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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 does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Red border granulation tissue
Prinzmetal angina
Stretched muscle loses contractility

2. What type of vegetations are associated with Libman - Sacks endocarditis?
Infectious
Boot shaped heart
Sterile vegetations on surface and undersurface on mitral valve
Loeffler syndrome

3. What are the clinical features of endocarditis? What causes each feature?
Atherosclerosis of coronary arteries
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
Left -->right
S aureus

4. What side of the heart do carcinoid tumors affect? Why?
Boot shaped heart
Right side - serotonin and other secretory products detoxified in the lung
RBC damaged while crossing the calcified valve causing schistocytes
Spontaneous

5. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
When a bacterial protein resembles a protein in human tissue
Papillary muscle - free wall - IV septum
Coexisting mitral stenosis and fusion of commisures exist
Prinzmetal

6. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Anterior wall of LV and anterior septum
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Regurg vs stenosis

7. What is the gross and microscopic appearance of cardiac myxomas?
Anterior wall of LV and anterior septum
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Ventricle
Gelatinous - abundant ground substance

8. What are the HACEK organisms? With what condition are they associated?
Circumflex
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Plump fibroblasts - collagen - blood vessels
Pts w/previously damaged valves

9. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Heart can't fill
Increased blood in right heart delays closure of P valve
Bicuspid aortic valve

10. What is the basic principle of CHF?
Systolic ejection click followed by crescendo - decrescendo murmur
Pump failure
4-24 hours
Spontaneous

11. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myxoid degeneration
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

12. What is the gold standard blood marker for MI?
S viridans
Tender lesions on fingers or toes.
Troponin I
Right to left

13. How does O2 tx MI?
Regurg vs stenosis
Large vegetations of S aureus
Minimizes ischemia
Sterile vegetations on surface and undersurface on mitral valve

14. What congenital heart defect does indomethacin tx?
Right to left
RCA
PDA
RHF

15. Which coronary artery supplies the anterior wall and anterior septum?
Rhabdomyoma
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Inability to maintain systemic pressure w/lack of O2 to vital organs
LAD

16. What type of shunt results in cyanosis at birth?
Preductal - post aortic arch
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Prinzmetal
Right to left

17. What is the classic EKG finding of restrictive cardiomyopathy?
Pulsating nail bed
Low voltage EKG w/diminished QRS amplitude
Fibrinous pericarditis
Heart can't fill

18. How does squating decrease hypoxemia in tetralogy of fallot?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Sterile vegetations on surface and undersurface on mitral valve
Troponin I
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

19. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Prinzmetal stable and unstable
1%
Aortic regurg

20. What is eythema marginatum? What parts of the body does it commonly involve?
Cyanosis - RV hypertrophy - polycythemia - clubbing
PDA
Anterior wall of LV and anterior septum
Annular - non pruritic rash w/erythematous borders trunks and limbs

21. How does adult coarctation of the aorta present?
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
Infantile coarctation of the aorta PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

22. What type of valvular vegetations does S aureus cause?
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
Large - destructive vegetations
Migratory polyarthritis
ASD - R-->L

23. What is the most common cause of aortic stenosis?
Wear and tear
Dilation of all four chambers of the heart
Prophylactic abx during dental procedures
Systolic ejection click followed by crescendo - decrescendo murmur

24. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Yellow pallor macrophages
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Fibrosis and dystrophic calcification
Libman - Sacks endocarditis

25. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Prinzmetal angina
Streptococcus viridans
Pump failure

26. What is the most common valve infected by S aureus?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Myxoma - benign
ASD - R-->L
Tricuspid

27. Is scar tissue or myocardium stronger?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Eisenmenger syndrome
Myocardium
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

28. What is the rate of congenital heart defects?
Small vegetations along the line of closure
MI
1%
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

29. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Pancarditis
Streptococcus viridans
Myxoma - benign
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

30. What are the causes of LHF?
Infantile coarctation of the aorta PDA
Squatting - increased systemic resistence decreases LV emptying
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Hypertophy of RV atrophy of LV

31. How does hypertension cause LHF?

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32. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Sudden cardiac death
Transposition of the great vessels
Gelatinous - abundant ground substance

33. What heart sound manifest with an ASD?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Subendocardial
Janeway lesions
Split S2 on auscultation

34. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Split S2 on auscultation
Pulsating nail bed
Aortic regurg

35. Systolic ejection click followed by crescendo - decrescendo murmur.
Trisomy 21
Nitroglycerin
Aortic stenosis
Libman - Sacks endocarditis

36. Why are cardiac enzymes elevated after an MI?
Membrane damage
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Congenital rubella
Left -->right

37. How do ACE inhibitors tx MI?
Pancarditis
Prinzmetal angina - cocaine
Decrease in blood flow to an organ
Decreases LV dilation by decreasing volume

38. Which angina(s) show ST elevation on EKG? ST depression?
Eisenmenger syndrome
Anterior wall of LV and anterior septum
Prinzmetal stable and unstable
Circumflex

39. What is the most common cause of endocarditis in IV drug users?
Large vegetations of S aureus
>60 years - bicuspid aortic valve
S aureus
Valve replacement once LV dysfx develops

40. Which congenital heart defect is associated with congenital rubella?
NG or Ca channel blocker
Valve replacement AFTER the onset of complications
PDA
Valve replacement

41. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Increased hydrostatic pressure
Aneurysm - mural thrombus - Dressler syndrome
Pump failure

42. What are other (not atherosclerotic) causes of MI?
Doxorubicin - cocaine
Coronary artery vasospasm - emboli - vasculitis
SLE
Infantile coarctation of the aorta PDA

43. What coronary arterysupplies the lateral wall of the LV?
Valve scarring that arises as a consequence of rheumatic fever
Mitral regurg
Circumflex
Prinzmetal stable and unstable

44. Friction rub and chest pain.
Red border granulation tissue
Pericarditits
Harmartoma
Heart can't fill

45. Large vegetations on tricuspid valve?
S aureus
Reversible
Prinzmetal angina - cocaine
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

46. What causes a mid - systolic click followed by a regurgitation murmur?
Chronic ischemic heart disease
Circumflex
NG or Ca channel blocker
Mitral valve prolapse

47. What is the leading cause of death in the US?
Tetralogy of fallot
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Ischemic heart disease
Hypertophy of RV atrophy of LV

48. Myofiber hypertrophy with disarray.
Prinzmetal
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Hypertrophic cardiomyopathy

49. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
2-4 hours - 24 hours - 7-10 days
Acute inflammation
Increased blood in right heart delays closure of P valve

50. What causes heart failure cells?
Janeway lesions
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
SLE
Concentric LV hypertophy