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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 gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Streptococcus viridans
Streptococcus bovis/

2. What is the most common cause of myocarditis?
2-3 weeks
Holosystolic blowing murmur
Minimizes ischemia
Coxsackie A or B

3. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Type I
Left -->right

4. What drug relieves stable angina?
Type I
Coronary artery vasospasm - emboli - vasculitis
Nitroglycerin
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

5. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Opening snap followed by diastolic rumble
Infantile coarctation of the aorta PDA
Ehlers - Danlow and Marfan syndrome

6. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Low voltage EKG w/diminished QRS amplitude
Pump failure
Anitschow cell

7. What makes the MV prolapse murmur louder? Why?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Membrane damage
Adult coarctation of the aorta
Squatting - increased systemic resistence decreases LV emptying

8. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Mitral and tricuspid regurg - arrhythmia
Wear and tear
Squatting - expiration
Myxoma - benign

9. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Plump fibroblasts - collagen - blood vessels
Tuberous sclerosis
Troponin I
Nonbacterial thrombotic endocarditis (marantic endocarditis)

10. What type of shunt does ASD cause?
Restrictive cardiomyopathy
Left -->right
Thickening of chrodae tendinae and cusps - mitral stenosis
1-3 days

11. What are the causes of restrictive cardiomyopathy in adults?
Myocardium
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
ST- segment depression
S viridans

12. Turner syndrome is associated with which congenital heart defect?
Janeway lesions
Infantile coarctation of the aorta
Group A beta - hemolytic streptococci
Cardiogenic shock - CHF - arrhythmia

13. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Libman - Sacks endocarditis
Opening snap followed by diastolic rumble
Erythematous nontender lesions on palms and soles.

14. How does subendocardial MI/ischemia present on EKG?
S viridans
ST- segment depression
Cardiac tamponade
Months out fibrosis

15. When is an MI pt at greatest risk for cardiogenic shock?
Annular - non pruritic rash w/erythematous borders trunks and limbs
First 4 hours
MI
Bicuspid aortic valve

16. What are the sx of right - to - left shunt?
Harmartoma
Systemic venous congestion
Cyanosis - RV hypertrophy - polycythemia - clubbing
Coexisting mitral stenosis and fusion of commisures exist

17. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Aneurysm - mural thrombus - Dressler syndrome
Annular - non pruritic rash w/erythematous borders trunks and limbs

18. How does O2 tx MI?
Anitschow cell
Ehlers - Danlow and Marfan syndrome
Minimizes ischemia
Aschoff bodies

19. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
Inability to fill ventricles
Hypertrophic cardiomyopathy
Nonbacterial thrombotic endocarditis (marantic endocarditis)

20. What increases the risk for chronic rheumatic heart disease?
LA
Open blocked vessels
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
LHF

21. What is the most common congenital heart defect?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
VSD
Valve replacement once LV dysfx develops
Pulsating nail bed

22. In which chamber of the heart are rhabdomyomas found?
Ventricle
Systolic dysfx leading to biventricular CHF
Prophylactic abx during dental procedures
Kawasaki disease

23. When is an MI patent at highest risk for fibrionous pericarditis?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
1-3 days out
Open blocked vessels
PDA

24. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Opening snap followed by diastolic rumble
Gelatinous - abundant ground substance
Wear and tear

25. Systolic ejection click followed by crescendo - decrescendo murmur.
Right -->left
4-6 hours - 24 hours - 72 hours
Aortic stenosis
Inability to maintain systemic pressure w/lack of O2 to vital organs

26. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Hypertrophic cardiomyopathy
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
>70%

27. What does nonbacterial thrombotic endocarditis cause?
Atria and RV
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Mitral regurg
Pericarditits

28. When does the heart have a yellow pallor post MI?
Day 1-7
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Left -->right
S epidermidis

29. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Annular - non pruritic rash w/erythematous borders trunks and limbs
Months out fibrosis
Pump failure

30. What is a Quincke pulse?
Libman - Sacks endocarditis
Membrane damage
Pulsating nail bed
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

31. What always follows necrosis?
S aureus
Right -->left
Cardiogenic shock - CHF - arrhythmia
Acute inflammation

32. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Dilated
Migratory polyarthritis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Mitral mitral+aortic

33. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Mitral valve prolapse
Pancarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

34. What is systolic dysfx?
Kawasaki disease
Ventricles cannot pump
Pump failure
Louder - increased systemic resistence decreases LV emptying

35. What is migratory polyarthritis?
When a bacterial protein resembles a protein in human tissue
Coexisting mitral stenosis and fusion of commisures exist
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
CK- MB

36. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Heart can't fill
Stretched muscle loses contractility
Preductal - post aortic arch

37. What are the minor critera of the Jones criteria?
Ventricles cannot pump
Myocardium
Mid - systolic click followed by regurgitation murmur
Nonspecific - eg fever and elevated ESR

38. What is the characteristic murmurr of mitral stenosis?
Mitral insufficiency
Holosystolic machine like murmur
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Opening snap followed by diastolic rumble

39. When does the heart have dark discoloration post MI?
Group A beta - hemolytic streptococci
Valve replacement once LV dysfx develops
4-24 hours
Atria and RV

40. Opening snap followed by diastolic rumble.
NG or Ca channel blocker
Mitral regurg
Mitral stenosis
S viridans

41. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Congenital rubella
Concentric LV hypertophy
Troponin I

42. Tender lesions on fingers or toes.
Mitral insufficiency
Limits thrombosis
Osler nodes (ouch - ouch Osler)
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

43. 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
Limits thrombosis
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Trisomy 21

44. With what congenital heart defect is ADULT coarctation of the aorta associated?
1%
Restrictive cardiomyopathy
Holosystolic machine like murmur
Bicuspid aortic valve

45. What does Libman - Sacks endocarditis cause?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Pump failure
Mitral regurg

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

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47. What type of shunt does transposition of the great vessels cause?
Plump fibroblasts - collagen - blood vessels
Dark discoloration coagulative necrosis
R-->L
Myocarditis

48. What are the major criteria of the Jones criteria?
Transesophageal echo
Myocarditis
Endocardial fibroelastosis (rare)
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

49. What % stenosis causes stable angina?
Squat in response to cyanotic spell
Rupture of free wall - IV septum - or papillary muscle
Hypercoagulable state or underlying adenocarcinoma
>70%

50. How does asprin/heparin tx MI?
Mitral mitral+aortic
Mitral regurg
Limits thrombosis
ST- segment depression