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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 gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
SLE
RHF
Reperfusion injury

2. Why are cardiac enzymes elevated after an MI?
PGE
Membrane damage
Systolic ejection click followed by crescendo - decrescendo murmur
Maternal diabetes

3. What is the leading cause of death in the US?
PDA
Cardiogenic shock - CHF - arrhythmia
L->R
Ischemic heart disease

4. What type of shunt does truncus arteriosus cause?
R-->L
Transposition of the great vessels
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Mitral mitral+aortic

5. How does hypertension cause LHF?

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6. What are the Jones criteria?
CK- MB
Libman - Sacks endocarditis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Dark discoloration coagulative necrosis

7. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Ostium primum
Prinzmetal stable and unstable
Doxorubicin - cocaine

8. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Large vegetations of S aureus
Maternal diabetes
4-7 days macrophage infiltration
Months out fibrosis

9. What causes the dependent pitting edema in RHF?
Aortic stenosis
Increased hydrostatic pressure
Mitral stenosis
IV drug users

10. What creates the immune reaction in acute rhuematic fever?

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11. What does rupture of the IV septum cause?
Shunt
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Hypertophy of RV atrophy of LV
Concentric LV hypertophy

12. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Fibrinous pericarditis
Squat in response to cyanotic spell
Streptococcus bovis/

13. Which angina(s) show ST elevation on EKG? ST depression?
ACE inhibitor
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Prinzmetal stable and unstable
Systolic ejection click followed by crescendo - decrescendo murmur

14. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mitral insufficiency
RCA
Infantile coarctation of the aorta PDA

15. What is typically the mechanims of sudden cardiac death?
Small vegetations along the line of closure
Ventricular arrhythmia
Surgical closure small defects may close spontaneously
Months out fibrosis

16. How does O2 tx MI?
Contraction band necrosis - reperfusion injury
Minimizes ischemia
Aortic regurg
Wear and tear

17. What is the major cause of MI?
Infectious
Infectious endocarditis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Split S2 on auscultation

18. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Mitral insufficiency
Coronary artery vasospasm - emboli - vasculitis
Fetal alcohol syndrome

19. Systolic ejection click followed by crescendo - decrescendo murmur.
Chronic rheumatic heart disease
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Restrictive cardiomyopathy
Aortic stenosis

20. What is the classic EKG finding of restrictive cardiomyopathy?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Atherosclerosis of coronary arteries
Minimizes ischemia
Low voltage EKG w/diminished QRS amplitude

21. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Hypertrophic cardiomyopathy
Subendocardial
Volume overload and LHF

22. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Colon cancer
Loeffler syndrome
Mitral regurg

23. Erythematous nontender lesions on palms and soles.
Reversible
Membrane damage
Atherosclerosis of coronary arteries
Janeway lesions

24. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Mitral regurg
Congestive heart failure
Right side - serotonin and other secretory products detoxified in the lung

25. What causes wear and tear aortic stenosis?
Louder - increased systemic resistence decreases LV emptying
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
>60 years - bicuspid aortic valve
Fibrosis and dystrophic calcification

26. What causes microangiopathic hemolytic anemia in aortic stenosis?
Mitral regurg
ST- segment depression
RBC damaged while crossing the calcified valve causing schistocytes
Turner syndrome

27. What is the characteristic murmur of aortic stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
VSD
Systolic ejection click followed by crescendo - decrescendo murmur
RCA

28. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
White scar fibrosis
Pump failure
ASD - R-->L
Migratory polyarthritis

29. What type of shunt results in cyanosis at birth?
ASD - R-->L
Subendocardial
Right to left
Colon cancer

30. What valves are most commonly involved in chronic rheumatic heart disease?
Systemic venous congestion
Decreased forward perfusion pulmonary congestion
CHF
Mitral mitral+aortic

31. What are the causes of LHF?
Aortic stenosis
Infantile coarctation of the aorta
Mitral regurg
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

32. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Janeway lesions
S epidermidis
Ostium secundum (90%)
Colon cancer

33. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Aortic regurg
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Valve replacement once LV dysfx develops

34. What tests show prior group A beta - hemolytic strep infection?
Months out fibrosis
20 min
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Elevated ASO anti - DNase B titers

35. What causes heart failure cells?
Kawasaki disease
Restrictive cardiomyopathy
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Paradoxical emboli

36. At what point in development do congenital heart defects arise?
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
Mitral regurg
3-8 wks
LHF

37. What endocarditis is commonly found in patients with colon cancer?
Breast and lung carcinoma - melanoma - lymphoma
Mitral mitral+aortic
Streptococcus bovis/
2-4 hours - 24 hours - 7-10 days

38. What causes notching of the ribs in adult coarctation of the aorta?
Mitral regurg
CK- MB
Sterile vegetations on surface and undersurface on mitral valve
Intercostal arteries enlarged due to collateral circulation

39. How does subendocardial MI/ischemia present on EKG?
Libman - Sacks endocarditis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Turner syndrome
ST- segment depression

40. In what pt population does S aureus commonly cause valvular disease?
R-->L
Ventricular arrhythmia
Reperfusion injury
IV drug users

41. When do neutrophils infiltrate the myocardium post MI?
MI
1-3 days
Congested central veins
S epidermidis

42. What gross and microscopic changes occur months after an MI?
Ventricles cannot pump
Holosystolic machine like murmur
White scar fibrosis
Ischemic heart disease

43. What murmur ccan be heard in PDA?
Libman - Sacks endocarditis
Erythematous nontender lesions on palms and soles.
4-6 hours - 24 hours - 72 hours
Holosystolic machine like murmur

44. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Hypertrophic cardiomyopathy
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Paradoxical emboli
Prinzmetal stable and unstable

45. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Streptococcus bovis/
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Stable angina

46. What are the major criteria of the Jones criteria?
Aortic regurg
Red border granulation tissue
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

47. When is an MI patent at highest risk for fibrionous pericarditis?
Mitral regurg
1-3 days out
Split S2 on auscultation
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

48. What type of shunt does transposition of the great vessels cause?
Eisenmenger syndrome
R-->L
Mitral regurg
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

49. What complications occur within 4 hrs post MI?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Inability to fill ventricles
Cardiogenic shock - CHF - arrhythmia
Acute inflammation

50. In which chamber of the heart are rhabdomyomas found?
ACE inhibitor
Ventricle
Limits thrombosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria