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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. How long after pharyngitis does acute rheumatic fever occur?
Granulation tissue
2-3 weeks
Contraction band necrosis - reperfusion injury
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

2. What are the four defects in tetralogy of fallot?
>70%
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Endocardial fibroelastosis
Acute inflammation

3. What does granulation tissue contain?
Plump fibroblasts - collagen - blood vessels
Red border granulation tissue
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Preductal - post aortic arch

4. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Intercostal arteries enlarged due to collateral circulation

5. Turner syndrome is associated with which congenital heart defect?
Positive blood cultures anemia of chronic disease
Infantile coarctation of the aorta
Membrane damage
Adult coarctation of the aorta

6. What is chronic rheumatic heart disease?
4-7 days macrophage infiltration
Turner syndrome
Mitral valve prolapse
Valve scarring that arises as a consequence of rheumatic fever

7. What are the sx of hypertrophic cardiomyopathy?
Coronary artery vasospasm
Myxoma - benign
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Type I

8. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Mitral regurg
Sterile vegetations on surface and undersurface on mitral valve
Hemosiderin laden macrophages
Stable and unstable prinzmetal

9. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
R-->L
SLE

10. What is the most common type of endocarditis?
Infectious
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Troponin I
Prinzmetal

11. What type of shunt results in cyanosis at birth?
Months out fibrosis
Right to left
Asymptomatic
Large - destructive vegetations

12. What is the main cause of MV regurg? What are other causes?
4-6 hours - 24 hours - 72 hours
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
Congenital rubella
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

13. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Dilated
20 min
Preductal - post aortic arch

14. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Dilated
VSD
R-->L
Sudden cardiac death

15. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Valve scarring that arises as a consequence of rheumatic fever
R-->L
Chronic ischemic heart disease

16. What effect does transposition of the great vessels have on the ventricles?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Circumflex
Hypertophy of RV atrophy of LV
Contraction band necrosis

17. What does rupture of a papillary muscle cause?
Squat in response to cyanotic spell
Mitral regurg
Ventricle
Mitral insufficiency

18. What are Osler nodes?
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
Dressler syndrome
Tender lesions on fingers or toes.
Acute inflammation

19. Why would cardiac enzymes continue to increase after the initial MI?
Mitral and tricuspid regurg - arrhythmia
Streptococcus bovis/
Reperfusion injury
Mitral regurg

20. What is Dressler syndrome? When does it occur?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
1-3 days out
S epidermidis
Autoimmune pericarditis 6-8 wks post MI

21. How does restrictive cardiomyopathy cause LHF?

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22. What effect does dilated cardiomyopathy have on the heart?
Prinzmetal angina - cocaine
Indomethacin - decreases PGE
Valve replacement AFTER the onset of complications
Systolic dysfx leading to biventricular CHF

23. What complications occur within 4 hrs post MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Cardiogenic shock - CHF - arrhythmia
Infectious
VSD

24. Tender lesions on fingers or toes.
Valve replacement AFTER the onset of complications
Osler nodes (ouch - ouch Osler)
Infectious
Harmartoma

25. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Ventricles cannot pump
IV drug users
PDA

26. How do nitrates tx MI?
Right side - serotonin and other secretory products detoxified in the lung
Prophylactic abx during dental procedures
Gelatinous - abundant ground substance
Decrease preload -->lowers myocardial stress

27. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Ventricular arrhythmia
Colon cancer
Loss of LV fx
Prinzmetal

28. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Decreases LV dilation by decreasing volume
Streptococcus bovis/
Myocarditis

29. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Systolic ejection click followed by crescendo - decrescendo murmur

30. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Loss of LV fx
Boot shaped heart
Nonbacterial thrombotic endocarditis (marantic endocarditis)
20 min

31. What makes the MV prolapse murmur louder? Why?
4-24 hours
Yellow pallor neutrophils
Months out fibrosis
Squatting - increased systemic resistence decreases LV emptying

32. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Myocarditis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Chest pain <20 min brought on by exertion or emotional stress

33. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Myofiber hypertrophy with disarray
3-8 wks
RCA
Pericardial effusion due to pericardial involvement

34. Which coronary artery supplies the anterior wall and anterior septum?
PDA
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Prinzmetal angina - cocaine
LAD

35. What are the sx of right - to - left shunt?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
4-6 hours - 24 hours - 72 hours
Cyanosis - RV hypertrophy - polycythemia - clubbing
Plump fibroblasts - collagen - blood vessels

36. With what virus is PDA associated?
Congenital rubella
LA dilation
Acute inflammation
Squatting - increased systemic resistence decreases LV emptying

37. What is the murmur of mitral regurg?
4-7 days macrophage infiltration
Holosystolic blowing murmur
Right side - serotonin and other secretory products detoxified in the lung
Ventricles cannot pump

38. What is the characteristic finding on CXR in tetralogy of fallot?
Streptococcus bovis/
Doxorubicin - cocaine
When a bacterial protein resembles a protein in human tissue
Boot shaped heart

39. EKG for stable angina?
Systemic venous congestion
Holosystolic blowing murmur
4-6 hours - 24 hours - 72 hours
ST- segment depression

40. What is the most common valve infected by S aureus?
Bounding pulse
Tricuspid
Janeway lesions
Reactive histiocyte with caterpillar nucleus

41. What are the complications that occur months after an MI?
Infectious endocarditis - arrythmias - severe mitral regurg no
Boot shaped heart
Aneurysm - mural thrombus - Dressler syndrome
Reactive histiocyte with caterpillar nucleus

42. What type of shunt dose PDA cause?
Left -->right
Nonspecific - eg fever and elevated ESR
Transesophageal echo
Granulation tissue

43. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Infantile coarctation of the aorta PDA
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

44. How does contraction band necrosis occur?
20 min
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Elevated ASO anti - DNase B titers
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

45. Which congenital heart defect is associated with congenital rubella?
PDA
ST- segment depression
Erythematous nontender lesions on palms and soles.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

46. When does the heart have dark discoloration post MI?
RCA
4-7 days
4-24 hours
ASD - R-->L

47. What coronary arterysupplies the lateral wall of the LV?
Pancarditis
Ischemic heart disease
Circumflex
Cardiogenic shock - CHF - arrhythmia

48. What drug relieves stable angina?
Nitroglycerin
Tetralogy of fallot
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Nonspecific - eg fever and elevated ESR

49. What is a Quincke pulse?
Pulsating nail bed
4-7 days macrophage infiltration
Myofiber hypertrophy with disarray
Small - nondestructive vegetations (subacute endocarditis)

50. What effect does mitral stenosis have on the heart chambers?
LA dilation
Ventricular arrhythmia
Ehlers - Danlow and Marfan syndrome
Mitral regurg