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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. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Surgical closure small defects may close spontaneously
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
R-->L
Anitschow cell

2. What type of endocarditis is associated with SLE?
Posterior wall of LV - posterior septum - papillary muscles
Autoimmune pericarditis 6-8 wks post MI
Libman - Sacks endocarditis
Anterior wall of LV and anterior septum

3. What shunt does tetralogy of fallot produce?
First 4 hours
Infectious
Right -->left
Large - destructive vegetations

4. What % stenosis causes stable angina?
Maternal diabetes
Prophylactic abx during dental procedures
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
>70%

5. Dense layer of elastic and fibrotic tissue in the endocardium.
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Reversible
Hypertrophic cardiomyopathy
Endocardial fibroelastosis

6. What are the clinical features of endocarditis? What causes each feature?
VSD
Yellow pallor macrophages
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
Reperfusion injury

7. When does the heart have dark discoloration post MI?
Autoimmune pericarditis 6-8 wks post MI
Rupture of free wall - IV septum - or papillary muscle
4-24 hours
Heart transplant

8. What is the tx for LHF?
Squat in response to cyanotic spell
Cardiac tamponade
ACE inhibitor
Mitral valve prolapse

9. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Squatting - increased systemic resistence decreases LV emptying
Nonbacterial thrombotic endocarditis (marantic endocarditis)
L->R

10. What are the sx of aortic regurg?
Endocardial fibroelastosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Pericardial effusion due to pericardial involvement

11. What genetic conditions predispose a pt to mitral valve prolapse?
Infectious
Nitroglycerin
Ehlers - Danlow and Marfan syndrome
Hypertrophic cardiomyopathy

12. What causes wear and tear aortic stenosis?
Left -->right
S epidermidis
Bicuspid aortic valve
Fibrosis and dystrophic calcification

13. What type of vegetations does Strep viridans cause?
Right to left
Ischemic heart disease
Atherosclerosis of coronary arteries
Small - nondestructive vegetations (subacute endocarditis)

14. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Pericarditits
Reperfusion injury
LHF
Ostium primum

15. What is the most common congenital heart defect?
Large vegetations of S aureus
Wear and tear
Streptococcus viridans
VSD

16. What type of shunt does ASD cause?
Prinzmetal
1%
Left -->right
Mitral regurg

17. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Decrease in blood flow to an organ
ASD - R-->L
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

18. When do neutrophils infiltrate the myocardium post MI?
PDA
VSD
1-3 days
Heart can't fill

19. What causes angina and syncope in aortic stenosis?

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20. What side of the heart do carcinoid tumors affect? Why?
Mitral mitral+aortic
Right side - serotonin and other secretory products detoxified in the lung
LAD
Valve replacement

21. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Pulsating nail bed
RCA

22. What type of shunt does truncus arteriosus cause?
Ischemic heart disease
R-->L
Months out fibrosis
PDA

23. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Months out fibrosis
Endocardial fibroelastosis (rare)
Inability to maintain systemic pressure w/lack of O2 to vital organs

24. Ostium primum ASD is associated with what congenital disorder?
2-3%
1-3 days out
Myxoma - benign
Trisomy 21

25. What compensatory mechanism do tetralogy of fallot pts learn?
Kawasaki disease
Squat in response to cyanotic spell
ASD - R-->L
PDA

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

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27. With what congenital heart defect is ADULT coarctation of the aorta 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
Bicuspid aortic valve
Infantile coarctation of the aorta PDA
Day 1-7

28. What are the sx of cardiac myxoma?
Regurg vs stenosis
1-3 days out
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Tuberous sclerosis

29. How does O2 tx MI?
Ostium primum
Intercostal arteries enlarged due to collateral circulation
S aureus
Minimizes ischemia

30. What is the rate of mitral valve prolapse in the US?
Prinzmetal
2-3%
Ventricles cannot pump
45%

31. What does Libman - Sacks endocarditis cause?
Months out fibrosis
Mitral regurg
Metastasis
Hemosiderin laden macrophages

32. What type of shunt does transposition of the great vessels cause?
R-->L
Bounding pulse
Tender lesions on fingers or toes.
3-8 wks

33. How do nitrates tx MI?
4-6 hours - 24 hours - 72 hours
Holosystolic machine like murmur
Decrease preload -->lowers myocardial stress
Left -->right

34. How do you tx prinzmetal angina?
Valve scarring that arises as a consequence of rheumatic fever
Limits thrombosis
Coxsackie A or B
NG or Ca channel blocker

35. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Reperfusion injury
Bounding pulse
Systolic ejection click followed by crescendo - decrescendo murmur

36. What is the tx for mitral valve prolapse?
Friction rub and chest pain
S viridans
Mitral regurg
Valve replacement

37. What type of shunt results in cyanosis at birth?
2-4 hours - 24 hours - 7-10 days
Right to left
Infectious
PDA

38. How does squating decrease hypoxemia in tetralogy of fallot?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Hypertophy of RV atrophy of LV
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Indomethacin - decreases PGE

39. What are complications of dilated cardiomyopathy?
Squatting - expiration
Months out fibrosis
Eisenmenger syndrome
Mitral and tricuspid regurg - arrhythmia

40. EKG for stable angina?
ST- segment depression
R-->L
Congested central veins
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

41. How does Eisenmeger syndrome occur?
Reperfusion injury
Valve replacement
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
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

42. What is the 1day-1wk -1mo mneumonic for MI?
Nitroglycerin
Ostium primum
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Degree of pulmonary artery stenosis

43. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Left -->right
Day 1-7
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
RCA

44. What causes unstable angina?
Hypertrophic cardiomyopathy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Wear and tear
Dilation of all four chambers of the heart

45. What is the characteristic murmurr of mitral stenosis?
Aneurysm - mural thrombus - Dressler syndrome
CHF
Opening snap followed by diastolic rumble
2-4 hours - 24 hours - 7-10 days

46. What is a Quincke pulse?
Left -->right
Fibrosis and dystrophic calcification
Pulsating nail bed
Pericarditits

47. What are the clinical features of RHF?
Mid - systolic click followed by regurgitation murmur
Holosystolic machine like murmur
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Degree of pulmonary artery stenosis

48. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decrease preload -->lowers myocardial stress
Limits thrombosis

49. What causes endocarditis of prosthetic valves?
Mitral and tricuspid regurg - arrhythmia
Reperfusion injury
S epidermidis
Cardiac tamponade

50. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
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
Decreases LV dilation by decreasing volume
Kawasaki disease
RHF