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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 type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Indomethacin - decreases PGE
Yellow pallor macrophages
Hypertophy of RV atrophy of LV

2. What is the rate of congenital heart defects?
Ostium primum
Right side - serotonin and other secretory products detoxified in the lung
IV drug users
1%

3. What characterizes acute rheumatic fever endocarditiis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Small vegetations along the line of closure
Squatting - increased systemic resistence decreases LV emptying
Decreases LV dilation by decreasing volume

4. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
NG or Ca channel blocker
Prinzmetal
20 min
Infectious endocarditis

5. What are the Jones criteria?
Doxorubicin - cocaine
Mitral regurg
Hypertophy of RV atrophy of LV
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

6. What is the most common cause of death during the acute phase of rheumatic fever?
RBC damaged while crossing the calcified valve causing schistocytes
R-->L
1%
Myocarditis

7. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Anitschow cell
Infantile coarctation of the aorta
Cardiogenic shock - CHF - arrhythmia

8. What causes an early - blowing diastolic murmur?
Ventricular arrhythmia
Aortic regurg
Annular - non pruritic rash w/erythematous borders trunks and limbs
Myxoma - benign

9. What causes angina and syncope in aortic stenosis?

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10. What is eythema marginatum? What parts of the body does it commonly involve?
Breast and lung carcinoma - melanoma - lymphoma
ASD - R-->L
Coexisting mitral stenosis and fusion of commisures exist
Annular - non pruritic rash w/erythematous borders trunks and limbs

11. What typically causes hypertrophic cardiomyopathy?
Eisenmenger syndrome
AD mutation in sarcomere proteins
Infectious endocarditis
Stable angina

12. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
PDA
Dense layer of elastic and fibrotic tissue in the endocardium - children
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

13. What is the foundation of a scar?
Granulation tissue
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
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
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

14. What are complications of dilated cardiomyopathy?
Tender lesions on fingers or toes.
Mitral and tricuspid regurg - arrhythmia
Prophylactic abx during dental procedures
Dark discoloration coagulative necrosis

15. In transposition of the great vessels - What is required for survival? How is this achieved?
Boot shaped heart
Stable and unstable prinzmetal
Shunt - PGE to maintain PDA until surgical repair can be performed
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

16. Vegetations on surface and undersurface of mitral valve.
Aortic regurg
Libman - Sacks endocarditis
ACE inhibitor
Infantile coarctation of the aorta PDA

17. How do nitrates tx MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Minimizes ischemia
Type I
Decrease preload -->lowers myocardial stress

18. L- to - R shunt switching to R- to - L shunt.
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Eisenmenger syndrome
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Friction rub and chest pain

19. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Decreases LV dilation by decreasing volume
Congested central veins
First 4 hours
Sudden cardiac death

20. What are the forward and backward sx of LHF?
Rupture of free wall - IV septum - or papillary muscle
LAD
Annular - non pruritic rash w/erythematous borders trunks and limbs
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

21. What is the gross and microscopic appearance of cardiac myxomas?
Reperfusion injury
Large - destructive vegetations
Aneurysm - mural thrombus - Dressler syndrome
Gelatinous - abundant ground substance

22. What is molecular mimicry?
Concentric LV hypertophy
Hypertrophic cardiomyopathy
When a bacterial protein resembles a protein in human tissue
Chronic rheumatic heart disease

23. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
NG or Ca channel blocker
Right to left
>60 years - bicuspid aortic valve
Harmartoma

24. How does restrictive cardiomyopathy present?
Congestive heart failure
Heart transplant
Hemosiderin laden macrophages
Small - nondestructive vegetations (subacute endocarditis)

25. What are the major criteria of the Jones criteria?
3-8 wks
Rupture of free wall - IV septum - or papillary muscle
Pulsating nail bed
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

26. What is the most common cause of aortic stenosis?
Cardiogenic shock - CHF - arrhythmia
MI
Wear and tear
Valve replacement once LV dysfx develops

27. What causes wear and tear aortic stenosis?
Bicuspid aortic valve
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
MI
Fibrosis and dystrophic calcification

28. What are the sx of right - to - left shunt?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Cyanosis - RV hypertrophy - polycythemia - clubbing
Streptococcus bovis/
PDA

29. What endocarditis is commonly found in patients with colon cancer?
Spontaneous
>60 years - bicuspid aortic valve
Streptococcus bovis/
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

30. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Degree of pulmonary artery stenosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Ventricle

31. What is cardiogenic shock?
Atherosclerosis of coronary arteries
LAD
Inability to maintain systemic pressure w/lack of O2 to vital organs
Backward LHF pulm htn and RHF - afib and associated mural thombis

32. What are the four defects in tetralogy of fallot?
Decreased forward perfusion pulmonary congestion
Yellow pallor neutrophils
Rhabdomyoma
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

33. What is dilated cardiomyopathy?
Erythematous nontender lesions on palms and soles.
Dilation of all four chambers of the heart
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Streptococcus viridans

34. What is the most common type of ASD? What %?
Hypercoagulable state or underlying adenocarcinoma
Ostium secundum (90%)
White scar fibrosis
Sudden cardiac death

35. What structures are susceptible to rupture post MI?
Gelatinous - abundant ground substance
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Papillary muscle - free wall - IV septum
Doxorubicin - cocaine

36. What is the tx for VSD?
IV drug users
2-3 weeks
Surgical closure small defects may close spontaneously
Osler nodes (ouch - ouch Osler)

37. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
20 min
Aschoff bodies
Coexisting mitral stenosis and fusion of commisures exist
Holosystolic machine like murmur

38. What type of shunt does a VSD cause?
L->R
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Small - nondestructive vegetations (subacute endocarditis)
Hemosiderin laden macrophages

39. What is the characteristic murmurr of mitral stenosis?
Loeffler syndrome
Red border granulation tissue
Opening snap followed by diastolic rumble
Right side - serotonin and other secretory products detoxified in the lung

40. What disesase has Aschoff bodies?
Intercostal arteries enlarged due to collateral circulation
Aschoff bodies
Mitral stenosis
Myocarditis in acute rheumatic heart fever

41. How does Eisenmeger syndrome occur?
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
1-3 days
Loss of LV fx
Bacterial endocarditis

42. What are Osler nodes?
Contraction band necrosis - reperfusion injury
Mitral regurg
Tender lesions on fingers or toes.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

43. What does chronic ischemic heart disease progress to?
20 min
ACE inhibitor
CHF
Harmartoma

44. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Coronary artery vasospasm
RBC damaged while crossing the calcified valve causing schistocytes
Transesophageal echo

45. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Valve replacement AFTER the onset of complications
ASD - R-->L
Months out fibrosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

46. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Squatting - expiration
Systolic ejection click followed by crescendo - decrescendo murmur
Dilation of all four chambers of the heart

47. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Coronary artery vasospasm - emboli - vasculitis
LHF
Concentric LV hypertophy
Contraction band necrosis - reperfusion injury

48. How does contraction band necrosis occur?
Nitroglycerin
45%
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

49. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Endocarditis of prosthetic valves
Systemic venous congestion

50. What is the major cause of MI?
Pericarditits
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Annular - non pruritic rash w/erythematous borders trunks and limbs
Inability to fill ventricles