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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 JOneS mneumonic?
Cardiac tamponade
Wear and tear
Coronary artery vasospasm - emboli - vasculitis
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

2. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Mitral mitral+aortic
LAD
Stretched muscle loses contractility

3. What is eythema marginatum? What parts of the body does it commonly involve?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
3-8 wks
Annular - non pruritic rash w/erythematous borders trunks and limbs
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

4. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Sterile vegetations on surface and undersurface on mitral valve
Libman - Sacks endocarditis

5. Tx for PDA?
Indomethacin - decreases PGE
2-4 hours - 24 hours - 7-10 days
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
Reactive histiocyte with caterpillar nucleus

6. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Slow HR - decreasing O2 demand and risk for arrhythmia
Left -->right
PDA
Months out fibrosis

7. What is the most common tumor of the heart?
Metastasis
Decrease preload -->lowers myocardial stress
Open blocked vessels
Heart can't fill

8. Opening snap followed by diastolic rumble.
Tetralogy of fallot
RCA
Thickening of chrodae tendinae and cusps - mitral stenosis
Mitral stenosis

9. What is the most common cause of aortic stenosis?
Wear and tear
PDA
Valve replacement
Atherosclerosis of coronary arteries

10. How does stable angina present?
Dark discoloration coagulative necrosis
Wear and tear
Atherosclerosis of coronary arteries
Chest pain <20 min brought on by exertion or emotional stress

11. What are the clinical features of RHF?
ST- segment elevation
Sterile vegetations on mitral valve along lines of closure
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Loss of LV fx

12. What are the minor critera of the Jones criteria?
Subendocardial
S viridans
Nonspecific - eg fever and elevated ESR
Myocarditis

13. Poor myocardial fx due to chronic ischemic damage?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Granulation tissue
Chronic ischemic heart disease
Transesophageal echo

14. In which pts does S viridans cause endocarditits?
Type I
Infantile coarctation of the aorta PDA
Endocarditis of prosthetic valves
Pts w/previously damaged valves

15. What type of shunt does transposition of the great vessels cause?
SLE
PDA
Elevated ASO anti - DNase B titers
R-->L

16. What congenital heart defect does indomethacin tx?
PDA
Hypercoagulable state or underlying adenocarcinoma
Slow HR - decreasing O2 demand and risk for arrhythmia
CK- MB

17. When do CK- MB levels rise - peak - and return to normal?
Left -->right
Positive blood cultures anemia of chronic disease
Sudden cardiac death
4-6 hours - 24 hours - 72 hours

18. What are the causes of restrictive cardiomyopathy in adults?
LA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Months out fibrosis
Volume overload and LHF

19. What are other (not atherosclerotic) causes of MI?
Small - nondestructive vegetations (subacute endocarditis)
Bacterial endocarditis
Coronary artery vasospasm - emboli - vasculitis
Decreases LV dilation by decreasing volume

20. Vegetations on surface and undersurface of mitral valve.
Myocarditis
S aureus
CHF
Libman - Sacks endocarditis

21. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
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
S viridans
Small vegetations along the line of closure

22. What is migratory polyarthritis?
Large vegetations of S aureus
Low voltage EKG w/diminished QRS amplitude
Spontaneous
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

23. What valves are involved in rhuematic endocarditis?
Hemosiderin laden macrophages
Anitschow cell
Mitral mitral+aortic
When a bacterial protein resembles a protein in human tissue

24. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Infantile coarctation of the aorta
Reperfusion injury
R-->L
Myocarditis in acute rheumatic heart fever

25. What is the most common cause of death during the acute phase of rheumatic fever?
Endocardial fibroelastosis
S epidermidis
Myocarditis
Decrease in blood flow to an organ

26. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Acute inflammation
LHF
Libman - Sacks endocarditis
Large vegetations of S aureus

27. How does restrictive cardiomyopathy cause LHF?

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28. Lower extremity cyanosis later in life - holostystolic machine like murmur.
LA dilation
PDA
Plump fibroblasts - collagen - blood vessels
45%

29. What does granulation tissue contain?
Split S2 on auscultation
Plump fibroblasts - collagen - blood vessels
Myocarditis in acute rheumatic heart fever
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

30. What shunt does tetralogy of fallot produce?
Holosystolic machine like murmur
Sterile vegetations on surface and undersurface on mitral valve
Mitral valve prolapse
Right -->left

31. What is the most common congenital heart defect?
IV drug users
Rupture of free wall - IV septum - or papillary muscle
VSD
Right side - serotonin and other secretory products detoxified in the lung

32. What is the tx for VSD?
Split S2 on auscultation
Surgical closure small defects may close spontaneously
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

33. Dilated cardiomyopathy is a late complication of what illness?
ST- segment elevation
Annular - non pruritic rash w/erythematous borders trunks and limbs
Colon cancer
Myocarditis

34. What is the characteristic murmur of aortic stenosis?
Anitschow cell
Systolic ejection click followed by crescendo - decrescendo murmur
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Dark discoloration coagulative necrosis

35. What % stenosis causes stable angina?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
>70%
Large - destructive vegetations
Inability to maintain systemic pressure w/lack of O2 to vital organs

36. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Troponin I
Valve replacement
4-7 days macrophage infiltration

37. Erythematous nontender lesions on palms and soles.
Circumflex
LAD
Mid - systolic click followed by regurgitation murmur
Janeway lesions

38. What is the effect of mitral regurg on the heart?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Left -->right
Volume overload and LHF

39. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Annular - non pruritic rash w/erythematous borders trunks and limbs
S aureus
Pericarditits

40. How do you prevent S viridans endocarditis?
Mitral regurg
Prophylactic abx during dental procedures
Dressler syndrome
Yellow pallor macrophages

41. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Posterior wall of LV - posterior septum - papillary muscles
Anitschow cell
Reperfusion injury

42. What is a water - hammer pulse?
Bounding pulse
Shunt
IV drug users
Loss of fx

43. At what point in development do congenital heart defects arise?
Positive blood cultures anemia of chronic disease
Congested central veins
Nitroglycerin
3-8 wks

44. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Myocarditis
Right to left
Nitroglycerin
Coxsackie A or B

45. What generally causes ischemic heart disease?
VSD
Atherosclerosis of coronary arteries
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Aneurysm - mural thrombus - Dressler syndrome

46. What typically causes hypertrophic cardiomyopathy?
Shunt - PGE to maintain PDA until surgical repair can be performed
AD mutation in sarcomere proteins
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

47. What causes wear and tear aortic stenosis?
Reactive histiocyte with caterpillar nucleus
Large - destructive vegetations
Fibrosis and dystrophic calcification
Minimizes ischemia

48. What is an important complication of ASD?
Tricuspid
Coexisting mitral stenosis and fusion of commisures exist
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Paradoxical emboli

49. Large vegetations on tricuspid valve?
Ostium primum
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Concentric LV hypertophy
S aureus

50. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
4-24 hours
Cardiogenic shock - CHF - arrhythmia
Papillary muscle - free wall - IV septum