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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 is the gross and microscopic appearance of cardiac myxomas?
Dilation of all four chambers of the heart
Increased blood in right heart delays closure of P valve
Circumflex
Gelatinous - abundant ground substance

2. Which congenital heart defect is associated with congenital rubella?
PDA
Contraction band necrosis - reperfusion injury
Metastasis
Surgical closure small defects may close spontaneously

3. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Decreased forward perfusion pulmonary congestion
Myxoma - benign
Papillary muscle - free wall - IV septum
Degree of pulmonary artery stenosis

4. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Right side - serotonin and other secretory products detoxified in the lung
Colon cancer
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Metastasis

5. What does chronic ischemic heart disease progress to?
Small - nondestructive vegetations (subacute endocarditis)
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Contraction band necrosis
CHF

6. What are the clinical features of LHF due to?
Myxoma - benign
Chronic ischemic heart disease
Valve scarring that arises as a consequence of rheumatic fever
Decreased forward perfusion pulmonary congestion

7. What is molecular mimicry?
Valve scarring that arises as a consequence of rheumatic fever
When a bacterial protein resembles a protein in human tissue
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Aschoff bodies

8. What is the characteristic murmurr of mitral stenosis?
Prophylactic abx during dental procedures
LA
Opening snap followed by diastolic rumble
Endocardial fibroelastosis (rare)

9. What effect does transposition of the great vessels have on the ventricles?
PDA
Hypertophy of RV atrophy of LV
Membrane damage
Rupture of free wall - IV septum - or papillary muscle

10. What characterizes acute rheumatic fever endocarditiis?
Large vegetations of S aureus
Squat in response to cyanotic spell
Small vegetations along the line of closure
3-8 wks

11. What cardiac disease is associated with tuberous sclerosis?
Erythematous nontender lesions on palms and soles.
Chronic ischemic heart disease
Rhabdomyoma
Eisenmenger syndrome

12. What are the complications of mitral stenosis?
Day 1-7
Elevated ASO anti - DNase B titers
Ventricular arrhythmia
Backward LHF pulm htn and RHF - afib and associated mural thombis

13. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Pericarditits
Reperfusion injury
Backward LHF pulm htn and RHF - afib and associated mural thombis

14. What is the most common cause of infectious endocarditis?
Reversible
Streptococcus viridans
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Endocardial fibroelastosis

15. Friction rub and chest pain.
Pericarditits
Holosystolic machine like murmur
Mitral and tricuspid regurg - arrhythmia
Mitral mitral+aortic

16. How does adult coarctation of the aorta present?
Pts w/previously damaged valves
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Endocardial fibroelastosis (rare)
ASD - R-->L

17. What is the most common form of cardiomyopathy?
First 4 hours
Endocardial fibroelastosis
Myocarditis
Dilated

18. What is the most common cause of endocarditis in IV drug users?
S aureus
Hypertophy of RV atrophy of LV
Myocardium
Small vegetations along the line of closure

19. What is a Quincke pulse?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
4-24 hours
Pulsating nail bed
Anterior wall of LV and anterior septum

20. What type of collagen is involved in fibrosis?
RCA
Type I
Left -->right
RBC damaged while crossing the calcified valve causing schistocytes

21. What type of ASD is associated w/Down syndrome?
Left -->right
Ostium primum
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pedunculated mass in the LA that causes syncope due to obstruction of MV

22. When would arrhythmia occur after MI?
Large - destructive vegetations
Within the first day
Ehlers - Danlow and Marfan syndrome
Reperfusion injury

23. How does ischemia cause LHF?
Opening snap followed by diastolic rumble
Loss of fx
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Mitral and tricuspid regurg - arrhythmia

24. With what congenital heart defect is ADULT coarctation of the aorta associated?
Rupture of free wall - IV septum - or papillary muscle
Bicuspid aortic valve
S aureus
Holosystolic machine like murmur

25. What shunt does tetralogy of fallot produce?
Ventricular arrhythmia
Right -->left
Infantile coarctation of the aorta
Inability to maintain systemic pressure w/lack of O2 to vital organs

26. How does aortic regurg affect the heart chambers?
>60 years - bicuspid aortic valve
LV dilation and eccentric hypertrophy
Inability to maintain systemic pressure w/lack of O2 to vital organs
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

27. How does squating decrease hypoxemia in tetralogy of fallot?
Myocarditis
Granulation tissue
Systolic dysfx leading to biventricular CHF
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

28. What is the only Jones criteria that doesn't resolve with time?
Systolic dysfx leading to biventricular CHF
Loss of fx
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Pancarditis

29. What does rupture of a papillary muscle cause?
1-3 days
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Contraction band necrosis
Mitral insufficiency

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

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31. At what point in development do congenital heart defects arise?
Myxoid degeneration
4-6 hours - 24 hours - 72 hours
3-8 wks
Loss of LV fx

32. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Heart can't fill
4-7 days
Contraction band necrosis
Libman - Sacks endocarditis

33. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Months out fibrosis
Mitral mitral+aortic
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

34. What congenital heart defect often is present with infantile coarctation of the aorta?
Systolic ejection click followed by crescendo - decrescendo murmur
Aschoff bodies
Sterile vegetations on surface and undersurface on mitral valve
PDA

35. EKG for stable angina?
ST- segment depression
S aureus
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
Nitroglycerin

36. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Opening snap followed by diastolic rumble
Plump fibroblasts - collagen - blood vessels
RBC damaged while crossing the calcified valve causing schistocytes
Months out fibrosis

37. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Indomethacin - decreases PGE
Prinzmetal angina
Wear and tear

38. What two things happen when a blocked vessel is opened after an MI?
4-6 hours - 24 hours - 72 hours
Wear and tear
Loeffler syndrome
Contraction band necrosis - reperfusion injury

39. What is the rate of mitral valve prolapse in the US?
Fibrinous pericarditis
Prinzmetal angina - cocaine
Tetralogy of fallot
2-3%

40. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Rhabdomyoma
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
1%

41. Systolic ejection click followed by crescendo - decrescendo murmur.
Myxoid degeneration
Aortic stenosis
Mitral regurg
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

42. What is the major cause of MI?
Dressler syndrome
When a bacterial protein resembles a protein in human tissue
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Rhabdomyoma

43. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Systolic ejection click followed by crescendo - decrescendo murmur
Shunt - PGE to maintain PDA until surgical repair can be performed
Yellow pallor neutrophils

44. What causes an early - blowing diastolic murmur?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aortic regurg
45%
Coronary artery vasospasm - emboli - vasculitis

45. How do ACE inhibitors tx MI?
Squat in response to cyanotic spell
Decreases LV dilation by decreasing volume
PDA
Valve replacement once LV dysfx develops

46. What coronary arterysupplies the lateral wall of the LV?
Rhadbomyoma - benign
S epidermidis
Gelatinous - abundant ground substance
Circumflex

47. What causes unstable angina?
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
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Chest pain <20 min brought on by exertion or emotional stress
Holosystolic machine like murmur

48. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Hemosiderin laden macrophages
Myofiber hypertrophy with disarray
Systolic ejection click followed by crescendo - decrescendo murmur

49. Tx for PDA?
Degree of pulmonary artery stenosis
Indomethacin - decreases PGE
AD mutation in sarcomere proteins
Aortic regurg

50. What is the definition of ischemia?
Streptococcus viridans
Hypercoagulable state or underlying adenocarcinoma
Decrease in blood flow to an organ
S aureus