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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 is the most common form of cardiomyopathy?
Loss of fx
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
Dilated
Turner syndrome

2. What is the tx for dilated cardiomyopathy?
Trisomy 21
Heart transplant
Coexisting mitral stenosis and fusion of commisures exist
Mitral valve prolapse

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

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4. In which chamber of the heart are cardiac myxomas found?
Stable angina
LA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Heart can't fill

5. With what disease is transposition of the great vessels associated?
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
RBC damaged while crossing the calcified valve causing schistocytes
Maternal diabetes
Erythematous nontender lesions on palms and soles.

6. What is dilated cardiomyopathy?
Chronic rheumatic heart disease
Dilation of all four chambers of the heart
Decreased forward perfusion pulmonary congestion
Limits thrombosis

7. In which chamber of the heart are rhabdomyomas found?
RCA
Membrane damage
Ventricle
Reperfusion injury

8. Friction rub and chest pain.
Pericarditits
Limits thrombosis
ST- segment elevation
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

9. What genetic conditions predispose a pt to mitral valve prolapse?
Holosystolic blowing murmur
Ehlers - Danlow and Marfan syndrome
Minimizes ischemia
Mitral and tricuspid regurg - arrhythmia

10. What is a complication of chronic rheumatic heart disease?
LHF
Infectious endocarditis
SLE
Left -->right

11. What does nonbacterial thrombotic endocarditis cause?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Subendocardial
Mitral regurg
Dilated

12. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Transposition of the great vessels
Ventricular arrhythmia
Dense layer of elastic and fibrotic tissue in the endocardium - children

13. Opening snap followed by diastolic rumble.
Mitral stenosis
Preductal - post aortic arch
Asymptomatic
Shunt

14. When do macrophagess infiltrate the myocardium post MI?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Ventricular arrhythmia
4-7 days
Cyanosis - RV hypertrophy - polycythemia - clubbing

15. With what congenital heart defect is ADULT coarctation of the aorta associated?
Erythematous nontender lesions on palms and soles.
Transposition of the great vessels
4-24 hours
Bicuspid aortic valve

16. With what endocarditis is S epidermidis associated?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Heart can't fill
Endocarditis of prosthetic valves
Aortic regurg

17. What is the foundation of a scar?
Open blocked vessels
Granulation tissue
Fibrosis and dystrophic calcification
White scar fibrosis

18. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Valve scarring that arises as a consequence of rheumatic fever
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Coexisting mitral stenosis and fusion of commisures exist
Annular - non pruritic rash w/erythematous borders trunks and limbs

19. What are complications of dilated cardiomyopathy?
Mid - systolic click followed by regurgitation murmur
Mitral and tricuspid regurg - arrhythmia
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
Transesophageal echo

20. What always follows necrosis?
Acute inflammation
2-3 weeks
Pulsating nail bed
Prinzmetal angina

21. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Mitral regurg
Colon cancer
Mitral mitral+aortic
Ostium secundum (90%)

22. What does a biopsy of hypertrophic cardiomyopathy look like?
Increased blood in right heart delays closure of P valve
Myofiber hypertrophy with disarray
RCA
>70%

23. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Tricuspid
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Tuberous sclerosis

24. What are the sx of aortic regurg?
Yellow pallor neutrophils
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
LAD

25. What is the most common cause of endocarditis in IV drug users?
S aureus
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
Ventricle
Shunt - PGE to maintain PDA until surgical repair can be performed

26. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Shunt - PGE to maintain PDA until surgical repair can be performed
Pericarditits
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Streptococcus viridans

27. When do troponin levels rise - peak - and return to normal?
Infantile coarctation of the aorta
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
2-4 hours - 24 hours - 7-10 days
Opening snap followed by diastolic rumble

28. What is the definition of ischemia?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Decrease in blood flow to an organ
Congestive heart failure
Gelatinous - abundant ground substance

29. Is injury due angina reversible or irreversible?
Slow HR - decreasing O2 demand and risk for arrhythmia
Large - destructive vegetations
Reversible
PGE

30. With what condition are rhabdomyomas associated?
Aortic regurg
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Shunt
Tuberous sclerosis

31. What complications occur within 4 hrs post MI?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Cardiogenic shock - CHF - arrhythmia
Reperfusion injury

32. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Decrease in blood flow to an organ
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

33. What is Loeffler syndrome?
Mitral insufficiency
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
SLE
Thickening of chrodae tendinae and cusps - mitral stenosis

34. What is the basic principle of CHF?
Low voltage EKG w/diminished QRS amplitude
Autoimmune pericarditis 6-8 wks post MI
Pump failure
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

35. What causes mitral valve prolapse?
Colon cancer
VSD
Myxoid degeneration
Anitschow cell

36. When does the heart have dark discoloration post MI?
4-24 hours
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Months out fibrosis

37. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Ventricles cannot pump
Nonbacterial thrombotic endocarditis (marantic endocarditis)
ST- segment depression

38. What is diastolic dysfx?
Inability to fill ventricles
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Aschoff bodies
Congenital rubella

39. What complications occur 4-7 days post MI?
S aureus
Shunt
Fetal alcohol syndrome
Rupture of free wall - IV septum - or papillary muscle

40. What iis the tx for aortic regurg?
Nitroglycerin
Heart transplant
Valve replacement once LV dysfx develops
LAD

41. What effect does chronic rheumatic heart disease have on the aortic valve?

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42. How does adult coarctation of the aorta present?
Sterile vegetations on mitral valve along lines of closure
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
4-24 hours
Congestive heart failure

43. When is an MI pt at greatest risk for cardiogenic shock?
Fetal alcohol syndrome
RCA
AD mutation in sarcomere proteins
First 4 hours

44. What is the JOneS mneumonic?
MI
Within the first day
Endocardial fibroelastosis
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

45. What is the most comon cause of aortic regurg? What are the other causes?
LAD
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Dilated
Annular - non pruritic rash w/erythematous borders trunks and limbs

46. What is the most common congenital heart defect?
Type I
Atria and RV
LAD
VSD

47. What effect does aortic stenosis have on the chambers of the heart?
Systolic ejection click followed by crescendo - decrescendo murmur
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Rhadbomyoma - benign
Concentric LV hypertophy

48. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Atria and RV
Increased blood in right heart delays closure of P valve
Metastasis

49. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Holosystolic machine like murmur
Shunt - PGE to maintain PDA until surgical repair can be performed
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

50. 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.
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Myocarditis
Aneurysm - mural thrombus - Dressler syndrome
Stable angina

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