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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 drugs can cause dilated cardiomyopathy?
Shunt
Aortic regurg
Doxorubicin - cocaine
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

2. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
3-8 wks
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Infantile coarctation of the aorta

3. What is the most common cause of mitral stenosis?
Stretched muscle loses contractility
Rupture of free wall - IV septum - or papillary muscle
Mitral regurg
Chronic rheumatic heart disease

4. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Streptococcus bovis/
Pedunculated mass in the LA that causes syncope due to obstruction of MV
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

5. Tx for PDA?
Indomethacin - decreases PGE
Mitral regurg
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Months out fibrosis

6. What does rupture of the LV free wall cause?
Cardiac tamponade
Pericarditits
Anitschow cell
Transposition of the great vessels

7. What generally causes ischemic heart disease?
Endocardial fibroelastosis
Atherosclerosis of coronary arteries
Shunt - PGE to maintain PDA until surgical repair can be performed
Sterile vegetations on surface and undersurface on mitral valve

8. What is the etiology of S viridans endocarditis?
Loeffler syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Inability to maintain systemic pressure w/lack of O2 to vital organs
Infectious

9. What are the minor critera of the Jones criteria?
Chest pain <20 min brought on by exertion or emotional stress
Nonspecific - eg fever and elevated ESR
Volume overload and LHF
Hypertophy of RV atrophy of LV

10. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Cardiogenic shock - CHF - arrhythmia
Reversible
Endocardial fibroelastosis
Months out fibrosis

11. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
MI
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
Squatting - increased systemic resistence decreases LV emptying

12. What bug causes acute rheumatic fever?
Transposition of the great vessels
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
2-4 hours - 24 hours - 7-10 days
Group A beta - hemolytic streptococci

13. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
Aortic regurg
Ventricular arrhythmia
Nonspecific - eg fever and elevated ESR

14. When do macrophagess infiltrate the myocardium post MI?
Friction rub and chest pain
Intercostal arteries enlarged due to collateral circulation
Adult coarctation of the aorta
4-7 days

15. What disesase has Aschoff bodies?
Plump fibroblasts - collagen - blood vessels
Myocarditis in acute rheumatic heart fever
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Bicuspid aortic valve

16. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Chest pain <20 min brought on by exertion or emotional stress
MI
Maternal diabetes
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

17. What is typically the mechanims of sudden cardiac death?
Chronic ischemic heart disease
Ventricular arrhythmia
Day 1-7
Myofiber hypertrophy with disarray

18. What are the clinical features of LHF due to?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Stretched muscle loses contractility
Decreased forward perfusion pulmonary congestion
Friction rub and chest pain

19. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Tender lesions on fingers or toes.
Degree of pulmonary artery stenosis
Aortic regurg

20. In which chamber of the heart are cardiac myxomas found?
Left -->right
LA
Mitral stenosis
Tender lesions on fingers or toes.

21. How does adult coarctation of the aorta present?
Decreases LV dilation by decreasing volume
ST- segment elevation
Mitral valve prolapse
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

22. What congenital heart defect is associated with fetal alcohol syndrome?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Myocardium
VSD
Sterile vegetations on surface and undersurface on mitral valve

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

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24. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Small vegetations along the line of closure
Left -->right

25. What is a water - hammer pulse?
Bounding pulse
Bicuspid aortic valve
ST- segment elevation
VSD

26. What causes an early - blowing diastolic murmur?
Mitral and tricuspid regurg - arrhythmia
IV drug users
Aortic regurg
Elevated ASO anti - DNase B titers

27. What is systolic dysfx?
Hypertrophic cardiomyopathy
Large - destructive vegetations
VSD
Ventricles cannot pump

28. What is the gold standard blood marker for MI?
Troponin I
S aureus
1%
Regurg vs stenosis

29. What side of the heart do carcinoid tumors affect? Why?
Intercostal arteries enlarged due to collateral circulation
Right side - serotonin and other secretory products detoxified in the lung
Tuberous sclerosis
Indomethacin - decreases PGE

30. What are the Jones criteria?
Valve scarring that arises as a consequence of rheumatic fever
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Holosystolic machine like murmur
Kawasaki disease

31. What causes the dependent pitting edema in RHF?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Congestive heart failure
Increased hydrostatic pressure
Preductal - post aortic arch

32. What areas of the heart does the LAD supply?
Reperfusion injury
PDA
Anterior wall of LV and anterior septum
Dilated

33. What does rupture of the IV septum cause?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
R-->L
Shunt
Right -->left

34. How long after pharyngitis does acute rheumatic fever occur?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
2-3 weeks
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Prinzmetal stable and unstable

35. Is injury due angina reversible or irreversible?
Reversible
Decreased forward perfusion pulmonary congestion
Sterile vegetations on mitral valve along lines of closure
>60 years - bicuspid aortic valve

36. What is the most common cause of dilated cardiomyopathy? What are other causes?
Fibrosis and dystrophic calcification
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Myocarditis
White scar fibrosis

37. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Cardiogenic shock - CHF - arrhythmia
Volume overload and LHF
MI

38. What are the causes of restrictive cardiomyopathy in adults?
Endocarditis of prosthetic valves
Stable angina
CHF
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

39. What is eythema marginatum? What parts of the body does it commonly involve?
Myocarditis
Small vegetations along the line of closure
Annular - non pruritic rash w/erythematous borders trunks and limbs
Heart can't fill

40. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Sudden cardiac death
First 4 hours
Myxoma - benign

41. In which chamber of the heart are rhabdomyomas found?
Ventricle
Holosystolic machine like murmur
Months out fibrosis
CK- MB

42. What coronary artery supplies the mitral valve papillary muscles?
>60 years - bicuspid aortic valve
Regurg vs stenosis
Libman - Sacks endocarditis
RCA

43. What causes mitral valve prolapse?
Myxoid degeneration
When a bacterial protein resembles a protein in human tissue
Reperfusion injury
CK- MB

44. What is the tx for aortic stenosis?
Wear and tear
LV dilation and eccentric hypertrophy
Decreased forward perfusion pulmonary congestion
Valve replacement AFTER the onset of complications

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

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46. What type of vegetations does Strep viridans cause?
ST- segment elevation
Small - nondestructive vegetations (subacute endocarditis)
Louder - increased systemic resistence decreases LV emptying
Sterile vegetations on mitral valve along lines of closure

47. How do you tx prinzmetal angina?
Myofiber hypertrophy with disarray
Split S2 on auscultation
Pericarditits
NG or Ca channel blocker

48. How do you prevent S viridans endocarditis?
Hypertrophic cardiomyopathy
MI
Anterior wall of LV and anterior septum
Prophylactic abx during dental procedures

49. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Plump fibroblasts - collagen - blood vessels
Stable and unstable prinzmetal
Red border granulation tissue

50. Pericarditis 6-8 wks post MI.
Ostium primum
Doxorubicin - cocaine
Dressler syndrome
Pericardial effusion due to pericardial involvement