within the first day
ST- segment elevation
Migratory polyarthritis

24. What congenital heart defect does indomethacin tx?
Chronic rheumatic heart disease
Mitral regurg
RCA
PDA

25. Which chambers of the heart are generally spared in an MI?
Congenital rubella
3-8 wks
Tetralogy of fallot
Atria and RV

26. What type of ischemia does stable angina cause?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Valve replacement
Inability to fill ventricles
Subendocardial

27. What is the most common valve infected by S aureus?
Mitral mitral+aortic
Tricuspid
Bacterial endocarditis
Within the first day

28. What type of shunt does a VSD cause?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Preductal - post aortic arch
Posterior wall of LV - posterior septum - papillary muscles
L->R

29. What heart sound manifest with an ASD?
Nitroglycerin
Nitroglycerin
Split S2 on auscultation
Coexisting mitral stenosis and fusion of commisures exist

30. What disesase has Aschoff bodies?
Hypercoagulable state or underlying adenocarcinoma
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Myocarditis in acute rheumatic heart fever
Stable and unstable prinzmetal

31. What does rupture of the IV septum cause?
Shunt
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
Right -->left
Myocarditis in acute rheumatic heart fever

32. What are the clinical features of RHF due to?
Yellow pallor neutrophils
Decrease in blood flow to an organ
Systemic venous congestion
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

33. What is systolic dysfx?
Wear and tear
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
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
Ventricles cannot pump

34. How does squating decrease hypoxemia in tetralogy of fallot?
Cardiogenic shock - CHF - arrhythmia
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
L->R
Months out fibrosis

35. With what virus is PDA associated?
Congenital rubella
Increased blood in right heart delays closure of P valve
2-4 hours - 24 hours - 7-10 days
Myocarditis in acute rheumatic heart fever

36. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Valve replacement
Preductal - post aortic arch

37. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Stable angina
Coronary artery vasospasm - emboli - vasculitis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

38. How does restrictive cardiomyopathy present?
Hypertrophic cardiomyopathy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Chest pain <20 min brought on by exertion or emotional stress
Congestive heart failure

39. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Holosystolic machine like murmur
PDA
Mitral regurg

40. What is the classic EKG finding of restrictive cardiomyopathy?
Myxoma - benign
Mitral regurg
Mitral regurgitation due to vegetations
Low voltage EKG w/diminished QRS amplitude

41. What is the tx for LHF?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Slow HR - decreasing O2 demand and risk for arrhythmia
Turner syndrome
ACE inhibitor

42. What causes mitral valve prolapse?
Pericardial effusion due to pericardial involvement
Low voltage EKG w/diminished QRS amplitude
Myxoid degeneration
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

43. Pericarditis 6-8 wks post MI.
Louder - increased systemic resistence decreases LV emptying
4-7 days
Autoimmune pericarditis 6-8 wks post MI
Dressler syndrome

44. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Mitral insufficiency
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Anitschow cell

45. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
S viridans
Circumflex
Cyanosis - RV hypertrophy - polycythemia - clubbing

46. How long after pharyngitis does acute rheumatic fever occur?
Mitral stenosis
Contraction band necrosis - reperfusion injury
2-3 weeks
Maternal diabetes

47. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Mitral regurgitation due to vegetations
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Holosystolic blowing murmur

48. What is an important complication of ASD?
Plump fibroblasts - collagen - blood vessels
Infantile coarctation of the aorta PDA
Paradoxical emboli
Papillary muscle - free wall - IV septum

49. What are the major criteria of the Jones criteria?
Autoimmune pericarditis 6-8 wks post MI
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
VSD

50. What is a water - hammer pulse?
Reperfusion injury
Loeffler syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Bounding pulse