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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 diastolic dysfx?
Libman - Sacks endocarditis
Mitral mitral+aortic
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Inability to fill ventricles

2. What is a Quincke pulse?
White scar fibrosis
Dressler syndrome
Pulsating nail bed
Pedunculated mass in the LA that causes syncope due to obstruction of MV

3. What is an Anitschow cell?
Mitral stenosis
Anitschow cell
Reactive histiocyte with caterpillar nucleus
RCA

4. What effect does chronic rheumatic heart disease have the mitral valve?
4-24 hours
Thickening of chrodae tendinae and cusps - mitral stenosis
Asymptomatic
Aortic regurg

5. What is the main cause of MV regurg? What are other causes?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Trisomy 21
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Cyanosis - RV hypertrophy - polycythemia - clubbing

6. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Mitral valve prolapse
Stable angina
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Congenital rubella

7. Which chambers of the heart are generally spared in an MI?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Ehlers - Danlow and Marfan syndrome
Atria and RV
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

8. What cardiac enzyme is useful for detecting reinfarction?
Janeway lesions
CK- MB
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Mitral regurgitation due to vegetations

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

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10. What effect does aortic regurg have on the pulse pressure? Why?
Nonspecific - eg fever and elevated ESR
Annular - non pruritic rash w/erythematous borders trunks and limbs
Holosystolic blowing murmur
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

11. What is the most common valve infected by S aureus?
Systolic ejection click followed by crescendo - decrescendo murmur
Anterior wall of LV and anterior septum
Harmartoma
Tricuspid

12. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Mitral regurg
Mitral stenosis
Regurg vs stenosis

13. How does fibrinolysis/angioplasty tx MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Open blocked vessels
Endocardial fibroelastosis
VSD

14. What does nonbacterial thrombotic endocarditis cause?
Congestive heart failure
Atherosclerosis of coronary arteries
Mitral regurg
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

15. What is an important complication of ASD?
CHF
Restrictive cardiomyopathy
Paradoxical emboli
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

16. What are the HACEK organisms? With what condition are they associated?
Anitschow cell
Mitral regurg
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Coronary artery vasospasm

17. In which chamber of the heart are rhabdomyomas found?
Ventricle
Stable and unstable prinzmetal
Decrease in blood flow to an organ
Small - nondestructive vegetations (subacute endocarditis)

18. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Aneurysm - mural thrombus - Dressler syndrome
Rupture of free wall - IV septum - or papillary muscle
Tuberous sclerosis

19. What type of tumor is a rhabdomyoma?
Pulsating nail bed
L->R
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Harmartoma

20. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Posterior wall of LV - posterior septum - papillary muscles
Tender lesions on fingers or toes.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

21. What is the most common cause of endocarditis in IV drug users?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Wear and tear
S aureus
Slow HR - decreasing O2 demand and risk for arrhythmia

22. Systolic ejection click followed by crescendo - decrescendo murmur.
Troponin I
Aortic stenosis
Transesophageal echo
4-6 hours - 24 hours - 72 hours

23. What is the 1day-1wk -1mo mneumonic for MI?
1-3 days
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
ASD - R-->L
Pancarditis

24. Which coronary artery supplies the posterior wall of the LV and posterior septum?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Louder - increased systemic resistence decreases LV emptying
CHF
RCA

25. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Bicuspid aortic valve
Low voltage EKG w/diminished QRS amplitude
PDA

26. What are the complications of aortic stenosis?
Months out fibrosis
Hemosiderin laden macrophages
Opening snap followed by diastolic rumble
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

27. What effect does aortic stenosis have on the chambers of the heart?
RCA
Concentric LV hypertophy
Minimizes ischemia
Troponin I

28. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Prophylactic abx during dental procedures
RCA

29. What is the murmur of mitral regurg?
Eisenmenger syndrome
Holosystolic blowing murmur
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
ST- segment depression

30. What is eythema marginatum? What parts of the body does it commonly involve?
Cardiac tamponade
Heart can't fill
Annular - non pruritic rash w/erythematous borders trunks and limbs
Opening snap followed by diastolic rumble

31. What disesase has Aschoff bodies?
Mitral mitral+aortic
LV dilation and eccentric hypertrophy
Myocarditis in acute rheumatic heart fever
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

32. What is the tx for LHF?
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
Infantile coarctation of the aorta PDA
Mitral regurg
ACE inhibitor

33. What are the complications that occur months after an MI?
Tricuspid
Prinzmetal stable and unstable
Mitral valve prolapse
Aneurysm - mural thrombus - Dressler syndrome

34. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
4-7 days macrophage infiltration
Mitral regurg
Blood vessels coming in from normal tissue

35. Why are cardiac enzymes elevated after an MI?
2-4 hours - 24 hours - 7-10 days
Coronary artery vasospasm
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Membrane damage

36. What is the etiology of S viridans endocarditis?
Myocardium
Infectious endocarditis
Loeffler syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

37. What % stenosis causes stable angina?
>70%
Aneurysm - mural thrombus - Dressler syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Chest pain <20 min brought on by exertion or emotional stress

38. What is a common complication of cardiac metastasis?
Hypertrophic cardiomyopathy
Infectious endocarditis - arrythmias - severe mitral regurg no
Pericardial effusion due to pericardial involvement
Reactive histiocyte with caterpillar nucleus

39. When would arrhythmia occur after MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Congestive heart failure
Within the first day
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

40. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Tetralogy of fallot
Sterile vegetations on mitral valve along lines of closure
1%

41. What is the characteristic finding on CXR in tetralogy of fallot?
Prinzmetal angina
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
Boot shaped heart
Mitral regurg

42. Are most congenital heart defects spontaneous or inherited?
Systolic dysfx leading to biventricular CHF
NG or Ca channel blocker
Spontaneous
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

43. What valves are most commonly involved in chronic rheumatic heart disease?
LAD
Loss of LV fx
Red border granulation tissue
Mitral mitral+aortic

44. Vegetations on surface and undersurface of mitral valve.
Trisomy 21
Regurg vs stenosis
Libman - Sacks endocarditis
3-8 wks

45. What complications occur 4-7 days post MI?
Aortic stenosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Months out fibrosis
Rupture of free wall - IV septum - or papillary muscle

46. What is Dressler syndrome? When does it occur?
1%
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Autoimmune pericarditis 6-8 wks post MI
Increased blood in right heart delays closure of P valve

47. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Myocardium
Reactive histiocyte with caterpillar nucleus
Split S2 on auscultation

48. When does the heart have a yellow pallor post MI?
Myocarditis
Day 1-7
Bicuspid aortic valve
PDA

49. What bug causes acute rheumatic fever?
Valve replacement AFTER the onset of complications
ASD - R-->L
Fibrinous pericarditis
Group A beta - hemolytic streptococci

50. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
PDA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Autoimmune pericarditis 6-8 wks post MI

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