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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 are the HACEK organisms? With what condition are they associated?
Turner syndrome
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Pericarditits
Positive blood cultures anemia of chronic disease

2. What type of shunt results in cyanosis at birth?
Bicuspid aortic valve
Tuberous sclerosis
Right to left
Posterior wall of LV - posterior septum - papillary muscles

3. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Red border granulation tissue
Aortic stenosis

4. What effect does aortic regurg have on the pulse pressure? Why?
LHF
Prinzmetal angina
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
1%

5. What effect does transposition of the great vessels have on the ventricles?
Shunt
Membrane damage
Pulsating nail bed
Hypertophy of RV atrophy of LV

6. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Volume overload and LHF
Chronic ischemic heart disease
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

7. What are the causes of restrictive cardiomyopathy in adults?
>60 years - bicuspid aortic valve
Streptococcus bovis/
Metastasis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

8. What is the most common type of endocarditis?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Right side - serotonin and other secretory products detoxified in the lung
Infectious
Coexisting mitral stenosis and fusion of commisures exist

9. Erythematous nontender lesions on palms and soles.
Janeway lesions
Ventricles cannot pump
Dilated
Inability to fill ventricles

10. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
>60 years - bicuspid aortic valve
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Prinzmetal angina - cocaine

11. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
LA

12. How does ischemia cause LHF?
Myocarditis in acute rheumatic heart fever
Increased blood in right heart delays closure of P valve
Yellow pallor macrophages
Loss of fx

13. What causes the dependent pitting edema in RHF?
Surgical closure small defects may close spontaneously
Acute inflammation
Contraction band necrosis - reperfusion injury
Increased hydrostatic pressure

14. What is chronic rheumatic heart disease?
Rupture of free wall - IV septum - or papillary muscle
20 min
Valve scarring that arises as a consequence of rheumatic fever
Osler nodes (ouch - ouch Osler)

15. Is scar tissue or myocardium stronger?
Myocardium
Decreases LV dilation by decreasing volume
Concentric LV hypertophy
Ostium secundum (90%)

16. What does granulation tissue contain?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
S epidermidis
Plump fibroblasts - collagen - blood vessels
Aortic regurg

17. How does restrictive cardiomyopathy present?
Surgical closure small defects may close spontaneously
Congestive heart failure
Prinzmetal
Nonbacterial thrombotic endocarditis (marantic endocarditis)

18. How do ACE inhibitors tx MI?
Bounding pulse
Opening snap followed by diastolic rumble
Decreases LV dilation by decreasing volume
45%

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

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20. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Pancarditis
RCA
Heart can't fill

21. What type of ischemia does stable angina cause?
Months out fibrosis
Subendocardial
Group A beta - hemolytic streptococci
Pericardial effusion due to pericardial involvement

22. When does the heart have dark discoloration post MI?
Tetralogy of fallot
Harmartoma
4-24 hours
NG or Ca channel blocker

23. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Concentric LV hypertophy
Mitral and tricuspid regurg - arrhythmia
Stable angina
Mitral insufficiency

24. How does reperfusion injury occur?
Anitschow cell
Elevated ASO anti - DNase B titers
Stable and unstable prinzmetal
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

25. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Positive blood cultures anemia of chronic disease
Yellow pallor macrophages
Intercostal arteries enlarged due to collateral circulation

26. What artery is the 2nd most often occluded in an MI?
Mitral mitral+aortic
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Trisomy 21
RCA

27. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Elevated ASO anti - DNase B titers
Systolic dysfx leading to biventricular CHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Months out fibrosis

28. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Chronic rheumatic heart disease
Asymptomatic
Migratory polyarthritis
Slow HR - decreasing O2 demand and risk for arrhythmia

29. Ostium primum ASD is associated with what congenital disorder?
Decreases LV dilation by decreasing volume
4-7 days
Trisomy 21
Adult coarctation of the aorta

30. Tx for PDA?
Indomethacin - decreases PGE
Maternal diabetes
Libman - Sacks endocarditis
Right -->left

31. What is the most common cause of myocarditis?
Myocarditis
Mitral regurg
Mitral stenosis
Coxsackie A or B

32. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Tricuspid
Ostium primum
Myxoma - benign
Backward LHF pulm htn and RHF - afib and associated mural thombis

33. Which artery is most often occluded in an MI?
NG or Ca channel blocker
Circumflex
LAD
Breast and lung carcinoma - melanoma - lymphoma

34. When does the heart have a yellow pallor post MI?
RCA
Endocardial fibroelastosis
Indomethacin - decreases PGE
Day 1-7

35. What is the 1day-1wk -1mo mneumonic for MI?
Large - destructive vegetations
Systolic ejection click followed by crescendo - decrescendo murmur
Reperfusion injury
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

36. How does restrictive cardiomyopathy cause LHF?

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37. How does adult coarctation of the aorta present?
Valve replacement
R-->L
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Gelatinous - abundant ground substance

38. What gross and microscopic changes occur 1-3 weeks after an MI?
Fetal alcohol syndrome
Red border granulation tissue
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Within the first day

39. What effect does chronic rheumatic heart disease have the mitral valve?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Systolic ejection click followed by crescendo - decrescendo murmur
Thickening of chrodae tendinae and cusps - mitral stenosis
Coexisting mitral stenosis and fusion of commisures exist

40. What does rupture of a papillary muscle cause?
Mitral insufficiency
LV dilation and eccentric hypertrophy
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Ventricles cannot pump

41. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Colon cancer
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Ventricular arrhythmia

42. What endocarditis is commonly found in patients with colon cancer?
1-3 days out
Myxoid degeneration
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Streptococcus bovis/

43. What type of shunt does truncus arteriosus cause?
S aureus
R-->L
Posterior wall of LV - posterior septum - papillary muscles
Small vegetations along the line of closure

44. EKG for stable angina?
Plump fibroblasts - collagen - blood vessels
ST- segment depression
Rupture of free wall - IV septum - or papillary muscle
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

45. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Maternal diabetes
Janeway lesions
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Streptococcus bovis/

46. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
LHF
Group A beta - hemolytic streptococci

47. How does contraction band necrosis occur?
Janeway lesions
Stable and unstable prinzmetal
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

48. What causes mitral valve prolapse?
White scar fibrosis
Pump failure
Janeway lesions
Myxoid degeneration

49. What causes prinzmetal angina?
Transesophageal echo
Valve scarring that arises as a consequence of rheumatic fever
Congenital rubella
Coronary artery vasospasm

50. What causes an early - blowing diastolic murmur?
Aortic regurg
Bacterial endocarditis
Tender lesions on fingers or toes.
Erythematous nontender lesions on palms and soles.