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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 are the laboratory findings of bacterial endocarditis?
Myocardium
Decreases LV dilation by decreasing volume
Positive blood cultures anemia of chronic disease
Ventricles cannot pump

2. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Red border granulation tissue
Prinzmetal angina - cocaine
Infectious endocarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

3. What is systolic dysfx?
Ventricles cannot pump
LHF
Bacterial endocarditis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

4. When does the heart have dark discoloration post MI?
4-24 hours
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Annular - non pruritic rash w/erythematous borders trunks and limbs
White scar fibrosis

5. With what endocarditis is S epidermidis associated?
Dark discoloration coagulative necrosis
Acute inflammation
Endocarditis of prosthetic valves
1%

6. What are the Jones criteria?
Hypercoagulable state or underlying adenocarcinoma
VSD
Granulation tissue
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

7. Boot - shaped heart on x- ray?
Tetralogy of fallot
Turner syndrome
Hypertrophic cardiomyopathy
Sterile vegetations on mitral valve along lines of closure

8. What type of shunt results in cyanosis at birth?
Right to left
Osler nodes (ouch - ouch Osler)
Within the first day
R-->L

9. What shunt does tetralogy of fallot produce?
Congested central veins
Right -->left
Shunt
Pancarditis

10. What are the tx for MI?
Valve scarring that arises as a consequence of rheumatic fever
Bicuspid aortic valve
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

11. What is the murmur of mitral regurg?
Transposition of the great vessels
ASD - R-->L
Holosystolic blowing murmur
Stable angina

12. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Mitral stenosis
Prinzmetal angina
Bicuspid aortic valve

13. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Anterior wall of LV and anterior septum
Left -->right

14. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Myocarditis
Louder - increased systemic resistence decreases LV emptying
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Open blocked vessels

15. What are the four defects in tetralogy of fallot?
Squat in response to cyanotic spell
NG or Ca channel blocker
>60 years - bicuspid aortic valve
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

16. What are the clinical features of RHF due to?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Systemic venous congestion
PGE
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

17. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
Coxsackie A or B
Infectious
Day 1-7

18. With what virus is PDA associated?
Hypertophy of RV atrophy of LV
Congenital rubella
RCA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

19. What type of shunt does a VSD cause?
1-3 days
Squat in response to cyanotic spell
PGE
L->R

20. Opening snap followed by diastolic rumble.
Heart can't fill
1-3 days
Mitral stenosis
Prinzmetal

21. What maintains patency of the PDA?
Asymptomatic
PGE
IV drug users
Decrease in blood flow to an organ

22. What does nonbacterial thrombotic endocarditis cause?
PGE
Mitral regurg
Friction rub and chest pain
Right to left

23. Is injury due angina reversible or irreversible?
Systemic venous congestion
Reversible
Pulsating nail bed
Decreases LV dilation by decreasing volume

24. What are other (not atherosclerotic) causes of MI?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Concentric LV hypertophy
Valve replacement AFTER the onset of complications
Coronary artery vasospasm - emboli - vasculitis

25. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Open blocked vessels
IV drug users
Red border granulation tissue
Coexisting mitral stenosis and fusion of commisures exist

26. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Mitral mitral+aortic
Day 1-7
R-->L

27. What is the tx for LHF?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
ACE inhibitor
Indomethacin - decreases PGE
Ischemic heart disease

28. What are the sx of PDA at birth?
Asymptomatic
LAD
4-24 hours
Spontaneous

29. What are the sx of hypertrophic cardiomyopathy?
Degree of pulmonary artery stenosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Streptococcus bovis/

30. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Migratory polyarthritis
Papillary muscle - free wall - IV septum
Mitral mitral+aortic

31. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Myxoma - benign
Right side - serotonin and other secretory products detoxified in the lung
Indomethacin - decreases PGE

32. What causes angina and syncope in aortic stenosis?

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33. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Hypercoagulable state or underlying adenocarcinoma
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Nitroglycerin
Anitschow cell

34. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Inability to fill ventricles
Pancarditis
1-3 days out

35. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Increased blood in right heart delays closure of P valve
Coexisting mitral stenosis and fusion of commisures exist
4-24 hours

36. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Left -->right
AD mutation in sarcomere proteins
Aortic regurg
RHF

37. What type of shunt dose PDA cause?
Left -->right
Troponin I
Anitschow cell
4-7 days macrophage infiltration

38. With what disease is Libman - Sacks endocarditis associated?
Pericarditits
PDA
Reperfusion injury
SLE

39. What complications occur within 4 hrs post MI?
Intercostal arteries enlarged due to collateral circulation
Infectious endocarditis
Cardiogenic shock - CHF - arrhythmia
Mitral and tricuspid regurg - arrhythmia

40. What is the basic principle of CHF?
Chronic rheumatic heart disease
Coexisting mitral stenosis and fusion of commisures exist
Pump failure
Bicuspid aortic valve

41. When do CK- MB levels rise - peak - and return to normal?
Tuberous sclerosis
LV dilation and eccentric hypertrophy
4-6 hours - 24 hours - 72 hours
Loss of fx

42. Holosystolic blowing murmur that increases w/expiration?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Right side - serotonin and other secretory products detoxified in the lung
Aortic regurg
Mitral regurg

43. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Decrease preload -->lowers myocardial stress
Decrease in blood flow to an organ
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

44. Infects predamaged valves after transient bacteremia?
Cardiogenic shock - CHF - arrhythmia
Prinzmetal stable and unstable
Right side - serotonin and other secretory products detoxified in the lung
S viridans

45. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Streptococcus bovis/
Coronary artery vasospasm
Fetal alcohol syndrome

46. What is the most common valve infected by S aureus?
LAD
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Kawasaki disease
Tricuspid

47. What are the major criteria of the Jones criteria?
Aschoff bodies
Fibrosis and dystrophic calcification
Squatting - increased systemic resistence decreases LV emptying
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

48. Pericarditis 6-8 wks post MI.
NG or Ca channel blocker
Dressler syndrome
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

49. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Blood vessels coming in from normal tissue
Ischemic heart disease

50. Are most congenital heart defects spontaneous or inherited?
PDA
S epidermidis
Spontaneous
Tender lesions on fingers or toes.