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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?
Preductal - post aortic arch
Dilated
Decreases LV dilation by decreasing volume
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

2. What are the sx of PDA at birth?
Reactive histiocyte with caterpillar nucleus
Asymptomatic
Hypertrophic cardiomyopathy
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

3. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Fibrinous pericarditis
S aureus
Nonbacterial thrombotic endocarditis (marantic endocarditis)

4. What is the effect of mitral regurg on the heart?
Volume overload and LHF
R-->L
Anterior wall of LV and anterior septum
Yellow pallor macrophages

5. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Prinzmetal angina
Systolic ejection click followed by crescendo - decrescendo murmur
Increased blood in right heart delays closure of P valve

6. What is the tx for dilated cardiomyopathy?
Heart transplant
Tricuspid
Mid - systolic click followed by regurgitation murmur
Aneurysm - mural thrombus - Dressler syndrome

7. What are the complications of mitral stenosis?
Surgical closure small defects may close spontaneously
Backward LHF pulm htn and RHF - afib and associated mural thombis
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
Migratory polyarthritis

8. How does Eisenmeger syndrome occur?
CK- MB
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Libman - Sacks endocarditis
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

9. What effect does aortic regurg have on the pulse pressure? Why?
Cardiac tamponade
Libman - Sacks endocarditis
Congenital rubella
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

10. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Squat in response to cyanotic spell
Months out fibrosis
Aortic regurg
PDA

11. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
ST- segment depression
Circumflex

12. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Decrease in blood flow to an organ
2-4 hours - 24 hours - 7-10 days
Surgical closure small defects may close spontaneously
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

13. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
RBC damaged while crossing the calcified valve causing schistocytes
Ehlers - Danlow and Marfan syndrome
Subendocardial
Regurg vs stenosis

14. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
RBC damaged while crossing the calcified valve causing schistocytes
Myocardium
VSD

15. In which pts does S viridans cause endocarditits?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Cardiogenic shock - CHF - arrhythmia
Pts w/previously damaged valves
2-3%

16. What is the tx for LHF?
Pericardial effusion due to pericardial involvement
Osler nodes (ouch - ouch Osler)
ACE inhibitor
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

17. What is the foundation of a scar?
Granulation tissue
ST- segment depression
VSD
Infectious endocarditis - arrythmias - severe mitral regurg no

18. What are the sx of hypertrophic cardiomyopathy?
Infectious
Systemic venous congestion
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
LA

19. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Pancarditis
RCA
Valve replacement

20. What % stenosis causes stable angina?
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
>70%
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Congestive heart failure

21. Which chambers of the heart are generally spared in an MI?
Elevated ASO anti - DNase B titers
Atria and RV
Pericarditits
LV dilation and eccentric hypertrophy

22. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Valve replacement AFTER the onset of complications
Granulation tissue
>60 years - bicuspid aortic valve
ST- segment depression

23. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Pts w/previously damaged valves
Mitral regurg
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

24. What type of shunt does truncus arteriosus cause?
R-->L
Decrease preload -->lowers myocardial stress
Osler nodes (ouch - ouch Osler)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

25. What are the clinical features of RHF due to?
Pericardial effusion due to pericardial involvement
Streptococcus bovis/
Loss of fx
Systemic venous congestion

26. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Decreased forward perfusion pulmonary congestion
NG or Ca channel blocker
Decrease preload -->lowers myocardial stress
Stable and unstable prinzmetal

27. What is the characteristic murmur of aortic stenosis?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Mitral mitral+aortic
Systolic ejection click followed by crescendo - decrescendo murmur
Mitral regurg

28. Tx for PDA?
Decrease preload -->lowers myocardial stress
Indomethacin - decreases PGE
Endocardial fibroelastosis (rare)
Right -->left

29. What is the 1day-1wk -1mo mneumonic for MI?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Months out fibrosis

30. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Harmartoma
Coronary artery vasospasm
Slow HR - decreasing O2 demand and risk for arrhythmia

31. Myofiber hypertrophy with disarray.
PDA
Pts w/previously damaged valves
Hypertrophic cardiomyopathy
S viridans

32. What is an Aschoff body?
Systolic dysfx leading to biventricular CHF
2-3%
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Tetralogy of fallot

33. How does stable angina present?
Inability to maintain systemic pressure w/lack of O2 to vital organs
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
Maternal diabetes
Chest pain <20 min brought on by exertion or emotional stress

34. How does restrictive cardiomyopathy cause LHF?

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35. What effect does transposition of the great vessels have on the ventricles?
Squatting - increased systemic resistence decreases LV emptying
Hypertophy of RV atrophy of LV
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
R-->L

36. What is dilated cardiomyopathy?
LHF
Dilation of all four chambers of the heart
Systemic venous congestion
Mitral regurgitation due to vegetations

37. What is a Quincke pulse?
Colon cancer
2-3%
Pulsating nail bed
Reversible

38. With what virus is PDA associated?
Mitral valve prolapse
Pancarditis
NG or Ca channel blocker
Congenital rubella

39. What type of vegetations does Strep viridans cause?
Hypertophy of RV atrophy of LV
Small - nondestructive vegetations (subacute endocarditis)
Stable angina
Heart transplant

40. What characterizes acute rheumatic fever endocarditiis?
Fibrosis and dystrophic calcification
Small vegetations along the line of closure
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
Pancarditis

41. What gross and microscopic changes occur 4-7 days after an MI?
Pericardial effusion due to pericardial involvement
Yellow pallor macrophages
Fetal alcohol syndrome
Mitral valve prolapse

42. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Chest pain <20 min brought on by exertion or emotional stress
2-3%
Loeffler syndrome
Pedunculated mass in the LA that causes syncope due to obstruction of MV

43. Erythematous nontender lesions on palms and soles.
PDA
Low voltage EKG w/diminished QRS amplitude
When a bacterial protein resembles a protein in human tissue
Janeway lesions

44. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
White scar fibrosis
Sterile vegetations on mitral valve along lines of closure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LAD

45. What is the rate of mitral valve prolapse in the US?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
2-3%
Coxsackie A or B
Fibrinous pericarditis

46. What is a water - hammer pulse?
Loss of LV fx
Bounding pulse
White scar fibrosis
Large vegetations of S aureus

47. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Heart transplant
Hypertrophic cardiomyopathy
Mitral mitral+aortic

48. What is the most common cause of myocarditis?
Months out fibrosis
Prinzmetal stable and unstable
Coxsackie A or B
Doxorubicin - cocaine

49. What are the clinical features of RHF?
Blood vessels coming in from normal tissue
Positive blood cultures anemia of chronic disease
Coexisting mitral stenosis and fusion of commisures exist
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

50. How does aortic regurg affect the heart chambers?
Tuberous sclerosis
Turner syndrome
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
LV dilation and eccentric hypertrophy