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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 aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
2-3 weeks
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

2. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Sudden cardiac death
Boot shaped heart
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

3. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Transposition of the great vessels
Metastasis
ST- segment elevation

4. What is the most common type of ASD? What %?
Red border granulation tissue
Chest pain <20 min brought on by exertion or emotional stress
Small vegetations along the line of closure
Ostium secundum (90%)

5. Is injury due angina reversible or irreversible?
Reversible
Trisomy 21
Anterior wall of LV and anterior septum
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

6. 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
S epidermidis
Tricuspid
When a bacterial protein resembles a protein in human tissue

7. What type of ischemia does stable angina cause?
Open blocked vessels
Annular - non pruritic rash w/erythematous borders trunks and limbs
Subendocardial
ST- segment depression

8. When does the heart have dark discoloration post MI?
Transesophageal echo
4-24 hours
Prinzmetal angina - cocaine
Reactive histiocyte with caterpillar nucleus

9. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Decrease preload -->lowers myocardial stress
Myocarditis
Paradoxical emboli

10. What maintains patency of the PDA?
Months out fibrosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
PGE
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

11. Lower extremity cyanosis in infants? In adults?
4-6 hours - 24 hours - 72 hours
Adult coarctation of the aorta
1-3 days out
Infantile coarctation of the aorta PDA

12. Which coronary artery supplies the anterior wall and anterior septum?
Within the first day
Coxsackie A or B
LAD
Loss of fx

13. With what disease is transposition of the great vessels associated?
Autoimmune pericarditis 6-8 wks post MI
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Maternal diabetes
MI

14. At what point in development do congenital heart defects arise?
Myocarditis
Rhabdomyoma
Small vegetations along the line of closure
3-8 wks

15. What areas of the heart does the LAD supply?
Libman - Sacks endocarditis
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Anterior wall of LV and anterior septum
Restrictive cardiomyopathy

16. What endocarditis is commonly found in patients with colon cancer?
Small vegetations along the line of closure
AD mutation in sarcomere proteins
Streptococcus bovis/
Fetal alcohol syndrome

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

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18. What is a complication of chronic rheumatic heart disease?
Months out fibrosis
Infectious endocarditis
45%
Heart transplant

19. What increases the volume of mitral regurg murmur?
Erythematous nontender lesions on palms and soles.
Squatting - expiration
Small - nondestructive vegetations (subacute endocarditis)
Hypercoagulable state or underlying adenocarcinoma

20. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Hypertophy of RV atrophy of LV

21. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
2-3%
LHF
Fibrosis and dystrophic calcification
Right side - serotonin and other secretory products detoxified in the lung

22. Which chambers of the heart are generally spared in an MI?
Atria and RV
Membrane damage
ASD - R-->L
Coronary artery vasospasm

23. Large vegetations on tricuspid valve?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Split S2 on auscultation
S aureus
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

24. What generally causes ischemic heart disease?
Dressler syndrome
Coronary artery vasospasm - emboli - vasculitis
Atherosclerosis of coronary arteries
Infectious endocarditis - arrythmias - severe mitral regurg no

25. What gross and microscopic changes occur 4-7 days after an MI?
RCA
Yellow pallor macrophages
1%
Pulsating nail bed

26. How does Eisenmeger syndrome occur?
Valve replacement once LV dysfx develops
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
Concentric LV hypertophy
Nonspecific - eg fever and elevated ESR

27. What effect does dilated cardiomyopathy have on the heart?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Holosystolic blowing murmur
Systolic dysfx leading to biventricular CHF
Regurg vs stenosis

28. What is the most common cause of dilated cardiomyopathy? What are other causes?
Volume overload and LHF
Prinzmetal
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
LA dilation

29. What are the tx for MI?
Endocarditis of prosthetic valves
Tuberous sclerosis
L->R
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

30. Which congenital heart defect is associated with congenital rubella?
PDA
Congestive heart failure
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
L->R

31. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Within the first day
Months out fibrosis

32. When would arrhythmia occur after MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Cardiac tamponade
Aortic stenosis
Within the first day

33. What are the clinical features of RHF due to?
Squat in response to cyanotic spell
Systemic venous congestion
Tricuspid
Myocardium

34. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Prinzmetal angina - cocaine
Anitschow cell
White scar fibrosis
Hypercoagulable state or underlying adenocarcinoma

35. What cardiac disease is associated with tuberous sclerosis?
Decreases LV dilation by decreasing volume
45%
Dilated
Rhabdomyoma

36. Are most congenital heart defects spontaneous or inherited?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Holosystolic machine like murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Spontaneous

37. How does aortic regurg affect the heart chambers?
Myxoid degeneration
Hemosiderin laden macrophages
Atria and RV
LV dilation and eccentric hypertrophy

38. What is an important complication of ASD?
Limits thrombosis
S epidermidis
Paradoxical emboli
Hypercoagulable state or underlying adenocarcinoma

39. Dense layer of elastic and fibrotic tissue in the endocardium.
Myocardium
Bicuspid aortic valve
Endocardial fibroelastosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

40. What heart sound manifest with an ASD?
Aortic regurg
Split S2 on auscultation
Slow HR - decreasing O2 demand and risk for arrhythmia
Spontaneous

41. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Loss of LV fx
Prinzmetal angina
Aneurysm - mural thrombus - Dressler syndrome

42. In which chamber of the heart are cardiac myxomas found?
Prinzmetal angina - cocaine
Inability to maintain systemic pressure w/lack of O2 to vital organs
LA
Turner syndrome

43. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
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
RHF
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Coexisting mitral stenosis and fusion of commisures exist

44. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Pump failure
Transesophageal echo

45. What type of shunt does truncus arteriosus cause?
MI
R-->L
Valve replacement once LV dysfx develops
Myxoid degeneration

46. What is the tx for LHF?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hypertophy of RV atrophy of LV
Small vegetations along the line of closure
ACE inhibitor

47. Which vasculitis can cause MI?
Kawasaki disease
Asymptomatic
Sterile vegetations on mitral valve along lines of closure
Thickening of chrodae tendinae and cusps - mitral stenosis

48. What bug causes acute rheumatic fever?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Mitral regurg
Group A beta - hemolytic streptococci
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

49. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Valve replacement
Metastasis

50. Ostium primum ASD is associated with what congenital disorder?
RBC damaged while crossing the calcified valve causing schistocytes
Trisomy 21
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pump failure