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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. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Aortic regurg
Loss of fx
Systolic ejection click followed by crescendo - decrescendo murmur
Adult coarctation of the aorta

2. What gross and microscopic changes occur 4-7 days after an MI?
Infectious endocarditis - arrythmias - severe mitral regurg no
Yellow pallor macrophages
Granulation tissue
Pancarditis

3. With what developmental disorder is VSD associated?
Mitral and tricuspid regurg - arrhythmia
Fetal alcohol syndrome
Congestive heart failure
4-6 hours - 24 hours - 72 hours

4. What congenital heart defect presents later in life with lower extremity cyanosis?
Small - nondestructive vegetations (subacute endocarditis)
PDA
SLE
Sudden cardiac death

5. How long after pharyngitis does acute rheumatic fever occur?
First 4 hours
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
2-3 weeks
Contraction band necrosis - reperfusion injury

6. What is a common complication of cardiac metastasis?
Reperfusion injury
Myocarditis
Pericardial effusion due to pericardial involvement
Bicuspid aortic valve

7. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Rhadbomyoma - benign
Contraction band necrosis - reperfusion injury
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

8. What is the rate of mitral valve prolapse in the US?
2-3%
Coexisting mitral stenosis and fusion of commisures exist
Heart transplant
Pulsating nail bed

9. What is the most comon cause of aortic regurg? What are the other causes?
Decreases LV dilation by decreasing volume
Right side - serotonin and other secretory products detoxified in the lung
Decrease preload -->lowers myocardial stress
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

10. In which chamber of the heart are cardiac myxomas found?
Chest pain <20 min brought on by exertion or emotional stress
2-4 hours - 24 hours - 7-10 days
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
LA

11. What is the JOneS mneumonic?
Squatting - increased systemic resistence decreases LV emptying
Day 1-7
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
S viridans

12. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Myxoma - benign
Dense layer of elastic and fibrotic tissue in the endocardium - children
Doxorubicin - cocaine

13. Lower extremity cyanosis in infants? In adults?
Acute inflammation
Mitral insufficiency
Infantile coarctation of the aorta PDA
Cardiogenic shock - CHF - arrhythmia

14. What tests show prior group A beta - hemolytic strep infection?
Ehlers - Danlow and Marfan syndrome
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Streptococcus bovis/
Elevated ASO anti - DNase B titers

15. What effect does chronic rheumatic heart disease have on the aortic valve?

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16. Dense layer of elastic and fibrotic tissue in the endocardium.
Reversible
Trisomy 21
Endocardial fibroelastosis
Asymptomatic

17. What is the rate of congenital heart defects?
Congestive heart failure
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
CHF
1%

18. Is scar tissue or myocardium stronger?
Eisenmenger syndrome
IV drug users
Erythematous nontender lesions on palms and soles.
Myocardium

19. Is injury due angina reversible or irreversible?
Intercostal arteries enlarged due to collateral circulation
Reversible
Large vegetations of S aureus
Split S2 on auscultation

20. What artery is the 2nd most often occluded in an MI?
RCA
Subendocardial
SLE
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

21. Opening snap followed by diastolic rumble.
Fibrinous pericarditis
CK- MB
Spontaneous
Mitral stenosis

22. What areas of the heart does the LAD supply?
Tuberous sclerosis
PDA
Anterior wall of LV and anterior septum
Chest pain <20 min brought on by exertion or emotional stress

23. What genetic conditions predispose a pt to mitral valve prolapse?
Hypertrophic cardiomyopathy
4-6 hours - 24 hours - 72 hours
Ehlers - Danlow and Marfan syndrome
LHF

24. What two things happen when a blocked vessel is opened after an MI?
Ostium secundum (90%)
Contraction band necrosis - reperfusion injury
Restrictive cardiomyopathy
Increased hydrostatic pressure

25. What congenital heart defect does indomethacin tx?
Mid - systolic click followed by regurgitation murmur
Indomethacin - decreases PGE
1%
PDA

26. What areas of the heart does the RCA supply?
Reperfusion injury
Posterior wall of LV - posterior septum - papillary muscles
Decrease in blood flow to an organ
LA dilation

27. Poor myocardial fx due to chronic ischemic damage?
Large vegetations of S aureus
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Chronic ischemic heart disease

28. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Ventricular arrhythmia
Pts w/previously damaged valves
Holosystolic machine like murmur

29. What are the complications of mitral stenosis?
PDA
Membrane damage
Backward LHF pulm htn and RHF - afib and associated mural thombis
Opening snap followed by diastolic rumble

30. What are other (not atherosclerotic) causes of MI?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
LV dilation and eccentric hypertrophy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Coronary artery vasospasm - emboli - vasculitis

31. What % of MIs involve the LAD?
Hypertrophic cardiomyopathy
Valve replacement AFTER the onset of complications
45%
Pedunculated mass in the LA that causes syncope due to obstruction of MV

32. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
L->R
Mitral stenosis

33. What cardiac enzyme is useful for detecting reinfarction?
Minimizes ischemia
CK- MB
Group A beta - hemolytic streptococci
Cyanosis - RV hypertrophy - polycythemia - clubbing

34. What is the murmur of mitral regurg?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Pts w/previously damaged valves
Holosystolic blowing murmur
4-6 hours - 24 hours - 72 hours

35. What are heart failure cells?
Trisomy 21
Systolic dysfx leading to biventricular CHF
Prinzmetal angina
Hemosiderin laden macrophages

36. What type of shunt dose PDA cause?
Myofiber hypertrophy with disarray
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Left -->right
Acute inflammation

37. What is the most common cause of dilated cardiomyopathy? What are other causes?
Hypertrophic cardiomyopathy
Contraction band necrosis - reperfusion injury
Dense layer of elastic and fibrotic tissue in the endocardium - children
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

38. Ostium primum ASD is associated with what congenital disorder?
Pump failure
Trisomy 21
Rhadbomyoma - benign
Restrictive cardiomyopathy

39. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Streptococcus bovis/
Friction rub and chest pain
Nitroglycerin
Mitral regurg

40. What murmur ccan be heard in PDA?
Yellow pallor macrophages
Degree of pulmonary artery stenosis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Holosystolic machine like murmur

41. What is the foundation of a scar?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Granulation tissue
2-3%

42. What is the tx for aortic stenosis?
Loeffler syndrome
Valve replacement AFTER the onset of complications
Paradoxical emboli
Acute inflammation

43. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Aschoff bodies
Intercostal arteries enlarged due to collateral circulation
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

44. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Right to left
Fibrinous pericarditis
Slow HR - decreasing O2 demand and risk for arrhythmia

45. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
PDA
45%
Troponin I

46. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Hypertrophic cardiomyopathy
Loeffler syndrome
Myxoma - benign
Backward LHF pulm htn and RHF - afib and associated mural thombis

47. What causes the split S2 in ASD?
Nitroglycerin
Sudden cardiac death
Increased blood in right heart delays closure of P valve
Red border granulation tissue

48. What causes the dependent pitting edema in RHF?
Increased hydrostatic pressure
LAD
Positive blood cultures anemia of chronic disease
PDA

49. What are the HACEK organisms? With what condition are they associated?
Reactive histiocyte with caterpillar nucleus
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
PDA
RCA

50. How does fibrinolysis/angioplasty tx MI?
Left -->right
Open blocked vessels
S aureus
PDA