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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 type of endocarditis is associated w/metastatic cancer and wasting conditions?
Breast and lung carcinoma - melanoma - lymphoma
2-3%
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S viridans

2. When does the heart have dark discoloration post MI?
Turner syndrome
Aortic regurg
4-24 hours
Right -->left

3. What is the most comon cause of aortic regurg? What are the other causes?
Mitral regurg
Ischemic heart disease
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Sterile vegetations on mitral valve along lines of closure

4. What are other (not atherosclerotic) causes of MI?
Indomethacin - decreases PGE
Holosystolic blowing murmur
Pts w/previously damaged valves
Coronary artery vasospasm - emboli - vasculitis

5. What gross and microscopic changes occur 4-24 hours after an MI?
Aortic regurg
Dark discoloration coagulative necrosis
Posterior wall of LV - posterior septum - papillary muscles
Shunt - PGE to maintain PDA until surgical repair can be performed

6. How does restrictive cardiomyopathy cause LHF?

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7. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Infectious
Restrictive cardiomyopathy
Pump failure

8. What does nonbacterial thrombotic endocarditis cause?
Mitral regurg
Nitroglycerin
Tuberous sclerosis
Transposition of the great vessels

9. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Posterior wall of LV - posterior septum - papillary muscles
Increased blood in right heart delays closure of P valve

10. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Yellow pallor macrophages
Red border granulation tissue
Rhadbomyoma - benign

11. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Myocarditis in acute rheumatic heart fever
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Pedunculated mass in the LA that causes syncope due to obstruction of MV

12. When do CK- MB levels rise - peak - and return to normal?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Ehlers - Danlow and Marfan syndrome
4-6 hours - 24 hours - 72 hours
Concentric LV hypertophy

13. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Spontaneous
Metastasis
Wear and tear
Coexisting mitral stenosis and fusion of commisures exist

14. With what congenital heart defect is ADULT coarctation of the aorta associated?
2-3 weeks
Tricuspid
Positive blood cultures anemia of chronic disease
Bicuspid aortic valve

15. What is the leading cause of death in the US?
Ischemic heart disease
Intercostal arteries enlarged due to collateral circulation
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Nonbacterial thrombotic endocarditis (marantic endocarditis)

16. Is scar tissue or myocardium stronger?
4-7 days
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
PDA
Myocardium

17. What are Osler nodes?
45%
Mid - systolic click followed by regurgitation murmur
4-24 hours
Tender lesions on fingers or toes.

18. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Large - destructive vegetations
PDA
Granulation tissue

19. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Ischemic heart disease
Right to left
Friction rub and chest pain

20. How does stable angina present?
Surgical closure small defects may close spontaneously
LHF
Chest pain <20 min brought on by exertion or emotional stress
Heart can't fill

21. What causes prinzmetal angina?
Yellow pallor neutrophils
Coronary artery vasospasm
Contraction band necrosis
Sterile vegetations on surface and undersurface on mitral valve

22. What is the most common cause of death during the acute phase of rheumatic fever?
Annular - non pruritic rash w/erythematous borders trunks and limbs
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myocarditis

23. What causes acute endocarditis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Kawasaki disease
Small vegetations along the line of closure
Large vegetations of S aureus

24. In which chamber of the heart are cardiac myxomas found?
Friction rub and chest pain
Myofiber hypertrophy with disarray
Annular - non pruritic rash w/erythematous borders trunks and limbs
LA

25. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Congenital rubella
Paradoxical emboli

26. How does squating decrease hypoxemia in tetralogy of fallot?
Loeffler syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Friction rub and chest pain
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

27. What complications occur 4-7 days post MI?
Prinzmetal angina - cocaine
Mitral and tricuspid regurg - arrhythmia
Rupture of free wall - IV septum - or papillary muscle
Prinzmetal stable and unstable

28. What causes mitral valve prolapse?
Right -->left
1-3 days out
Pump failure
Myxoid degeneration

29. What type of shunt does a VSD cause?
Fetal alcohol syndrome
L->R
Colon cancer
Decreased forward perfusion pulmonary congestion

30. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Rhadbomyoma - benign
Group A beta - hemolytic streptococci
Prinzmetal

31. What type of shunt does truncus arteriosus cause?
Mid - systolic click followed by regurgitation murmur
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Pedunculated mass in the LA that causes syncope due to obstruction of MV
R-->L

32. What are the clinical features of endocarditis? What causes each feature?
Ostium primum
Cyanosis - RV hypertrophy - polycythemia - clubbing
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
Subendocardial

33. When do neutrophils infiltrate the myocardium post MI?
Autoimmune pericarditis 6-8 wks post MI
PDA
Decrease in blood flow to an organ
1-3 days

34. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
MI
R-->L
Decreases LV dilation by decreasing volume

35. Ostium primum ASD is associated with what congenital disorder?
Spontaneous
Coronary artery vasospasm - emboli - vasculitis
Prinzmetal
Trisomy 21

36. What causes unstable angina?
20 min
Cardiogenic shock - CHF - arrhythmia
Months out fibrosis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

37. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Acute inflammation
Prinzmetal angina
Infectious
Hemosiderin laden macrophages

38. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
1-3 days
Elevated ASO anti - DNase B titers
Atherosclerosis of coronary arteries

39. Infects predamaged valves after transient bacteremia?
S viridans
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
ASD - R-->L
Stretched muscle loses contractility

40. What type of ASD is associated w/Down syndrome?
Preductal - post aortic arch
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Ostium primum

41. What type of shunt does transposition of the great vessels cause?
R-->L
MI
Atherosclerosis of coronary arteries
Reactive histiocyte with caterpillar nucleus

42. Dilated cardiomyopathy is a late complication of what illness?
Months out fibrosis
Boot shaped heart
Elevated ASO anti - DNase B titers
Myocarditis

43. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Months out fibrosis
Eisenmenger syndrome
Autoimmune pericarditis 6-8 wks post MI

44. What gross and microscopic changes occur months after an MI?
Spontaneous
White scar fibrosis
Trisomy 21
Adult coarctation of the aorta

45. What type of ischemia does stable angina cause?
Reversible
Mitral regurgitation due to vegetations
Subendocardial
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

46. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Anitschow cell
Endocardial fibroelastosis (rare)
RHF

47. What is the rate of mitral valve prolapse in the US?
Elevated ASO anti - DNase B titers
Valve replacement
2-3%
Harmartoma

48. What type of vegetations are associated with Libman - Sacks endocarditis?
Prinzmetal
Reperfusion injury
Sterile vegetations on surface and undersurface on mitral valve
Ventricular arrhythmia

49. With what developmental disorder is VSD associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Fetal alcohol syndrome
Rhadbomyoma - benign
Streptococcus viridans

50. What type of vegetations form in nonbacterial thrombotic endocarditis?
Red border granulation tissue
Sterile vegetations on mitral valve along lines of closure
Fibrosis and dystrophic calcification
Aneurysm - mural thrombus - Dressler syndrome