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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 is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Myocarditis in acute rheumatic heart fever
VSD
Systolic dysfx leading to biventricular CHF

2. What vavular defect results from acute rheumatic fever?
Plump fibroblasts - collagen - blood vessels
R-->L
Myocardium
Mitral regurgitation due to vegetations

3. What type of tumor is a rhabdomyoma?
Asymptomatic
Harmartoma
Sterile vegetations on surface and undersurface on mitral valve
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

4. What conditions can cause nonbacterial thrombotic endocarditis?
Streptococcus viridans
Rupture of free wall - IV septum - or papillary muscle
Tetralogy of fallot
Hypercoagulable state or underlying adenocarcinoma

5. What makes the MV prolapse murmur louder? Why?
Contraction band necrosis - reperfusion injury
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Squatting - increased systemic resistence decreases LV emptying
4-6 hours - 24 hours - 72 hours

6. Tx for PDA?
Indomethacin - decreases PGE
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
Backward LHF pulm htn and RHF - afib and associated mural thombis
Ventricles cannot pump

7. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Spontaneous
Bicuspid aortic valve
Ventricular arrhythmia

8. When do macrophagess infiltrate the myocardium post MI?
Congested central veins
Mid - systolic click followed by regurgitation murmur
Bounding pulse
4-7 days

9. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Fibrinous pericarditis
Reperfusion injury
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
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

10. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Contraction band necrosis - reperfusion injury
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myxoma - benign

11. What is the most common valve infected by S aureus?
Tricuspid
VSD
Posterior wall of LV - posterior septum - papillary muscles
Ostium secundum (90%)

12. What coronary artery supplies the mitral valve papillary muscles?
RCA
Prinzmetal angina - cocaine
NG or Ca channel blocker
Sudden cardiac death

13. What is the most common cause of myocarditis?
Stretched muscle loses contractility
Endocardial fibroelastosis (rare)
Coxsackie A or B
Sudden cardiac death

14. What endocarditis is commonly found in patients with colon cancer?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Months out fibrosis
Streptococcus bovis/
Gelatinous - abundant ground substance

15. What gross and microscopic changes occur 1-3 days after an MI?
Ostium secundum (90%)
4-7 days
Yellow pallor neutrophils
Osler nodes (ouch - ouch Osler)

16. What % stenosis causes stable angina?
PDA
>70%
ST- segment depression
Left -->right

17. How do nitrates tx MI?
Squatting - expiration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Type I
Decrease preload -->lowers myocardial stress

18. With what disease is Libman - Sacks endocarditis associated?
1-3 days
Right side - serotonin and other secretory products detoxified in the lung
Endocardial fibroelastosis (rare)
SLE

19. What effect does mitral stenosis have on the heart chambers?
Papillary muscle - free wall - IV septum
Aortic stenosis
Sudden cardiac death
LA dilation

20. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Fetal alcohol syndrome
L->R
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Nitroglycerin

21. What is the classic EKG finding of restrictive cardiomyopathy?
Decreased forward perfusion pulmonary congestion
PDA
Day 1-7
Low voltage EKG w/diminished QRS amplitude

22. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Bicuspid aortic valve
Chest pain <20 min brought on by exertion or emotional stress

23. What is systolic dysfx?
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
Ventricles cannot pump
White scar fibrosis

24. How does contraction band necrosis occur?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
When a bacterial protein resembles a protein in human tissue
LA dilation
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

25. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Rhabdomyoma
Concentric LV hypertophy
Heart transplant
Nonbacterial thrombotic endocarditis (marantic endocarditis)

26. What are Osler nodes?
2-3 weeks
Mitral stenosis
Atherosclerosis of coronary arteries
Tender lesions on fingers or toes.

27. Erythematous nontender lesions on palms and soles.
Janeway lesions
S epidermidis
Libman - Sacks endocarditis
S viridans

28. With what developmental disorder is VSD associated?
Atria and RV
Prinzmetal angina - cocaine
Fetal alcohol syndrome
Ventricular arrhythmia

29. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
3-8 wks
Months out fibrosis
Day 1-7
Rhabdomyoma

30. How does asprin/heparin tx MI?
Limits thrombosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
LA

31. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
VSD
Atria and RV

32. When do troponin levels rise - peak - and return to normal?
Contraction band necrosis
Janeway lesions
2-4 hours - 24 hours - 7-10 days
Heart can't fill

33. What % of MIs involve the LAD?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Opening snap followed by diastolic rumble
45%

34. What is a complication of chronic rheumatic heart disease?
Heart can't fill
Infectious endocarditis
Ischemic heart disease
Coexisting mitral stenosis and fusion of commisures exist

35. What causes acute endocarditis?
Large vegetations of S aureus
NG or Ca channel blocker
Mitral regurg
Preductal - post aortic arch

36. What does chronic ischemic heart disease progress to?
Preductal - post aortic arch
Right -->left
Eisenmenger syndrome
CHF

37. What side of the heart do carcinoid tumors affect? Why?
Thickening of chrodae tendinae and cusps - mitral stenosis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
4-7 days
Right side - serotonin and other secretory products detoxified in the lung

38. What causes angina and syncope in aortic stenosis?

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39. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Hypertrophic cardiomyopathy
Myocarditis
Papillary muscle - free wall - IV septum

40. What is the foundation of a scar?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Dilation of all four chambers of the heart
Granulation tissue
VSD

41. What iis the tx for aortic regurg?
Hypercoagulable state or underlying adenocarcinoma
Valve replacement once LV dysfx develops
Infantile coarctation of the aorta PDA
Regurg vs stenosis

42. What causes wear and tear aortic stenosis?
Coronary artery vasospasm - emboli - vasculitis
Infantile coarctation of the aorta PDA
Fibrosis and dystrophic calcification
Chest pain <20 min brought on by exertion or emotional stress

43. Which congenital heart defect is associated with congenital rubella?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PDA
Mitral stenosis
IV drug users

44. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Trisomy 21
Nonbacterial thrombotic endocarditis (marantic endocarditis)
ASD - R-->L
Ostium secundum (90%)

45. What is the main cause of MV regurg? What are other causes?
Limits thrombosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Migratory polyarthritis
AD mutation in sarcomere proteins

46. What is Dressler syndrome? When does it occur?
S aureus
Autoimmune pericarditis 6-8 wks post MI
Concentric LV hypertophy
Cardiogenic shock - CHF - arrhythmia

47. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Myxoma - benign
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Pts w/previously damaged valves

48. When does the heart have dark discoloration post MI?
Maternal diabetes
S aureus
4-24 hours
Mitral and tricuspid regurg - arrhythmia

49. Infects predamaged valves after transient bacteremia?
Right to left
S viridans
ST- segment depression
Regurg vs stenosis

50. What gross and microscopic changes occur 4-24 hours after an MI?
Anterior wall of LV and anterior septum
Dark discoloration coagulative necrosis
PDA
Erythematous nontender lesions on palms and soles.