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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 type of shunt does ASD cause?
Left -->right
Dark discoloration coagulative necrosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Bicuspid aortic valve

2. What valves are involved in rhuematic endocarditis?
Endocardial fibroelastosis
Mitral mitral+aortic
Preductal - post aortic arch
Loeffler syndrome

3. What are the Jones criteria?
1-3 days
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
Shunt - PGE to maintain PDA until surgical repair can be performed
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

4. With what congenital heart defect is ADULT coarctation of the aorta associated?
Contraction band necrosis
Bicuspid aortic valve
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
45%

5. What is the most common cause of myocarditis?
IV drug users
VSD
Coxsackie A or B
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

6. Which angina is relieved by Ca channel blockers?
Dark discoloration coagulative necrosis
Prophylactic abx during dental procedures
VSD
Prinzmetal

7. When is an MI pt at greatest risk for cardiogenic shock?
>70%
First 4 hours
Systolic dysfx leading to biventricular CHF
Hypercoagulable state or underlying adenocarcinoma

8. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RBC damaged while crossing the calcified valve causing schistocytes
Streptococcus viridans
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

9. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Aneurysm - mural thrombus - Dressler syndrome
NG or Ca channel blocker
Tender lesions on fingers or toes.

10. When do neutrophils infiltrate the myocardium post MI?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
1-3 days
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

11. How do you prevent S viridans endocarditis?
Sterile vegetations on mitral valve along lines of closure
Prophylactic abx during dental procedures
Spontaneous
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

12. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Myocarditis
Turner syndrome
Contraction band necrosis
Fibrinous pericarditis

13. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Contraction band necrosis
ST- segment elevation
Tender lesions on fingers or toes.

14. In what pt population does S aureus commonly cause valvular disease?
Gelatinous - abundant ground substance
Pericarditits
Bacterial endocarditis
IV drug users

15. What is the most common type of endocarditis?
Dressler syndrome
Ostium primum
Infectious
Restrictive cardiomyopathy

16. What is the most common cause of infectious endocarditis?
Boot shaped heart
2-3 weeks
Small - nondestructive vegetations (subacute endocarditis)
Streptococcus viridans

17. What is the most common cause of endocarditis in IV drug users?
Stable and unstable prinzmetal
Within the first day
S aureus
Chest pain <20 min brought on by exertion or emotional stress

18. What are the clinical features of RHF due to?
Systemic venous congestion
Myocardium
Transesophageal echo
Intercostal arteries enlarged due to collateral circulation

19. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Wear and tear
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

20. What is typically the mechanims of sudden cardiac death?
Troponin I
Autoimmune pericarditis 6-8 wks post MI
Aortic regurg
Ventricular arrhythmia

21. What genetic conditions predispose a pt to mitral valve prolapse?
CK- MB
Autoimmune pericarditis 6-8 wks post MI
Ehlers - Danlow and Marfan syndrome
Stable angina

22. What drug relieves stable angina?
Low voltage EKG w/diminished QRS amplitude
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Decrease preload -->lowers myocardial stress
Nitroglycerin

23. What causes the nutmeg color in nutmeg liver?
R-->L
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Congested central veins
Chest pain <20 min brought on by exertion or emotional stress

24. What is a complication of chronic rheumatic heart disease?
Loeffler syndrome
Infectious endocarditis
RCA
Myocarditis in acute rheumatic heart fever

25. What is endocardial fibroelastosis? In what population is it found?
Months out fibrosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Dense layer of elastic and fibrotic tissue in the endocardium - children
ST- segment depression

26. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
Pancarditis
Valve replacement
Months out fibrosis

27. Which congenital heart defect is associated with congenital rubella?
PDA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Low voltage EKG w/diminished QRS amplitude

28. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Coexisting mitral stenosis and fusion of commisures exist
VSD
Surgical closure small defects may close spontaneously
Sudden cardiac death

29. What type of ASD is associated w/Down syndrome?
Increased hydrostatic pressure
Large - destructive vegetations
2-3 weeks
Ostium primum

30. What type of vegetations does Strep viridans cause?
Anitschow cell
Limits thrombosis
Myocarditis
Small - nondestructive vegetations (subacute endocarditis)

31. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Low voltage EKG w/diminished QRS amplitude
Streptococcus bovis/
LHF
Coronary artery vasospasm

32. What is the characteristic finding on CXR in tetralogy of fallot?
AD mutation in sarcomere proteins
IV drug users
Hypertophy of RV atrophy of LV
Boot shaped heart

33. What gross and microscopic changes occur 1-3 days after an MI?
Restrictive cardiomyopathy
Yellow pallor neutrophils
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
Indomethacin - decreases PGE

34. With what disease is Libman - Sacks endocarditis associated?
SLE
1%
Atria and RV
Autoimmune pericarditis 6-8 wks post MI

35. What is the rate of congenital heart defects?
1%
Heart transplant
Systolic ejection click followed by crescendo - decrescendo murmur
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

36. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
4-24 hours
Heart transplant

37. How does asprin/heparin tx MI?
Limits thrombosis
Circumflex
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mid - systolic click followed by regurgitation murmur

38. How does ischemia cause LHF?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Valve scarring that arises as a consequence of rheumatic fever
Loss of LV fx
Loss of fx

39. With what virus is PDA associated?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Congenital rubella
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
LAD

40. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Type I
Reperfusion injury
>60 years - bicuspid aortic valve

41. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Rhadbomyoma - benign
Colon cancer
Ischemic heart disease

42. What are heart failure cells?
Bounding pulse
Hemosiderin laden macrophages
First 4 hours
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

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

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44. How does aortic regurg affect the heart chambers?
Minimizes ischemia
Endocardial fibroelastosis
Bicuspid aortic valve
LV dilation and eccentric hypertrophy

45. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Mitral regurgitation due to vegetations
Tuberous sclerosis
Turner syndrome
20 min

46. What is the murmur of mitral regurg?
Day 1-7
Holosystolic blowing murmur
Inability to maintain systemic pressure w/lack of O2 to vital organs
Pedunculated mass in the LA that causes syncope due to obstruction of MV

47. What are the clinical features of RHF?
Months out fibrosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Chronic rheumatic heart disease
Metastasis

48. What is the most common tumor of the heart?
Troponin I
PDA
Mitral mitral+aortic
Metastasis

49. What is the gross and microscopic appearance of cardiac myxomas?
Prinzmetal angina - cocaine
Gelatinous - abundant ground substance
Mitral stenosis
Chronic ischemic heart disease

50. How do nitrates tx MI?
Reperfusion injury
Decrease preload -->lowers myocardial stress
Increased hydrostatic pressure
PDA

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