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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 is the tx for LHF?
Stretched muscle loses contractility
VSD
ACE inhibitor
Reperfusion injury

2. Which angina(s) show ST elevation on EKG? ST depression?
Reversible
Prinzmetal stable and unstable
R-->L
Membrane damage

3. How do ACE inhibitors tx MI?
Chronic ischemic heart disease
Rupture of free wall - IV septum - or papillary muscle
ST- segment elevation
Decreases LV dilation by decreasing volume

4. What is the leading cause of death in the US?
IV drug users
Ischemic heart disease
Backward LHF pulm htn and RHF - afib and associated mural thombis
ACE inhibitor

5. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Prophylactic abx during dental procedures
Mitral mitral+aortic
Left -->right

6. What is the most common congenital heart defect?
Shunt - PGE to maintain PDA until surgical repair can be performed
RCA
VSD
Mitral stenosis

7. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Mitral mitral+aortic
Prinzmetal
MI
Day 1-7

8. With what disease is transposition of the great vessels associated?
Maternal diabetes
Plump fibroblasts - collagen - blood vessels
Membrane damage
Pulsating nail bed

9. What are the sx/complications of myocarditis?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Papillary muscle - free wall - IV septum
Aortic regurg
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

10. What congenital heart defect presents later in life with lower extremity cyanosis?
Volume overload and LHF
PDA
Libman - Sacks endocarditis
Cardiogenic shock - CHF - arrhythmia

11. Holosystolic blowing murmur that increases w/expiration?
Ehlers - Danlow and Marfan syndrome
Mitral regurg
Doxorubicin - cocaine
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

12. What is a Quincke pulse?
Red border granulation tissue
Mitral valve prolapse
Pulsating nail bed
Reversible

13. What type of endocarditis is associated with SLE?
Mitral stenosis
Congenital rubella
Libman - Sacks endocarditis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

14. What is the most common type of ASD? What %?
Rhabdomyoma
Systolic ejection click followed by crescendo - decrescendo murmur
Ostium secundum (90%)
VSD

15. When does the heart have dark discoloration post MI?
S viridans
Aschoff bodies
Tuberous sclerosis
4-24 hours

16. How does Eisenmeger syndrome occur?
Limits thrombosis
Myocarditis
Subendocardial
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

17. How does reperfusion injury occur?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Metastasis
Intercostal arteries enlarged due to collateral circulation

18. What is dilated cardiomyopathy?
Endocardial fibroelastosis (rare)
Holosystolic blowing murmur
LA dilation
Dilation of all four chambers of the heart

19. What congenital heart defect does indomethacin tx?
PDA
R-->L
Left -->right
Ventricle

20. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Trisomy 21
Myocardium
4-6 hours - 24 hours - 72 hours

21. What is diastolic dysfx?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
LAD
Reperfusion injury
Inability to fill ventricles

22. What effect does transposition of the great vessels have on the ventricles?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Hypertophy of RV atrophy of LV
Tetralogy of fallot
Pts w/previously damaged valves

23. What are other (not atherosclerotic) causes of MI?
Coronary artery vasospasm - emboli - vasculitis
Minimizes ischemia
4-24 hours
Cardiogenic shock - CHF - arrhythmia

24. What are the clinical features of endocarditis? What causes each feature?
Pericarditits
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
Right side - serotonin and other secretory products detoxified in the lung
Small vegetations along the line of closure

25. How does hypertension cause LHF?

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26. How do you prevent S viridans endocarditis?
Papillary muscle - free wall - IV septum
Prophylactic abx during dental procedures
Increased blood in right heart delays closure of P valve
Type I

27. What congenital heart defect is associated with fetal alcohol syndrome?
Libman - Sacks endocarditis
Elevated ASO anti - DNase B titers
>60 years - bicuspid aortic valve
VSD

28. What bug causes acute rheumatic fever?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
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
Group A beta - hemolytic streptococci
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

29. With what condition are rhabdomyomas associated?
Indomethacin - decreases PGE
Tuberous sclerosis
Prinzmetal angina - cocaine
Type I

30. What gross and microscopic changes occur 1-3 days after an MI?
1%
AD mutation in sarcomere proteins
Yellow pallor neutrophils
Low voltage EKG w/diminished QRS amplitude

31. What is the foundation of a scar?
ASD - R-->L
Elevated ASO anti - DNase B titers
CHF
Granulation tissue

32. What is the most common cause of myocarditis?
Acute inflammation
Coxsackie A or B
Mitral regurgitation due to vegetations
ST- segment depression

33. What are the sx of pericardiits?
Friction rub and chest pain
Rhabdomyoma
Aschoff bodies
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

34. What is the classic EKG finding of restrictive cardiomyopathy?
Ventricles cannot pump
Low voltage EKG w/diminished QRS amplitude
Bounding pulse
Holosystolic blowing murmur

35. How does subendocardial MI/ischemia present on EKG?
Valve scarring that arises as a consequence of rheumatic fever
ST- segment depression
Stretched muscle loses contractility
Endocardial fibroelastosis (rare)

36. What is the most common tumor of the heart?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Metastasis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
RCA

37. Is injury due angina reversible or irreversible?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reversible
Heart transplant
PDA

38. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Open blocked vessels
4-6 hours - 24 hours - 72 hours
Endocardial fibroelastosis (rare)

39. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Aneurysm - mural thrombus - Dressler syndrome
Tuberous sclerosis
PDA

40. What are the major criteria of the Jones criteria?
Maternal diabetes
Day 1-7
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Small - nondestructive vegetations (subacute endocarditis)

41. What effect does dilated cardiomyopathy have on the heart?
Small vegetations along the line of closure
Ventricles cannot pump
Libman - Sacks endocarditis
Systolic dysfx leading to biventricular CHF

42. What valves are most commonly involved in chronic rheumatic heart disease?
Posterior wall of LV - posterior septum - papillary muscles
Pancarditis
Mitral mitral+aortic
Valve replacement AFTER the onset of complications

43. In transposition of the great vessels - What is required for survival? How is this achieved?
Tricuspid
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Shunt - PGE to maintain PDA until surgical repair can be performed
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

44. Is scar tissue or myocardium stronger?
Myocardium
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
Bounding pulse
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

45. What increases the volume of mitral regurg murmur?
Atria and RV
Squatting - expiration
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
Large - destructive vegetations

46. What does chronic ischemic heart disease progress to?
LHF
CHF
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Shunt

47. What type of shunt does a VSD cause?
L->R
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Louder - increased systemic resistence decreases LV emptying
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

48. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Aschoff bodies
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
ST- segment depression

49. What is systolic dysfx?
ST- segment elevation
Transesophageal echo
Ventricles cannot pump
Sterile vegetations on surface and undersurface on mitral valve

50. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
2-4 hours - 24 hours - 7-10 days
Limits thrombosis
Trisomy 21