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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 are the complications of mitral stenosis?
1-3 days
Coexisting mitral stenosis and fusion of commisures exist
Backward LHF pulm htn and RHF - afib and associated mural thombis
Systolic dysfx leading to biventricular CHF

2. Which angina is relieved by Ca channel blockers?
Pts w/previously damaged valves
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
Prinzmetal
Coronary artery vasospasm - emboli - vasculitis

3. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
LA
Reperfusion injury
Endocardial fibroelastosis

4. When do neutrophils infiltrate the myocardium post MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
2-3%
Mitral stenosis
1-3 days

5. What are the sx of aortic regurg?
Coxsackie A or B
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Elevated ASO anti - DNase B titers
Mitral regurgitation due to vegetations

6. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Mitral insufficiency
Heart can't fill

7. What is Loeffler syndrome?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
RCA
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

8. What is migratory polyarthritis?
Limits thrombosis
Tender lesions on fingers or toes.
VSD
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

9. What type of shunt dose PDA cause?
Degree of pulmonary artery stenosis
Left -->right
Doxorubicin - cocaine
Squatting - increased systemic resistence decreases LV emptying

10. What type of collagen is involved in fibrosis?
Type I
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
>60 years - bicuspid aortic valve
Infectious endocarditis - arrythmias - severe mitral regurg no

11. What gross and microscopic changes occur 4-24 hours after an MI?
Streptococcus viridans
Dark discoloration coagulative necrosis
Valve replacement
Heart can't fill

12. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Reversible
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Aortic stenosis

13. What is an Aschoff body?
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
Prinzmetal angina
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

14. When would arrhythmia occur after MI?
Sterile vegetations on surface and undersurface on mitral valve
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Sudden cardiac death
Within the first day

15. What increases the volume of mitral regurg murmur?
Pancarditis
Squatting - expiration
Backward LHF pulm htn and RHF - afib and associated mural thombis
Wear and tear

16. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Posterior wall of LV - posterior septum - papillary muscles
Congested central veins
R-->L

17. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Troponin I
Group A beta - hemolytic streptococci
Myocarditis in acute rheumatic heart fever

18. Vegetations on surface and undersurface of mitral valve.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Small - nondestructive vegetations (subacute endocarditis)
Libman - Sacks endocarditis
CK- MB

19. How does O2 tx MI?
Contraction band necrosis - reperfusion injury
Troponin I
Minimizes ischemia
Coxsackie A or B

20. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Yellow pallor macrophages
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Transposition of the great vessels

21. How does hypertension cause LHF?

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22. What is the tx for VSD?
When a bacterial protein resembles a protein in human tissue
Surgical closure small defects may close spontaneously
Mid - systolic click followed by regurgitation murmur
Large vegetations of S aureus

23. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Right -->left
4-24 hours
>70%

24. What is the most common type of ASD? What %?
Ostium secundum (90%)
Mitral valve prolapse
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Surgical closure small defects may close spontaneously

25. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Mitral valve prolapse
S epidermidis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

26. What type of valvular vegetations does S aureus cause?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Large - destructive vegetations

27. With what virus is PDA associated?
Dilation of all four chambers of the heart
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Mitral regurgitation due to vegetations
Congenital rubella

28. What type of vegetations does Strep viridans cause?
Rhabdomyoma
Acute inflammation
Small - nondestructive vegetations (subacute endocarditis)
Pulsating nail bed

29. What are the clinical features of endocarditis? What causes each feature?
Split S2 on auscultation
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
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

30. What causes unstable angina?
Acute inflammation
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Left -->right

31. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
Bicuspid aortic valve
Aschoff bodies
Volume overload and LHF

32. When is an MI patent at highest risk for fibrionous pericarditis?
Chest pain <20 min brought on by exertion or emotional stress
Erythematous nontender lesions on palms and soles.
1-3 days out
Backward LHF pulm htn and RHF - afib and associated mural thombis

33. How does MI cause LHF?
Small - nondestructive vegetations (subacute endocarditis)
Harmartoma
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Loss of LV fx

34. What are the complications of mitral valve prolapse? Are they common?
VSD
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Infectious endocarditis - arrythmias - severe mitral regurg no
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

35. What is endocardial fibroelastosis? In what population is it found?
Reperfusion injury
Shunt
Restrictive cardiomyopathy
Dense layer of elastic and fibrotic tissue in the endocardium - children

36. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
PDA
LAD
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Months out fibrosis

37. What is the murmur of mitral regurg?
PDA
Trisomy 21
Holosystolic blowing murmur
Chronic ischemic heart disease

38. What is an important complication of ASD?
White scar fibrosis
Squat in response to cyanotic spell
Type I
Paradoxical emboli

39. In which chamber of the heart are rhabdomyomas found?
Ventricle
Valve replacement AFTER the onset of complications
Myocarditis
Membrane damage

40. How does squating decrease hypoxemia in tetralogy of fallot?
Small vegetations along the line of closure
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Myofiber hypertrophy with disarray
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

41. What is a common complication of cardiac metastasis?
Preductal - post aortic arch
Pericardial effusion due to pericardial involvement
Loss of LV fx
4-7 days macrophage infiltration

42. What valves are involved in rhuematic endocarditis?
Prinzmetal stable and unstable
Mitral mitral+aortic
Infectious endocarditis - arrythmias - severe mitral regurg no
Endocarditis of prosthetic valves

43. What always follows necrosis?
Acute inflammation
Preductal - post aortic arch
Dense layer of elastic and fibrotic tissue in the endocardium - children
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

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

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45. What cardiac enzyme is useful for detecting reinfarction?
4-7 days macrophage infiltration
CK- MB
Blood vessels coming in from normal tissue
Streptococcus bovis/

46. What is the tx for dilated cardiomyopathy?
Heart transplant
Spontaneous
Contraction band necrosis
Trisomy 21

47. Which artery is most often occluded in an MI?
Prinzmetal
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
LAD
Spontaneous

48. What is molecular mimicry?
Osler nodes (ouch - ouch Osler)
SLE
When a bacterial protein resembles a protein in human tissue
Type I

49. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Mitral mitral+aortic
Holosystolic machine like murmur
Split S2 on auscultation

50. What congenital heart defect often is present with infantile coarctation of the aorta?
Within the first day
Infantile coarctation of the aorta PDA
LHF
PDA