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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. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
LV dilation and eccentric hypertrophy
Prinzmetal angina
Aneurysm - mural thrombus - Dressler syndrome

2. What causes wear and tear aortic stenosis?
Aortic stenosis
Sudden cardiac death
Fibrosis and dystrophic calcification
Turner syndrome

3. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Janeway lesions
ASD - R-->L
VSD
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

4. With what condition are rhabdomyomas associated?
Ostium secundum (90%)
Tuberous sclerosis
Months out fibrosis
Opening snap followed by diastolic rumble

5. How does Eisenmeger syndrome occur?
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
Increased blood in right heart delays closure of P valve
Posterior wall of LV - posterior septum - papillary muscles
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

6. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Infectious endocarditis - arrythmias - severe mitral regurg no
Myxoid degeneration
Nitroglycerin
SLE

7. What causes angina and syncope in aortic stenosis?

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8. What is the characteristic finding on CXR in tetralogy of fallot?
Increased hydrostatic pressure
Boot shaped heart
Squatting - expiration
Posterior wall of LV - posterior septum - papillary muscles

9. What is the most common congenital heart defect?
VSD
Posterior wall of LV - posterior septum - papillary muscles
Pulsating nail bed
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

10. What does rupture of the LV free wall cause?
Tetralogy of fallot
RCA
Cardiac tamponade
Myxoid degeneration

11. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Tuberous sclerosis
Aortic regurg
Chronic rheumatic heart disease
RCA

12. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Heart can't fill
Low voltage EKG w/diminished QRS amplitude
Coronary artery vasospasm

13. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Valve replacement
NG or Ca channel blocker
Boot shaped heart

14. In transposition of the great vessels - What is required for survival? How is this achieved?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Libman - Sacks endocarditis
Shunt - PGE to maintain PDA until surgical repair can be performed
4-24 hours

15. 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
Maternal diabetes
PDA
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

16. How do ACE inhibitors tx MI?
Adult coarctation of the aorta
Decreases LV dilation by decreasing volume
Doxorubicin - cocaine
Turner syndrome

17. With what virus is PDA associated?
Congenital rubella
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Prinzmetal stable and unstable
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt

18. What is the most common cause of myocarditis?
Transposition of the great vessels
Coxsackie A or B
Congestive heart failure
Tender lesions on fingers or toes.

19. What maintains patency of the PDA?
Ventricles cannot pump
Squatting - increased systemic resistence decreases LV emptying
PGE
Indomethacin - decreases PGE

20. What is the definition of ischemia?
Decrease in blood flow to an organ
Endocardial fibroelastosis (rare)
Mid - systolic click followed by regurgitation murmur
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

21. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Split S2 on auscultation
AD mutation in sarcomere proteins
Heart can't fill
Stable angina

22. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Pump failure
Stable and unstable prinzmetal
Dense layer of elastic and fibrotic tissue in the endocardium - children
Dilation of all four chambers of the heart

23. What is a Quincke pulse?
Fibrinous pericarditis
Coronary artery vasospasm - emboli - vasculitis
Pulsating nail bed
Erythematous nontender lesions on palms and soles.

24. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
4-24 hours
Annular - non pruritic rash w/erythematous borders trunks and limbs
Congested central veins

25. How does O2 tx MI?
Mitral valve prolapse
Holosystolic machine like murmur
Minimizes ischemia
Right to left

26. What type of shunt does a VSD cause?
L->R
Transposition of the great vessels
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
Colon cancer

27. What is a complication of chronic rheumatic heart disease?
Left -->right
Contraction band necrosis - reperfusion injury
Infectious endocarditis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

28. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Right side - serotonin and other secretory products detoxified in the lung
Colon cancer
Intercostal arteries enlarged due to collateral circulation
Squatting - increased systemic resistence decreases LV emptying

29. What are the clinical features of LHF due to?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Decreased forward perfusion pulmonary congestion
S epidermidis
Contraction band necrosis - reperfusion injury

30. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Fibrinous pericarditis
Subendocardial
4-24 hours

31. What is the most common valve infected by S aureus?
Pump failure
PGE
Infectious
Tricuspid

32. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Limits thrombosis
Myocarditis
Hypertrophic cardiomyopathy

33. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Chronic ischemic heart disease
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

34. What are the cancers that most commonly metastasize to the heart?
RCA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Breast and lung carcinoma - melanoma - lymphoma
Hemosiderin laden macrophages

35. Infects predamaged valves after transient bacteremia?
Trisomy 21
LV dilation and eccentric hypertrophy
Pts w/previously damaged valves
S viridans

36. Which coronary artery supplies the anterior wall and anterior septum?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Shunt
Acute inflammation
LAD

37. What gross and microscopic changes occur 1-3 days after an MI?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Mitral regurg
Yellow pallor neutrophils
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

38. How does transmural MI/ischemia present on EKG?
ST- segment elevation
IV drug users
Dark discoloration coagulative necrosis
Infectious endocarditis - arrythmias - severe mitral regurg no

39. How does ischemia cause LHF?
Loss of fx
VSD
ST- segment depression
Concentric LV hypertophy

40. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
PDA
Bounding pulse
Migratory polyarthritis

41. What effect does transposition of the great vessels have on the ventricles?
Large - destructive vegetations
Reperfusion injury
Friction rub and chest pain
Hypertophy of RV atrophy of LV

42. What % stenosis causes stable angina?
>70%
CK- MB
Troponin I
Split S2 on auscultation

43. What is Dressler syndrome? When does it occur?
Rupture of free wall - IV septum - or papillary muscle
Autoimmune pericarditis 6-8 wks post MI
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Red border granulation tissue

44. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
Ischemic heart disease
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Paradoxical emboli

45. What coronary artery supplies the mitral valve papillary muscles?
Pancarditis
L->R
RCA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

46. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
2-3 weeks
Indomethacin - decreases PGE
Sudden cardiac death
>60 years - bicuspid aortic valve

47. Opening snap followed by diastolic rumble.
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Tetralogy of fallot
Mitral stenosis
Anterior wall of LV and anterior septum

48. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Ventricular arrhythmia
Mitral regurg
Pulsating nail bed

49. When does the heart have a yellow pallor post MI?
CHF
Day 1-7
ACE inhibitor
Acute inflammation

50. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Ehlers - Danlow and Marfan syndrome
4-6 hours - 24 hours - 72 hours
Slow HR - decreasing O2 demand and risk for arrhythmia