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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. 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
Infectious endocarditis - arrythmias - severe mitral regurg no
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Minimizes ischemia

2. What is the most common cause of aortic stenosis?
ST- segment depression
Wear and tear
Type I
CHF

3. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
2-3 weeks
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Nonbacterial thrombotic endocarditis (marantic endocarditis)

4. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Stable angina
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Breast and lung carcinoma - melanoma - lymphoma

5. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Sterile vegetations on surface and undersurface on mitral valve
PDA

6. What type of shunt does transposition of the great vessels cause?
Pump failure
R-->L
Maternal diabetes
Nitroglycerin

7. Why would cardiac enzymes continue to increase after the initial MI?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Migratory polyarthritis
Reperfusion injury
Decrease preload -->lowers myocardial stress

8. When does the heart have a yellow pallor post MI?
4-7 days
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
S aureus
Day 1-7

9. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Wear and tear
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Plump fibroblasts - collagen - blood vessels

10. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
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
Aschoff bodies
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Prophylactic abx during dental procedures

11. What is the basic principle of CHF?
Pulsating nail bed
Pump failure
1-3 days out
Minimizes ischemia

12. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Mitral regurg
Tricuspid
Friction rub and chest pain

13. Infects predamaged valves after transient bacteremia?
S viridans
R-->L
Ventricles cannot pump
Shunt

14. What heart sound manifest with an ASD?
Gelatinous - abundant ground substance
Fetal alcohol syndrome
RBC damaged while crossing the calcified valve causing schistocytes
Split S2 on auscultation

15. Where is the coarctation in infantile coarctation of the aorta?
Mitral regurgitation due to vegetations
CK- MB
Preductal - post aortic arch
Myocarditis

16. What causes the nutmeg color in nutmeg liver?
Congested central veins
Left -->right
20 min
Myocarditis

17. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Backward LHF pulm htn and RHF - afib and associated mural thombis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

18. What coronary artery supplies the mitral valve papillary muscles?
VSD
RCA
Transesophageal echo
Endocardial fibroelastosis

19. What side of the heart do carcinoid tumors affect? Why?
20 min
Decreases LV dilation by decreasing volume
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Right side - serotonin and other secretory products detoxified in the lung

20. At what point in development do congenital heart defects arise?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
3-8 wks
Prinzmetal stable and unstable
Atria and RV

21. Which angina is relieved by Ca channel blockers?
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
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Prinzmetal

22. When do neutrophils infiltrate the myocardium post MI?
1-3 days out
Cardiogenic shock - CHF - arrhythmia
1-3 days
RHF

23. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Pump failure
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral mitral+aortic
Anitschow cell

24. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Mitral mitral+aortic
Left -->right
Day 1-7

25. What does nonbacterial thrombotic endocarditis cause?
Dark discoloration coagulative necrosis
Infantile coarctation of the aorta PDA
Congested central veins
Mitral regurg

26. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Bounding pulse
S epidermidis
PDA

27. Dense layer of elastic and fibrotic tissue in the endocardium.
Split S2 on auscultation
Endocardial fibroelastosis
Rupture of free wall - IV septum - or papillary muscle
Reactive histiocyte with caterpillar nucleus

28. What is the major cause of MI?
Mitral and tricuspid regurg - arrhythmia
Infantile coarctation of the aorta PDA
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Pts w/previously damaged valves

29. Opening snap followed by diastolic rumble.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Valve replacement once LV dysfx develops
Rupture of free wall - IV septum - or papillary muscle
Mitral stenosis

30. Holosystolic blowing murmur that increases w/expiration?
Fetal alcohol syndrome
Mitral regurg
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Pericardial effusion due to pericardial involvement

31. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Valve replacement once LV dysfx develops
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
RHF

32. What is the most common cause of death during the acute phase of rheumatic fever?
Coronary artery vasospasm - emboli - vasculitis
Atria and RV
Myocarditis
Loeffler syndrome

33. How does ischemia cause LHF?
Endocardial fibroelastosis (rare)
Loss of fx
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Myxoma - benign

34. What does rupture of a papillary muscle cause?
Dressler syndrome
Harmartoma
4-7 days macrophage infiltration
Mitral insufficiency

35. Which vasculitis can cause MI?
Positive blood cultures anemia of chronic disease
Tricuspid
Kawasaki disease
Myocarditis

36. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Endocardial fibroelastosis (rare)
When a bacterial protein resembles a protein in human tissue
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aortic regurg

37. What is a complication of chronic rheumatic heart disease?
Surgical closure small defects may close spontaneously
ASD - R-->L
Cardiogenic shock - CHF - arrhythmia
Infectious endocarditis

38. What shunt does tetralogy of fallot produce?
LA
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Dense layer of elastic and fibrotic tissue in the endocardium - children
Right -->left

39. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
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
Prinzmetal angina
Nitroglycerin
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

40. What are the Jones criteria?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Within the first day
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

41. Which artery is most often occluded in an MI?
Preductal - post aortic arch
Gelatinous - abundant ground substance
LAD
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

42. With what virus is PDA associated?
Congenital rubella
Ostium primum
Shunt - PGE to maintain PDA until surgical repair can be performed
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

43. What is the characteristic finding on CXR in tetralogy of fallot?
Pump failure
Boot shaped heart
RHF
Endocardial fibroelastosis (rare)

44. How does Eisenmeger syndrome occur?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
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
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Sterile vegetations on surface and undersurface on mitral valve

45. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Boot shaped heart
Transesophageal echo

46. What are the causes of restrictive cardiomyopathy in adults?
Stretched muscle loses contractility
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Congestive heart failure
Friction rub and chest pain

47. How does hypertension cause LHF?

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48. Tender lesions on fingers or toes.
Friction rub and chest pain
ST- segment depression
Yellow pallor neutrophils
Osler nodes (ouch - ouch Osler)

49. What is the characteristic murmur of aortic stenosis?
First 4 hours
Systolic ejection click followed by crescendo - decrescendo murmur
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
Chronic rheumatic heart disease

50. Pericarditis 6-8 wks post MI.
Aneurysm - mural thrombus - Dressler syndrome
Dressler syndrome
Libman - Sacks endocarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

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