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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 maintains patency of the PDA?
PGE
4-7 days macrophage infiltration
R-->L
Right -->left

2. What always follows necrosis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
S aureus
Pericardial effusion due to pericardial involvement
Acute inflammation

3. What is the 1day-1wk -1mo mneumonic for MI?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Infectious
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Slow HR - decreasing O2 demand and risk for arrhythmia

4. What are heart failure cells?
Systolic dysfx leading to biventricular CHF
Pericarditits
Hemosiderin laden macrophages
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

5. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Hemosiderin laden macrophages

6. What congenital heart defect is associated with fetal alcohol syndrome?
Granulation tissue
Mid - systolic click followed by regurgitation murmur
Sudden cardiac death
VSD

7. What is the characteristic finding on CXR in tetralogy of fallot?
Wear and tear
Boot shaped heart
LA dilation
Prophylactic abx during dental procedures

8. What bug causes acute rheumatic fever?
Heart transplant
Group A beta - hemolytic streptococci
Cyanosis - RV hypertrophy - polycythemia - clubbing
Pulsating nail bed

9. What effect does transposition of the great vessels have on the ventricles?
Right side - serotonin and other secretory products detoxified in the lung
Adult coarctation of the aorta
Hypertophy of RV atrophy of LV
Infantile coarctation of the aorta PDA

10. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Prinzmetal stable and unstable
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
First 4 hours

11. What is Dressler syndrome? When does it occur?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Autoimmune pericarditis 6-8 wks post MI
Regurg vs stenosis
CHF

12. Pericarditis 6-8 wks post MI.
Dressler syndrome
4-7 days macrophage infiltration
Plump fibroblasts - collagen - blood vessels
Coxsackie A or B

13. How does adult coarctation of the aorta present?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Coxsackie A or B

14. Which vasculitis can cause MI?
Right side - serotonin and other secretory products detoxified in the lung
Mitral stenosis
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
Kawasaki disease

15. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
When a bacterial protein resembles a protein in human tissue
Sudden cardiac death
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Janeway lesions

16. What is the most common type of endocarditis?
Infectious
Coronary artery vasospasm - emboli - vasculitis
Anitschow cell
20 min

17. What are the minor critera of the Jones criteria?
Stable angina
Increased blood in right heart delays closure of P valve
ACE inhibitor
Nonspecific - eg fever and elevated ESR

18. What causes unstable angina?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Coexisting mitral stenosis and fusion of commisures exist

19. When does the heart have dark discoloration post MI?
Surgical closure small defects may close spontaneously
4-24 hours
Ischemic heart disease
ASD - R-->L

20. What causes angina and syncope in aortic stenosis?

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21. Low voltage EKG w/diminished QRS amplitude.
Janeway lesions
Atria and RV
Limits thrombosis
Restrictive cardiomyopathy

22. Which congenital heart defect is associated with maternal diabetes?
Mitral mitral+aortic
Shunt - PGE to maintain PDA until surgical repair can be performed
Transposition of the great vessels
Left -->right

23. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Increased hydrostatic pressure
LA dilation

24. What cardiac enzyme is useful for detecting reinfarction?
Coxsackie A or B
Thickening of chrodae tendinae and cusps - mitral stenosis
Decreases LV dilation by decreasing volume
CK- MB

25. What heart sound manifest with an ASD?
Large - destructive vegetations
Systemic venous congestion
Split S2 on auscultation
Autoimmune pericarditis 6-8 wks post MI

26. When would arrhythmia occur after MI?
Ventricles cannot pump
Within the first day
Valve scarring that arises as a consequence of rheumatic fever
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

27. What causes mitral valve prolapse?
PDA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Myxoid degeneration
LA

28. What are the tx for MI?
Decreases LV dilation by decreasing volume
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Paradoxical emboli
RCA

29. What causes a mid - systolic click followed by a regurgitation murmur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
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
Mitral valve prolapse
Bicuspid aortic valve

30. Systolic ejection click followed by crescendo - decrescendo murmur.
Transesophageal echo
Dilation of all four chambers of the heart
Aortic stenosis
Myofiber hypertrophy with disarray

31. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Group A beta - hemolytic streptococci
White scar fibrosis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

32. In which chamber of the heart are rhabdomyomas found?
Ventricle
SLE
Atria and RV
Squat in response to cyanotic spell

33. In what pt population does S aureus commonly cause valvular disease?
IV drug users
S epidermidis
Valve replacement AFTER the onset of complications
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

34. What causes microangiopathic hemolytic anemia in aortic stenosis?
Prinzmetal stable and unstable
Loeffler syndrome
RBC damaged while crossing the calcified valve causing schistocytes
4-7 days macrophage infiltration

35. What does nonbacterial thrombotic endocarditis cause?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Within the first day
Mitral regurg
Reversible

36. What increases the volume of mitral regurg murmur?
Squatting - expiration
Right -->left
Stretched muscle loses contractility
Reactive histiocyte with caterpillar nucleus

37. What tests show prior group A beta - hemolytic strep infection?
Opening snap followed by diastolic rumble
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
LV dilation and eccentric hypertrophy
Elevated ASO anti - DNase B titers

38. How does squating decrease hypoxemia in tetralogy of fallot?
Squat in response to cyanotic spell
RHF
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

39. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Bicuspid aortic valve
Reperfusion injury
Reactive histiocyte with caterpillar nucleus

40. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Elevated ASO anti - DNase B titers
Ventricular arrhythmia
Type I
MI

41. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
1-3 days
1%
>70%

42. What are the Jones criteria?
Chronic ischemic heart disease
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Turner syndrome

43. EKG for stable angina?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
VSD
ST- segment depression
Annular - non pruritic rash w/erythematous borders trunks and limbs

44. When do neutrophils infiltrate the myocardium post MI?
RHF
Rupture of free wall - IV septum - or papillary muscle
Aortic regurg
1-3 days

45. How do you tx prinzmetal angina?
NG or Ca channel blocker
Coxsackie A or B
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
ACE inhibitor

46. What is an Anitschow cell?
RCA
Blood vessels coming in from normal tissue
Autoimmune pericarditis 6-8 wks post MI
Reactive histiocyte with caterpillar nucleus

47. What is the most common cause of endocarditis in IV drug users?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Right -->left
Breast and lung carcinoma - melanoma - lymphoma
S aureus

48. What imaging test is useful for detecting lesions on valves?
S aureus
Myxoid degeneration
Transesophageal echo
Colon cancer

49. What increases the risk for chronic rheumatic heart disease?
Shunt - PGE to maintain PDA until surgical repair can be performed
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
LA
Systolic ejection click followed by crescendo - decrescendo murmur

50. What is a Quincke pulse?
Increased hydrostatic pressure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Months out fibrosis
Pulsating nail bed