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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. In which chamber of the heart are cardiac myxomas found?
RBC damaged while crossing the calcified valve causing schistocytes
Type I
Myocarditis in acute rheumatic heart fever
LA

2. What are the forward and backward sx of LHF?
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
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
PDA
Infantile coarctation of the aorta

3. What is molecular mimicry?
Shunt
When a bacterial protein resembles a protein in human tissue
2-3 weeks
Congested central veins

4. What type of shunt does a VSD cause?
Concentric LV hypertophy
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Aortic stenosis
L->R

5. How does transmural MI/ischemia present on EKG?
Fetal alcohol syndrome
Ventricles cannot pump
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
ST- segment elevation

6. What genetic conditions predispose a pt to mitral valve prolapse?
LAD
Ehlers - Danlow and Marfan syndrome
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Reperfusion injury

7. How do nitrates tx MI?
Mitral regurg
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Prinzmetal stable and unstable
Decrease preload -->lowers myocardial stress

8. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
S viridans
Positive blood cultures anemia of chronic disease
Mitral mitral+aortic

9. What is the most common cause of endocarditis in IV drug users?
S aureus
Transposition of the great vessels
Boot shaped heart
Subendocardial

10. What type of endocarditis is associated with SLE?
Sudden cardiac death
Myxoid degeneration
LAD
Libman - Sacks endocarditis

11. What increases the volume of mitral regurg murmur?
Slow HR - decreasing O2 demand and risk for arrhythmia
Coexisting mitral stenosis and fusion of commisures exist
ST- segment depression
Squatting - expiration

12. Where is the coarctation in infantile coarctation of the aorta?
Shunt - PGE to maintain PDA until surgical repair can be performed
Decreases LV dilation by decreasing volume
Preductal - post aortic arch
RCA

13. What causes endocarditis of prosthetic valves?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
S aureus
Mitral regurgitation due to vegetations
S epidermidis

14. What type of collagen is involved in fibrosis?
Type I
Large vegetations of S aureus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Hemosiderin laden macrophages

15. With what disease is infantile coarctation of the aorta associated?
Prophylactic abx during dental procedures
Sterile vegetations on mitral valve along lines of closure
Metastasis
Turner syndrome

16. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
LA
1-3 days out
Months out fibrosis
Reperfusion injury

17. What type of vegetations form in nonbacterial thrombotic endocarditis?
Loss of LV fx
Sterile vegetations on mitral valve along lines of closure
Aschoff bodies
Systolic ejection click followed by crescendo - decrescendo murmur

18. How does O2 tx MI?
R-->L
Myxoid degeneration
Large vegetations of S aureus
Minimizes ischemia

19. What coronary arterysupplies the lateral wall of the LV?
Circumflex
4-6 hours - 24 hours - 72 hours
2-3 weeks
Volume overload and LHF

20. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Stable and unstable prinzmetal
Aneurysm - mural thrombus - Dressler syndrome
Tender lesions on fingers or toes.
ASD - R-->L

21. How does restrictive cardiomyopathy cause LHF?

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22. Opening snap followed by diastolic rumble.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Decrease in blood flow to an organ
Mitral stenosis
Fibrosis and dystrophic calcification

23. What murmur ccan be heard in PDA?
Yellow pallor macrophages
Valve scarring that arises as a consequence of rheumatic fever
Loeffler syndrome
Holosystolic machine like murmur

24. Which artery is most often occluded in an MI?
2-3%
LHF
Chronic rheumatic heart disease
LAD

25. What is the most common cause of infectious endocarditis?
Streptococcus viridans
LA dilation
Valve scarring that arises as a consequence of rheumatic fever
White scar fibrosis

26. What is the tx for mitral valve prolapse?
Streptococcus viridans
Day 1-7
Valve replacement
Ehlers - Danlow and Marfan syndrome

27. What typically causes hypertrophic cardiomyopathy?
Reactive histiocyte with caterpillar nucleus
Decreases LV dilation by decreasing volume
AD mutation in sarcomere proteins
Type I

28. What causes mitral valve prolapse?
IV drug users
Plump fibroblasts - collagen - blood vessels
3-8 wks
Myxoid degeneration

29. What are the two effects of ATII?
Stable angina
Dilation of all four chambers of the heart
S aureus
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

30. What gross and microscopic changes occur 1-3 weeks after an MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Day 1-7
Rhadbomyoma - benign
Red border granulation tissue

31. What is the most common tumor of the heart?
Endocarditis of prosthetic valves
PDA
Metastasis
Chest pain <20 min brought on by exertion or emotional stress

32. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aschoff bodies
Holosystolic machine like murmur
Colon cancer

33. What causes unstable angina?
Mitral regurg
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Increased hydrostatic pressure
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

34. Friction rub and chest pain.
Friction rub and chest pain
Atherosclerosis of coronary arteries
Cardiogenic shock - CHF - arrhythmia
Pericarditits

35. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
S epidermidis
MI
Asymptomatic

36. How does squating decrease hypoxemia in tetralogy of fallot?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
AD mutation in sarcomere proteins
Aortic regurg

37. What is the most comon cause of aortic regurg? What are the other causes?
Troponin I
Bacterial endocarditis
Kawasaki disease
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

38. What is the effect of mitral regurg on the heart?
Anitschow cell
Endocardial fibroelastosis
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
Volume overload and LHF

39. What % stenosis causes stable angina?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Infectious endocarditis - arrythmias - severe mitral regurg no
1-3 days out
>70%

40. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RBC damaged while crossing the calcified valve causing schistocytes
4-7 days
Loeffler syndrome

41. What is the only Jones criteria that doesn't resolve with time?
VSD
Pancarditis
Streptococcus bovis/
2-4 hours - 24 hours - 7-10 days

42. What endocarditis is commonly found in patients with colon cancer?
Mitral valve prolapse
Reactive histiocyte with caterpillar nucleus
Contraction band necrosis
Streptococcus bovis/

43. What are the complications of aortic stenosis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Plump fibroblasts - collagen - blood vessels
LHF
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

44. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Anterior wall of LV and anterior septum
Squatting - expiration
S viridans

45. How does adult coarctation of the aorta present?
Intercostal arteries enlarged due to collateral circulation
Stable and unstable prinzmetal
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

46. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Aschoff bodies
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Increased blood in right heart delays closure of P valve

47. What is endocardial fibroelastosis? In what population is it found?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Libman - Sacks endocarditis
Pericarditits
Dense layer of elastic and fibrotic tissue in the endocardium - children

48. Large vegetations on tricuspid valve?
Squat in response to cyanotic spell
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
S aureus
Hypercoagulable state or underlying adenocarcinoma

49. What complications occur within 4 hrs post MI?
White scar fibrosis
Cardiogenic shock - CHF - arrhythmia
Chronic ischemic heart disease
Loeffler syndrome

50. What type of shunt does ASD cause?
Aschoff bodies
NG or Ca channel blocker
Left -->right
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy