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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. Dilated cardiomyopathy is a late complication of what illness?
Hypertophy of RV atrophy of LV
3-8 wks
Myocarditis
Chronic ischemic heart disease

2. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Erythematous nontender lesions on palms and soles.
Aortic regurg
ASD - R-->L
Left -->right

3. What two things happen when a blocked vessel is opened after an MI?
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
Contraction band necrosis - reperfusion injury
NG or Ca channel blocker
Prophylactic abx during dental procedures

4. What type of shunt does transposition of the great vessels cause?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Adult coarctation of the aorta
Mitral regurg
R-->L

5. What is the most common valve infected by S aureus?
Prinzmetal angina
Myocarditis
Months out fibrosis
Tricuspid

6. What is the tx for LHF?
LHF
Bacterial endocarditis
Minimizes ischemia
ACE inhibitor

7. How do you tx prinzmetal angina?
Elevated ASO anti - DNase B titers
Systolic dysfx leading to biventricular CHF
LA
NG or Ca channel blocker

8. Opening snap followed by diastolic rumble.
Mitral stenosis
>70%
Increased hydrostatic pressure
Mitral regurgitation due to vegetations

9. How does aortic regurg affect the heart chambers?
Squatting - increased systemic resistence decreases LV emptying
LV dilation and eccentric hypertrophy
Squat in response to cyanotic spell
Endocardial fibroelastosis

10. Tender lesions on fingers or toes.
Decrease preload -->lowers myocardial stress
Osler nodes (ouch - ouch Osler)
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Restrictive cardiomyopathy

11. Which angina is relieved by Ca channel blockers?
Bicuspid aortic valve
R-->L
Prinzmetal
Stretched muscle loses contractility

12. What is the foundation of a scar?
Granulation tissue
Infantile coarctation of the aorta
Valve replacement AFTER the onset of complications
Prinzmetal

13. What coronary arterysupplies the lateral wall of the LV?
3-8 wks
Pancarditis
Circumflex
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

14. What does a biopsy of hypertrophic cardiomyopathy look like?
Shunt
Myofiber hypertrophy with disarray
R-->L
Hypertrophic cardiomyopathy

15. What is the most common congenital heart defect?
VSD
>60 years - bicuspid aortic valve
Friction rub and chest pain
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

16. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Intercostal arteries enlarged due to collateral circulation
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Tetralogy of fallot

17. What maintains patency of the PDA?
PGE
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Congenital rubella
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

18. Lower extremity cyanosis in infants? In adults?
Small vegetations along the line of closure
RBC damaged while crossing the calcified valve causing schistocytes
Systolic ejection click followed by crescendo - decrescendo murmur
Infantile coarctation of the aorta PDA

19. What are the minor critera of the Jones criteria?
Libman - Sacks endocarditis
Nonspecific - eg fever and elevated ESR
Regurg vs stenosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

20. What are the sx of hypertrophic cardiomyopathy?
Myocarditis
Tender lesions on fingers or toes.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Type I

21. What is Loeffler syndrome?
Myxoid degeneration
Plump fibroblasts - collagen - blood vessels
Shunt
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

22. What is endocardial fibroelastosis? In what population is it found?
Inability to fill ventricles
Stable and unstable prinzmetal
20 min
Dense layer of elastic and fibrotic tissue in the endocardium - children

23. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Dressler syndrome
Myocarditis
Infantile coarctation of the aorta PDA
>60 years - bicuspid aortic valve

24. What is the tx for aortic stenosis?
Fetal alcohol syndrome
Libman - Sacks endocarditis
Intercostal arteries enlarged due to collateral circulation
Valve replacement AFTER the onset of complications

25. How does contraction band necrosis occur?
Ischemic heart disease
Surgical closure small defects may close spontaneously
Endocardial fibroelastosis (rare)
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

26. What valves are involved in rhuematic endocarditis?
Low voltage EKG w/diminished QRS amplitude
Mitral mitral+aortic
Heart can't fill
ACE inhibitor

27. What causes endocarditis of prosthetic valves?
S epidermidis
Thickening of chrodae tendinae and cusps - mitral stenosis
Contraction band necrosis - reperfusion injury
Paradoxical emboli

28. In which chamber of the heart are rhabdomyomas found?
S epidermidis
Tuberous sclerosis
Ventricle
Aschoff bodies

29. What % of MIs involve the LAD?
CHF
Sudden cardiac death
Mitral regurg
45%

30. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
RCA
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RHF
Contraction band necrosis - reperfusion injury

31. How do beta blockers tx MI?
4-7 days macrophage infiltration
Membrane damage
Prinzmetal
Slow HR - decreasing O2 demand and risk for arrhythmia

32. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Fibrosis and dystrophic calcification
Within the first day
Libman - Sacks endocarditis

33. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Streptococcus viridans
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Aschoff bodies
CHF

34. Myofiber hypertrophy with disarray.
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
Hypertrophic cardiomyopathy
RCA
Red border granulation tissue

35. Infects predamaged valves after transient bacteremia?
Ehlers - Danlow and Marfan syndrome
Volume overload and LHF
S viridans
PDA

36. EKG for stable angina?
Dressler syndrome
Prinzmetal angina - cocaine
Aschoff bodies
ST- segment depression

37. What is the murmur of mitral regurg?
Transesophageal echo
Holosystolic blowing murmur
Myocarditis in acute rheumatic heart fever
Squatting - expiration

38. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Fibrinous pericarditis
Harmartoma
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
4-7 days macrophage infiltration

39. What effect does mitral stenosis have on the heart chambers?
Prophylactic abx during dental procedures
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
LA dilation
Dressler syndrome

40. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Contraction band necrosis
Ventricle
Colon cancer
Inability to fill ventricles

41. With what virus is PDA associated?
Endocardial fibroelastosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Congenital rubella
Cardiogenic shock - CHF - arrhythmia

42. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Tetralogy of fallot
Stable angina
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

43. Poor myocardial fx due to chronic ischemic damage?
Pts w/previously damaged valves
Troponin I
Chronic ischemic heart disease
Left -->right

44. What is the most common form of cardiomyopathy?
Dilated
Opening snap followed by diastolic rumble
Nitroglycerin
Shunt

45. With what disease is transposition of the great vessels associated?
Mitral regurg
Myocarditis
Maternal diabetes
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

46. What is the most common cause of RHF? What are others?
Nonspecific - eg fever and elevated ESR
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Yellow pallor neutrophils

47. What effect does dilated cardiomyopathy have on the heart?
1-3 days out
Mitral mitral+aortic
Hypercoagulable state or underlying adenocarcinoma
Systolic dysfx leading to biventricular CHF

48. What does rupture of the IV septum cause?
Shunt
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Asymptomatic
Stable and unstable prinzmetal

49. What imaging test is useful for detecting lesions on valves?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Stable and unstable prinzmetal
NG or Ca channel blocker
Transesophageal echo

50. What causes wear and tear aortic stenosis?
Infectious endocarditis - arrythmias - severe mitral regurg no
Aortic regurg
Restrictive cardiomyopathy
Fibrosis and dystrophic calcification

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