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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 does chronic ischemic heart disease progress to?
Acute inflammation
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
CHF
Decrease preload -->lowers myocardial stress

2. When does the heart have a yellow pallor post MI?
Yellow pallor macrophages
Coronary artery vasospasm - emboli - vasculitis
Day 1-7
Bicuspid aortic valve

3. What is molecular mimicry?
When a bacterial protein resembles a protein in human tissue
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
S epidermidis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

4. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
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
Small vegetations along the line of closure
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Anitschow cell

5. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
4-6 hours - 24 hours - 72 hours
Asymptomatic
>70%

6. What are the forward and backward sx of LHF?
Holosystolic machine like murmur
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
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
Congenital rubella

7. What are the causes of restrictive cardiomyopathy in adults?
Prinzmetal angina - cocaine
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Bacterial endocarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

8. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Anitschow cell
2-3 weeks

9. What congenital heart defect is associated with fetal alcohol syndrome?
Infantile coarctation of the aorta PDA
Sudden cardiac death
Metastasis
VSD

10. What are the sx of right - to - left shunt?
Coronary artery vasospasm
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Cyanosis - RV hypertrophy - polycythemia - clubbing
Fetal alcohol syndrome

11. What are the sx of pericardiits?
Friction rub and chest pain
Transposition of the great vessels
Ostium secundum (90%)
Squatting - expiration

12. What gross and microscopic changes occur 1-3 days after an MI?
Paradoxical emboli
Yellow pallor neutrophils
Pericarditits
Erythematous nontender lesions on palms and soles.

13. What does rupture of the IV septum cause?
Holosystolic machine like murmur
Endocardial fibroelastosis (rare)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Shunt

14. How does restrictive cardiomyopathy cause LHF?

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15. What is the 1day-1wk -1mo mneumonic for MI?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
3-8 wks
Ischemic heart disease

16. Opening snap followed by diastolic rumble.
Dilated
Aortic regurg
Mitral stenosis
Elevated ASO anti - DNase B titers

17. What cardiac enzyme is useful for detecting reinfarction?
Mitral insufficiency
CK- MB
Group A beta - hemolytic streptococci
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

18. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Ehlers - Danlow and Marfan syndrome
4-24 hours
Myofiber hypertrophy with disarray

19. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Congestive heart failure
Sudden cardiac death
Breast and lung carcinoma - melanoma - lymphoma
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

20. What is the tx for dilated cardiomyopathy?
R-->L
Heart transplant
Fibrinous pericarditis
Sterile vegetations on surface and undersurface on mitral valve

21. What makes the MV prolapse murmur louder? Why?
Posterior wall of LV - posterior septum - papillary muscles
4-7 days
Rhadbomyoma - benign
Squatting - increased systemic resistence decreases LV emptying

22. How do ACE inhibitors tx MI?
Ischemic heart disease
LA dilation
Infantile coarctation of the aorta PDA
Decreases LV dilation by decreasing volume

23. What effect does mitral stenosis have on the heart chambers?
Yellow pallor macrophages
LV dilation and eccentric hypertrophy
Aortic stenosis
LA dilation

24. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Degree of pulmonary artery stenosis
Louder - increased systemic resistence decreases LV emptying
CHF
Endocardial fibroelastosis

25. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Mitral regurg
2-4 hours - 24 hours - 7-10 days
Inability to fill ventricles

26. What are the tx for MI?
Large vegetations of S aureus
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Endocardial fibroelastosis

27. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Turner syndrome
Yellow pallor macrophages

28. How does asprin/heparin tx MI?
Decrease in blood flow to an organ
Limits thrombosis
Left -->right
1-3 days

29. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Shunt
Degree of pulmonary artery stenosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Fibrosis and dystrophic calcification

30. What disesase has Aschoff bodies?
Endocardial fibroelastosis (rare)
Pts w/previously damaged valves
Gelatinous - abundant ground substance
Myocarditis in acute rheumatic heart fever

31. What is the most common type of endocarditis?
Hemosiderin laden macrophages
Valve scarring that arises as a consequence of rheumatic fever
Infectious
Ostium secundum (90%)

32. Poor myocardial fx due to chronic ischemic damage?
Thickening of chrodae tendinae and cusps - mitral stenosis
Chronic ischemic heart disease
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
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

33. Systolic ejection click followed by crescendo - decrescendo murmur.
Left -->right
Atherosclerosis of coronary arteries
Aortic stenosis
Valve replacement once LV dysfx develops

34. How does squating decrease hypoxemia in tetralogy of fallot?
Hemosiderin laden macrophages
RCA
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

35. Is injury due angina reversible or irreversible?
ST- segment depression
Fetal alcohol syndrome
Dense layer of elastic and fibrotic tissue in the endocardium - children
Reversible

36. What coronary arterysupplies the lateral wall of the LV?
Squatting - increased systemic resistence decreases LV emptying
Prinzmetal
Circumflex
Autoimmune pericarditis 6-8 wks post MI

37. What are the sx/complications of myocarditis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S aureus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
RCA

38. What is the cause of the red border around granulation tissue?
Prinzmetal angina
LHF
Blood vessels coming in from normal tissue
Mitral valve prolapse

39. What are Janeway lesions?
RHF
Erythematous nontender lesions on palms and soles.
PGE
Group A beta - hemolytic streptococci

40. Dense layer of elastic and fibrotic tissue in the endocardium.
Intercostal arteries enlarged due to collateral circulation
Loss of LV fx
Mitral valve prolapse
Endocardial fibroelastosis

41. What congenital heart defect does indomethacin tx?
Dense layer of elastic and fibrotic tissue in the endocardium - children
PDA
Loss of fx
LAD

42. At what point in development do congenital heart defects arise?
3-8 wks
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Left -->right
Prinzmetal angina

43. What is the most common cause of myocarditis?
Anitschow cell
Hypertophy of RV atrophy of LV
Subendocardial
Coxsackie A or B

44. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Infantile coarctation of the aorta
Myxoid degeneration

45. What is typically the mechanims of sudden cardiac death?
Limits thrombosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Ventricular arrhythmia
Louder - increased systemic resistence decreases LV emptying

46. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Chronic rheumatic heart disease
R-->L
Acute inflammation

47. Which congenital heart defect is associated with maternal diabetes?
Breast and lung carcinoma - melanoma - lymphoma
LA dilation
Transposition of the great vessels
Fetal alcohol syndrome

48. What type of shunt does ASD cause?
45%
Left -->right
Holosystolic machine like murmur
Mitral stenosis

49. What type of ASD is associated w/Down syndrome?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Valve replacement once LV dysfx develops
Systemic venous congestion
Ostium primum

50. How does Eisenmeger syndrome occur?
Valve scarring that arises as a consequence of rheumatic fever
PGE
Plump fibroblasts - collagen - blood vessels
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