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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 are the forward and backward sx of LHF?
Mitral regurgitation due to vegetations
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
Ventricles cannot pump
Restrictive cardiomyopathy

2. What type of collagen is involved in fibrosis?
Type I
Rhabdomyoma
Fibrinous pericarditis
First 4 hours

3. Vegetations on surface and undersurface of mitral valve.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Endocardial fibroelastosis (rare)
Metastasis
Libman - Sacks endocarditis

4. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Holosystolic machine like murmur
Dense layer of elastic and fibrotic tissue in the endocardium - children
Months out fibrosis
Thickening of chrodae tendinae and cusps - mitral stenosis

5. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Sudden cardiac death
Limits thrombosis
Nonspecific - eg fever and elevated ESR

6. What is an Anitschow cell?
Chronic ischemic heart disease
ACE inhibitor
Mitral regurg
Reactive histiocyte with caterpillar nucleus

7. What is typically the mechanims of sudden cardiac death?
Sterile vegetations on surface and undersurface on mitral valve
Right to left
Ventricular arrhythmia
Tender lesions on fingers or toes.

8. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
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
RBC damaged while crossing the calcified valve causing schistocytes

9. What maintains patency of the PDA?
Heart transplant
R-->L
PGE
L->R

10. What is migratory polyarthritis?
Coronary artery vasospasm
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Chronic ischemic heart disease
Left -->right

11. What drug relieves stable angina?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
RBC damaged while crossing the calcified valve causing schistocytes
Nitroglycerin
Decrease in blood flow to an organ

12. Systolic ejection click followed by crescendo - decrescendo murmur.
Yellow pallor neutrophils
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Tetralogy of fallot
Aortic stenosis

13. How does hypertension cause LHF?

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14. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Trisomy 21
Fibrinous pericarditis
Cyanosis - RV hypertrophy - polycythemia - clubbing

15. What type of shunt results in cyanosis at birth?
LAD
Right to left
Annular - non pruritic rash w/erythematous borders trunks and limbs
Posterior wall of LV - posterior septum - papillary muscles

16. What causes angina and syncope in aortic stenosis?

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17. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Thickening of chrodae tendinae and cusps - mitral stenosis
Loss of LV fx

18. What is the effect of mitral regurg on the heart?
Yellow pallor macrophages
Prinzmetal stable and unstable
Infantile coarctation of the aorta
Volume overload and LHF

19. What causes endocarditis of prosthetic valves?
RCA
CK- MB
Aortic regurg
S epidermidis

20. What cardiac disease is associated with tuberous sclerosis?
1-3 days out
Reactive histiocyte with caterpillar nucleus
Rhabdomyoma
Infantile coarctation of the aorta PDA

21. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Large vegetations of S aureus
Loeffler syndrome
Degree of pulmonary artery stenosis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

22. What disesase has Aschoff bodies?
Heart can't fill
White scar fibrosis
Pericarditits
Myocarditis in acute rheumatic heart fever

23. What increases the volume of mitral regurg murmur?
Endocardial fibroelastosis
Squatting - expiration
Myocarditis in acute rheumatic heart fever
Subendocardial

24. What gross and microscopic changes occur 4-24 hours after an MI?
Friction rub and chest pain
Dark discoloration coagulative necrosis
S aureus
Doxorubicin - cocaine

25. What is the cause of restrictive cardiomyopathy in children?
Sterile vegetations on mitral valve along lines of closure
Endocardial fibroelastosis (rare)
Systolic ejection click followed by crescendo - decrescendo murmur
Pulsating nail bed

26. Lower extremity cyanosis in infants? In adults?
Mitral valve prolapse
Infantile coarctation of the aorta PDA
Nitroglycerin
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

27. What % of MIs involve the LAD?
Reperfusion injury
45%
Mitral mitral+aortic
Nonspecific - eg fever and elevated ESR

28. How does reperfusion injury occur?
Hemosiderin laden macrophages
Stable and unstable prinzmetal
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

29. What type of vegetations does Strep viridans cause?
Infectious endocarditis
Small - nondestructive vegetations (subacute endocarditis)
First 4 hours
Anitschow cell

30. What is an important complication of ASD?
Prinzmetal
Opening snap followed by diastolic rumble
Minimizes ischemia
Paradoxical emboli

31. What is the most common cause of endocarditis in IV drug users?
S aureus
VSD
Mitral regurgitation due to vegetations
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

32. How does adult coarctation of the aorta present?
Contraction band necrosis - reperfusion injury
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Libman - Sacks endocarditis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

33. Dilated cardiomyopathy is a late complication of what illness?
Left -->right
Positive blood cultures anemia of chronic disease
Myocarditis
Streptococcus bovis/

34. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Colon cancer
Right -->left
Thickening of chrodae tendinae and cusps - mitral stenosis

35. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
Ischemic heart disease
ST- segment elevation
Elevated ASO anti - DNase B titers

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

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37. What are the clinical features of RHF due to?
Mid - systolic click followed by regurgitation murmur
Systemic venous congestion
VSD
Blood vessels coming in from normal tissue

38. What is the rate of congenital heart defects?
Granulation tissue
1%
RBC damaged while crossing the calcified valve causing schistocytes
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

39. What two things cause coronary artery vasospasm?
Tetralogy of fallot
Inability to fill ventricles
Prinzmetal angina
Prinzmetal angina - cocaine

40. What are the clinical features of endocarditis? What causes each feature?
Inability to fill ventricles
Prinzmetal
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
Annular - non pruritic rash w/erythematous borders trunks and limbs

41. With what developmental disorder is VSD associated?
Friction rub and chest pain
Fetal alcohol syndrome
Wear and tear
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

42. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Contraction band necrosis
Coronary artery vasospasm - emboli - vasculitis
Migratory polyarthritis

43. Which congenital heart defect is associated with congenital rubella?
PDA
VSD
Aneurysm - mural thrombus - Dressler syndrome
LA dilation

44. How does O2 tx MI?
Aortic regurg
Minimizes ischemia
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
White scar fibrosis

45. Poor myocardial fx due to chronic ischemic damage?
Loss of fx
Janeway lesions
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Chronic ischemic heart disease

46. What is Dressler syndrome? When does it occur?
PDA
Right side - serotonin and other secretory products detoxified in the lung
Autoimmune pericarditis 6-8 wks post MI
RCA

47. What effect does aortic stenosis have on the chambers of the heart?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Concentric LV hypertophy
3-8 wks
Trisomy 21

48. What type of tumor is a rhabdomyoma?
Harmartoma
LV dilation and eccentric hypertrophy
Maternal diabetes
4-24 hours

49. What type of ischemia does stable angina cause?
Subendocardial
L->R
Contraction band necrosis
Mitral and tricuspid regurg - arrhythmia

50. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
LAD
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Asymptomatic