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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 most common cause of aortic stenosis?
LAD
2-3%
Wear and tear
Large - destructive vegetations

2. What are the sx of aortic regurg?
Stable and unstable prinzmetal
Valve replacement AFTER the onset of complications
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Shunt

3. What are heart failure cells?
Type I
Infectious endocarditis
Hemosiderin laden macrophages
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

4. What % stenosis causes stable angina?
Months out fibrosis
Myocarditis
>70%
Nonbacterial thrombotic endocarditis (marantic endocarditis)

5. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
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
Migratory polyarthritis
Fetal alcohol syndrome
LA

6. What is the most common type of ASD? What %?
Ostium secundum (90%)
Mitral mitral+aortic
LA
Troponin I

7. What makes the MV prolapse murmur louder? Why?
LA
Acute inflammation
Squatting - increased systemic resistence decreases LV emptying
Myxoid degeneration

8. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Contraction band necrosis - reperfusion injury
Turner syndrome

9. What are the minor critera of the Jones criteria?
Turner syndrome
Nonspecific - eg fever and elevated ESR
Aschoff bodies
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

10. What is the characteristic finding on CXR in tetralogy of fallot?
Intercostal arteries enlarged due to collateral circulation
Prinzmetal
R-->L
Boot shaped heart

11. Opening snap followed by diastolic rumble.
Mitral stenosis
Cardiogenic shock - CHF - arrhythmia
Open blocked vessels
Tricuspid

12. What is the rate of mitral valve prolapse in the US?
S aureus
Dilation of all four chambers of the heart
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
2-3%

13. Which congenital heart defect is associated with congenital rubella?
L->R
PDA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Squat in response to cyanotic spell

14. What gross and microscopic changes occur months after an MI?
4-7 days macrophage infiltration
Myxoid degeneration
White scar fibrosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

15. What is the most common cause of death during the acute phase of rheumatic fever?
Cyanosis - RV hypertrophy - polycythemia - clubbing
1%
Myocarditis
Mitral insufficiency

16. What is the major cause of MI?
Preductal - post aortic arch
LA
MI
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

17. How does asprin/heparin tx MI?
Pulsating nail bed
Chest pain <20 min brought on by exertion or emotional stress
Limits thrombosis
Pericarditits

18. In which chamber of the heart are rhabdomyomas found?
Ventricle
Squatting - expiration
Months out fibrosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

19. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
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
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Decrease in blood flow to an organ

20. What endocarditis is commonly found in patients with colon cancer?
Mid - systolic click followed by regurgitation murmur
Streptococcus bovis/
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Pericardial effusion due to pericardial involvement

21. How does transmural MI/ischemia present on EKG?
Osler nodes (ouch - ouch Osler)
Pedunculated mass in the LA that causes syncope due to obstruction of MV
ST- segment elevation
Heart can't fill

22. How does restrictive cardiomyopathy cause LHF?

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23. What are the HACEK organisms? With what condition are they associated?
4-6 hours - 24 hours - 72 hours
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Rupture of free wall - IV septum - or papillary muscle
Volume overload and LHF

24. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Mitral insufficiency
MI
Granulation tissue

25. What conditions can cause nonbacterial thrombotic endocarditis?
Systolic ejection click followed by crescendo - decrescendo murmur
Eisenmenger syndrome
Congested central veins
Hypercoagulable state or underlying adenocarcinoma

26. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Valve replacement
Reperfusion injury
Stretched muscle loses contractility

27. What complications occur within 4 hrs post MI?
Systolic ejection click followed by crescendo - decrescendo murmur
Cardiogenic shock - CHF - arrhythmia
Hypercoagulable state or underlying adenocarcinoma
Granulation tissue

28. What congenital heart defect does indomethacin tx?
Ventricle
PDA
Harmartoma
Mitral valve prolapse

29. What bug causes acute rheumatic fever?
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
Shunt
Harmartoma
Group A beta - hemolytic streptococci

30. What congenital heart defect presents later in life with lower extremity cyanosis?
Dressler syndrome
Troponin I
Gelatinous - abundant ground substance
PDA

31. What is the leading cause of death in the US?
Ischemic heart disease
Prinzmetal stable and unstable
Nitroglycerin
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

32. How does subendocardial MI/ischemia present on EKG?
Hypertrophic cardiomyopathy
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
ST- segment depression
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

33. What increases the risk for chronic rheumatic heart disease?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Pulsating nail bed
Degree of pulmonary artery stenosis
First 4 hours

34. What drug relieves stable angina?
1-3 days
Prinzmetal stable and unstable
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nitroglycerin

35. Friction rub and chest pain.
Intercostal arteries enlarged due to collateral circulation
PDA
Pericarditits
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

36. What is the basic principle of CHF?
Mitral valve prolapse
Pump failure
White scar fibrosis
LHF

37. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Tender lesions on fingers or toes.
Bicuspid aortic valve
Anitschow cell
Endocarditis of prosthetic valves

38. What is Loeffler syndrome?
LV dilation and eccentric hypertrophy
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Mitral and tricuspid regurg - arrhythmia
Contraction band necrosis

39. Which angina(s) show ST elevation on EKG? ST depression?
Pericardial effusion due to pericardial involvement
Prinzmetal stable and unstable
SLE
ACE inhibitor

40. What effect does aortic regurg have on the pulse pressure? Why?
Sudden cardiac death
Squatting - increased systemic resistence decreases LV emptying
Degree of pulmonary artery stenosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

41. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Endocarditis of prosthetic valves
Contraction band necrosis
White scar fibrosis

42. Which vasculitis can cause MI?
Kawasaki disease
4-7 days macrophage infiltration
Right -->left
PDA

43. What effect does squatting have on the murmur of mitral valve prolapse? Why?
1-3 days
Louder - increased systemic resistence decreases LV emptying
Small - nondestructive vegetations (subacute endocarditis)
Chronic ischemic heart disease

44. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Heart transplant
Adult coarctation of the aorta
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
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

45. What is the characteristic murmurr of mitral stenosis?
Metastasis
4-6 hours - 24 hours - 72 hours
Pericardial effusion due to pericardial involvement
Opening snap followed by diastolic rumble

46. What is the etiology of S viridans endocarditis?
Loeffler syndrome
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
ST- segment depression
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

47. What are the two effects of ATII?
Anterior wall of LV and anterior septum
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Pericarditits

48. What is the gross and microscopic appearance of cardiac myxomas?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Squatting - expiration
Gelatinous - abundant ground substance
Regurg vs stenosis

49. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Increased hydrostatic pressure
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

50. What are the clinical features of endocarditis? What causes each feature?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
20 min
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
Opening snap followed by diastolic rumble

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