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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. With what condition are rhabdomyomas associated?
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
Infectious endocarditis - arrythmias - severe mitral regurg no
1-3 days
Tuberous sclerosis

2. With what disease is infantile coarctation of the aorta associated?
Annular - non pruritic rash w/erythematous borders trunks and limbs
RCA
Systemic venous congestion
Turner syndrome

3. EKG for stable angina?
ST- segment depression
Circumflex
2-3%
First 4 hours

4. What is the basic principle of CHF?
Pump failure
LA
Hypertrophic cardiomyopathy
Loeffler syndrome

5. What does rupture of the IV septum cause?
Valve replacement
Hemosiderin laden macrophages
Shunt
Prinzmetal

6. What is eythema marginatum? What parts of the body does it commonly involve?
Asymptomatic
Annular - non pruritic rash w/erythematous borders trunks and limbs
MI
PDA

7. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Red border granulation tissue
>70%
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

8. What is Dressler syndrome? When does it occur?
Positive blood cultures anemia of chronic disease
Autoimmune pericarditis 6-8 wks post MI
RCA
Infantile coarctation of the aorta PDA

9. What typically causes hypertrophic cardiomyopathy?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
AD mutation in sarcomere proteins
Low voltage EKG w/diminished QRS amplitude
Congested central veins

10. What complication occurs 1-3 days post MI?
Ventricular arrhythmia
Fibrinous pericarditis
SLE
Endocarditis of prosthetic valves

11. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
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
RCA
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

12. Erythematous nontender lesions on palms and soles.
PDA
Janeway lesions
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
Tuberous sclerosis

13. What is a Quincke pulse?
Pulsating nail bed
Dressler syndrome
Louder - increased systemic resistence decreases LV emptying
S epidermidis

14. What is the gold standard blood marker for MI?
Troponin I
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
PDA
Systemic venous congestion

15. Holosystolic blowing murmur that increases w/expiration?
Mitral and tricuspid regurg - arrhythmia
Aortic regurg
Mitral regurg
PGE

16. How does O2 tx MI?
Blood vessels coming in from normal tissue
Mitral insufficiency
Dilation of all four chambers of the heart
Minimizes ischemia

17. How does hypertension cause LHF?

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18. What % of MIs involve the LAD?
4-24 hours
45%
Infectious
Reperfusion injury

19. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Congenital rubella
Mitral mitral+aortic
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Hypertrophic cardiomyopathy

20. What is diastolic dysfx?
Inability to fill ventricles
Endocardial fibroelastosis
>60 years - bicuspid aortic valve
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

21. What is the foundation of a scar?
Transesophageal echo
Myocardium
Granulation tissue
Atria and RV

22. How does reperfusion injury occur?
Small - nondestructive vegetations (subacute endocarditis)
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
PGE
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

23. Lower extremity cyanosis in infants? In adults?
>70%
Infantile coarctation of the aorta PDA
Intercostal arteries enlarged due to collateral circulation
Streptococcus viridans

24. Why are cardiac enzymes elevated after an MI?
Ischemic heart disease
Metastasis
Membrane damage
Increased blood in right heart delays closure of P valve

25. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Holosystolic machine like murmur
Spontaneous

26. How does MI cause LHF?
Loss of LV fx
Aortic regurg
Infectious endocarditis - arrythmias - severe mitral regurg no
Mid - systolic click followed by regurgitation murmur

27. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Myocarditis
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
Red border granulation tissue

28. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
Plump fibroblasts - collagen - blood vessels
Restrictive cardiomyopathy
Rhabdomyoma

29. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Volume overload and LHF
Heart transplant
>60 years - bicuspid aortic valve

30. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Concentric LV hypertophy

31. What are heart failure cells?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Squatting - increased systemic resistence decreases LV emptying
Prophylactic abx during dental procedures
Hemosiderin laden macrophages

32. How do you tx prinzmetal angina?
MI
Months out fibrosis
Breast and lung carcinoma - melanoma - lymphoma
NG or Ca channel blocker

33. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Bicuspid aortic valve
PDA
Circumflex

34. When would arrhythmia occur after MI?
Hypertophy of RV atrophy of LV
Holosystolic blowing murmur
Stable angina
Within the first day

35. What is the most common congenital heart defect?
VSD
Fibrinous pericarditis
Ostium primum
Red border granulation tissue

36. What is the cause of the red border around granulation tissue?
Reversible
R-->L
Mitral regurg
Blood vessels coming in from normal tissue

37. What valves are involved in rhuematic endocarditis?
Ehlers - Danlow and Marfan syndrome
PDA
Mitral mitral+aortic
Squatting - expiration

38. What side of the heart do carcinoid tumors affect? Why?
Subendocardial
Minimizes ischemia
Right side - serotonin and other secretory products detoxified in the lung
PDA

39. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Right to left
4-7 days
ACE inhibitor

40. What causes the split S2 in ASD?
Stable angina
Thickening of chrodae tendinae and cusps - mitral stenosis
Increased blood in right heart delays closure of P valve
Kawasaki disease

41. What does granulation tissue contain?
Atherosclerosis of coronary arteries
Streptococcus bovis/
Plump fibroblasts - collagen - blood vessels
Within the first day

42. What type of tumor is a rhabdomyoma?
Harmartoma
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Paradoxical emboli
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

43. What are the sx of PDA at birth?
Hemosiderin laden macrophages
Asymptomatic
Endocardial fibroelastosis (rare)
Libman - Sacks endocarditis

44. Systolic ejection click followed by crescendo - decrescendo murmur.
Loss of LV fx
Aortic stenosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Endocardial fibroelastosis (rare)

45. What are the Jones criteria?
Rupture of free wall - IV septum - or papillary muscle
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Subendocardial
Hypertrophic cardiomyopathy

46. Tx for PDA?
Systemic venous congestion
Mitral mitral+aortic
Stable angina
Indomethacin - decreases PGE

47. Large vegetations on tricuspid valve?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
S aureus
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
20 min

48. What increases the risk for chronic rheumatic heart disease?
Small - nondestructive vegetations (subacute endocarditis)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Inability to maintain systemic pressure w/lack of O2 to vital organs

49. What is the murmur of mitral regurg?
Increased hydrostatic pressure
Ehlers - Danlow and Marfan syndrome
Holosystolic blowing murmur
Janeway lesions

50. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Plump fibroblasts - collagen - blood vessels
AD mutation in sarcomere proteins
Bacterial endocarditis
MI