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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 is the most common type of ASD? What %?
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
Aortic regurg
2-3 weeks
Ostium secundum (90%)

2. What are the clinical features of RHF?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Autoimmune pericarditis 6-8 wks post MI
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Coxsackie A or B

3. When is an MI patent at highest risk for fibrionous pericarditis?
Myxoid degeneration
Valve replacement AFTER the onset of complications
ACE inhibitor
1-3 days out

4. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Systemic venous congestion
20 min
Pericardial effusion due to pericardial involvement
VSD

5. What is the most common cause of mitral stenosis?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
3-8 wks
Kawasaki disease
Chronic rheumatic heart disease

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

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7. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Sterile vegetations on mitral valve along lines of closure
Aortic regurg
Prinzmetal angina - cocaine
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

8. What valves are involved in rhuematic endocarditis?
Large vegetations of S aureus
Myocarditis
Mitral mitral+aortic
Pts w/previously damaged valves

9. What is the tx for aortic stenosis?
2-4 hours - 24 hours - 7-10 days
Prinzmetal
Ostium secundum (90%)
Valve replacement AFTER the onset of complications

10. What are the sx of PDA at birth?
Sudden cardiac death
Asymptomatic
Left -->right
Cardiogenic shock - CHF - arrhythmia

11. How does aortic regurg affect the heart chambers?
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
Myocarditis
LV dilation and eccentric hypertrophy
ST- segment elevation

12. What type of tumor is a rhabdomyoma?
Harmartoma
Mitral regurg
Chest pain <20 min brought on by exertion or emotional stress
Mitral mitral+aortic

13. How does fibrinolysis/angioplasty tx MI?
Circumflex
Ventricle
Infectious endocarditis
Open blocked vessels

14. Sudden death in a young athlete.
Holosystolic blowing murmur
Decreases LV dilation by decreasing volume
Holosystolic machine like murmur
Hypertrophic cardiomyopathy

15. What are the complications of aortic stenosis?
Sterile vegetations on mitral valve along lines of closure
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Heart can't fill
Pericarditits

16. With what virus is PDA associated?
Shunt - PGE to maintain PDA until surgical repair can be performed
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Mitral and tricuspid regurg - arrhythmia
Congenital rubella

17. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
2-4 hours - 24 hours - 7-10 days
Aschoff bodies
Ehlers - Danlow and Marfan syndrome
Chest pain <20 min brought on by exertion or emotional stress

18. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Mitral regurg
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Plump fibroblasts - collagen - blood vessels

19. Which congenital heart defect is associated with maternal diabetes?
Colon cancer
Wear and tear
Subendocardial
Transposition of the great vessels

20. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Stable and unstable prinzmetal
Breast and lung carcinoma - melanoma - lymphoma
RHF

21. Infects predamaged valves after transient bacteremia?
S viridans
Split S2 on auscultation
4-6 hours - 24 hours - 72 hours
Dilation of all four chambers of the heart

22. How does reperfusion injury occur?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Contraction band necrosis - reperfusion injury
LAD
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

23. L- to - R shunt switching to R- to - L shunt.
Eisenmenger syndrome
Right -->left
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Decrease preload -->lowers myocardial stress

24. What increases the volume of mitral regurg murmur?
Ischemic heart disease
Squatting - expiration
S aureus
Ventricular arrhythmia

25. What type of ASD is associated w/Down syndrome?
Ostium primum
Heart transplant
Hypertrophic cardiomyopathy
PGE

26. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
ST- segment depression
Nitroglycerin
Months out fibrosis

27. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Infectious endocarditis - arrythmias - severe mitral regurg no
NG or Ca channel blocker
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

28. What are the causes of LHF?
Hypertophy of RV atrophy of LV
Dressler syndrome
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

29. What are the laboratory findings of bacterial endocarditis?
Infantile coarctation of the aorta
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Positive blood cultures anemia of chronic disease
Day 1-7

30. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Fibrosis and dystrophic calcification
Elevated ASO anti - DNase B titers
Myofiber hypertrophy with disarray

31. What % stenosis causes stable angina?
Prinzmetal angina
Mitral regurgitation due to vegetations
Mitral mitral+aortic
>70%

32. What are the HACEK organisms? With what condition are they associated?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral insufficiency
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Cyanosis - RV hypertrophy - polycythemia - clubbing

33. What effect does dilated cardiomyopathy have on the heart?
Streptococcus bovis/
Congenital rubella
Systolic dysfx leading to biventricular CHF
Squat in response to cyanotic spell

34. What shunt does tetralogy of fallot produce?
3-8 wks
Aortic stenosis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Right -->left

35. What are the forward and backward sx of LHF?
Rhabdomyoma
LA
Ventricular arrhythmia
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

36. What are the sx of hypertrophic cardiomyopathy?
Mitral insufficiency
Endocarditis of prosthetic valves
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Reactive histiocyte with caterpillar nucleus

37. In which chamber of the heart are rhabdomyomas found?
Increased blood in right heart delays closure of P valve
Aneurysm - mural thrombus - Dressler syndrome
Ehlers - Danlow and Marfan syndrome
Ventricle

38. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Fibrosis and dystrophic calcification
CK- MB

39. What are the major criteria of the Jones criteria?
Reperfusion injury
Cardiac tamponade
MI
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

40. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Decreases LV dilation by decreasing volume
SLE
Subendocardial

41. What effect does aortic regurg have on the pulse pressure? Why?
PDA
SLE
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Large vegetations of S aureus

42. What are heart failure cells?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
First 4 hours
Pulsating nail bed
Hemosiderin laden macrophages

43. What iis the tx for aortic regurg?
ST- segment depression
Valve replacement once LV dysfx develops
Asymptomatic
S viridans

44. What are the complications of mitral stenosis?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Osler nodes (ouch - ouch Osler)
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Backward LHF pulm htn and RHF - afib and associated mural thombis

45. What is diastolic dysfx?
Decrease preload -->lowers myocardial stress
Inability to fill ventricles
Infantile coarctation of the aorta PDA
Stable angina

46. What causes angina and syncope in aortic stenosis?

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47. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Bicuspid aortic valve
Metastasis
Breast and lung carcinoma - melanoma - lymphoma

48. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Breast and lung carcinoma - melanoma - lymphoma
Decreased forward perfusion pulmonary congestion
CK- MB

49. At what point in development do congenital heart defects arise?
3-8 wks
Coexisting mitral stenosis and fusion of commisures exist
Eisenmenger syndrome
Granulation tissue

50. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Loss of LV fx
Trisomy 21
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Bacterial endocarditis