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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 cardiac disease is associated with tuberous sclerosis?
LAD
Rhabdomyoma
Mitral mitral+aortic
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

2. What causes the dependent pitting edema in RHF?
Small - nondestructive vegetations (subacute endocarditis)
Transesophageal echo
Increased hydrostatic pressure
Large - destructive vegetations

3. What are the complications that occur months after an MI?
Anitschow cell
1-3 days
45%
Aneurysm - mural thrombus - Dressler syndrome

4. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Anitschow cell
L->R
Anterior wall of LV and anterior septum

5. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
When a bacterial protein resembles a protein in human tissue
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

6. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Rhabdomyoma
Nitroglycerin
Backward LHF pulm htn and RHF - afib and associated mural thombis

7. What is the cause of the red border around granulation tissue?
Dense layer of elastic and fibrotic tissue in the endocardium - children
PDA
Prinzmetal angina
Blood vessels coming in from normal tissue

8. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Prinzmetal
Stable and unstable prinzmetal
Months out fibrosis
Shunt

9. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RHF
Transesophageal echo
ACE inhibitor
RCA

10. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Boot shaped heart
Decreases LV dilation by decreasing volume
Nonspecific - eg fever and elevated ESR

11. What are the complications of aortic stenosis?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Squatting - increased systemic resistence decreases LV emptying
Subendocardial
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

12. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Hypertrophic cardiomyopathy
Asymptomatic
Coxsackie A or B

13. What causes microangiopathic hemolytic anemia in aortic stenosis?
Right to left
ST- segment elevation
Pericarditits
RBC damaged while crossing the calcified valve causing schistocytes

14. What does rupture of the LV free wall cause?
Cardiac tamponade
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
S epidermidis
Coxsackie A or B

15. What causes heart failure cells?
Prinzmetal angina
Atherosclerosis of coronary arteries
Fibrinous pericarditis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

16. What effect does mitral stenosis have on the heart chambers?
Pancarditis
LA dilation
Valve scarring that arises as a consequence of rheumatic fever
Infectious

17. When does the heart have dark discoloration post MI?
4-24 hours
Small vegetations along the line of closure
Pancarditis
>60 years - bicuspid aortic valve

18. What % of MIs involve the LAD?
45%
Myofiber hypertrophy with disarray
Congested central veins
SLE

19. What is chronic rheumatic heart disease?
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
Valve scarring that arises as a consequence of rheumatic fever
Coexisting mitral stenosis and fusion of commisures exist
Mitral regurgitation due to vegetations

20. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
VSD
Systemic venous congestion
Tetralogy of fallot

21. Which vasculitis can cause MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Heart can't fill
Rupture of free wall - IV septum - or papillary muscle
Kawasaki disease

22. What causes notching of the ribs in adult coarctation of the aorta?
Congested central veins
Mitral regurg
Regurg vs stenosis
Intercostal arteries enlarged due to collateral circulation

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

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24. What is the gold standard blood marker for MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Limits thrombosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Troponin I

25. Which congenital heart defect is associated with congenital rubella?
Ehlers - Danlow and Marfan syndrome
Cardiogenic shock - CHF - arrhythmia
PDA
1%

26. Which angina is relieved by Ca channel blockers?
Tricuspid
Dilation of all four chambers of the heart
When a bacterial protein resembles a protein in human tissue
Prinzmetal

27. How does asprin/heparin tx MI?
Left -->right
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Intercostal arteries enlarged due to collateral circulation
Limits thrombosis

28. What disesase has Aschoff bodies?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
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
Myocarditis in acute rheumatic heart fever
LAD

29. What are the sx of right - to - left shunt?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Cyanosis - RV hypertrophy - polycythemia - clubbing
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LA

30. What vavular defect results from acute rheumatic fever?
Day 1-7
Louder - increased systemic resistence decreases LV emptying
Mitral regurgitation due to vegetations
Ostium primum

31. What gross and microscopic changes occur 1-3 days after an MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
L->R
Slow HR - decreasing O2 demand and risk for arrhythmia
Yellow pallor neutrophils

32. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
CHF
Paradoxical emboli
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

33. What causes an early - blowing diastolic murmur?
Hemosiderin laden macrophages
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Aortic regurg
2-3 weeks

34. What does rupture of the IV septum cause?
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
2-3%
Shunt
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

35. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Tetralogy of fallot
Posterior wall of LV - posterior septum - papillary muscles
Aschoff bodies
Mitral stenosis

36. When do troponin levels rise - peak - and return to normal?
SLE
2-4 hours - 24 hours - 7-10 days
Myxoid degeneration
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

37. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Breast and lung carcinoma - melanoma - lymphoma
CHF
Granulation tissue

38. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Prinzmetal stable and unstable
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Sterile vegetations on surface and undersurface on mitral valve
Colon cancer

39. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Mitral mitral+aortic
Libman - Sacks endocarditis
4-24 hours

40. Infects predamaged valves after transient bacteremia?
S viridans
Endocardial fibroelastosis
Reperfusion injury
PGE

41. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Acute inflammation
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Chronic rheumatic heart disease

42. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
RCA
Mitral regurg

43. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Myofiber hypertrophy with disarray
Volume overload and LHF
LAD

44. What is the most common form of cardiomyopathy?
Anterior wall of LV and anterior septum
Dilated
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Sudden cardiac death

45. How do you prevent S viridans endocarditis?
Pump failure
Coexisting mitral stenosis and fusion of commisures exist
Sterile vegetations on mitral valve along lines of closure
Prophylactic abx during dental procedures

46. What type of shunt results in cyanosis at birth?
Right to left
1-3 days out
Granulation tissue
Pedunculated mass in the LA that causes syncope due to obstruction of MV

47. When is an MI pt at greatest risk for cardiogenic shock?
Aortic regurg
First 4 hours
Large - destructive vegetations
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

48. What are the major criteria of the Jones criteria?
Cardiac tamponade
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Paradoxical emboli
PDA

49. What is the tx for aortic stenosis?
Paradoxical emboli
Inability to fill ventricles
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Valve replacement AFTER the onset of complications

50. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Acute inflammation
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
>70%