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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. Lower extremity cyanosis in infants? In adults?
When a bacterial protein resembles a protein in human tissue
PDA
Infantile coarctation of the aorta PDA
ST- segment depression

2. What causes endocarditis of prosthetic valves?
When a bacterial protein resembles a protein in human tissue
Squat in response to cyanotic spell
Decreased forward perfusion pulmonary congestion
S epidermidis

3. What is endocardial fibroelastosis? In what population is it found?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Limits thrombosis
Prinzmetal
Months out fibrosis

4. How does ischemia cause LHF?
Loss of fx
Shunt
Paradoxical emboli
Posterior wall of LV - posterior septum - papillary muscles

5. What vavular defect results from acute rheumatic fever?
Wear and tear
Surgical closure small defects may close spontaneously
Mitral regurgitation due to vegetations
Reversible

6. In transposition of the great vessels - What is required for survival? How is this achieved?
Kawasaki disease
Congestive heart failure
Shunt - PGE to maintain PDA until surgical repair can be performed
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

7. Dilated cardiomyopathy is a late complication of what illness?
RHF
PDA
Doxorubicin - cocaine
Myocarditis

8. What structures are susceptible to rupture post MI?
Loss of fx
Membrane damage
LA dilation
Papillary muscle - free wall - IV septum

9. What is the murmur of mitral regurg?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Holosystolic blowing murmur
Cyanosis - RV hypertrophy - polycythemia - clubbing
Endocarditis of prosthetic valves

10. What type of ischemia does stable angina cause?
Subendocardial
Coxsackie A or B
Decrease in blood flow to an organ
Increased blood in right heart delays closure of P valve

11. What maintains patency of the PDA?
Contraction band necrosis - reperfusion injury
Adult coarctation of the aorta
PGE
Right -->left

12. What is eythema marginatum? What parts of the body does it commonly involve?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Heart can't fill
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Annular - non pruritic rash w/erythematous borders trunks and limbs

13. What coronary artery supplies the mitral valve papillary muscles?
CHF
Coexisting mitral stenosis and fusion of commisures exist
RCA
When a bacterial protein resembles a protein in human tissue

14. What are the tx for MI?
Friction rub and chest pain
Reperfusion injury
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
MI

15. When is an MI pt at greatest risk for cardiogenic shock?
Right to left
Hypertophy of RV atrophy of LV
>60 years - bicuspid aortic valve
First 4 hours

16. What is the effect of mitral regurg on the heart?
Congestive heart failure
Infectious endocarditis
Squat in response to cyanotic spell
Volume overload and LHF

17. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Breast and lung carcinoma - melanoma - lymphoma
SLE
Wear and tear

18. Which vasculitis can cause MI?
Mitral valve prolapse
Kawasaki disease
Boot shaped heart
Degree of pulmonary artery stenosis

19. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Yellow pallor neutrophils
Mitral regurgitation due to vegetations
Valve scarring that arises as a consequence of rheumatic fever

20. What is the most common form of cardiomyopathy?
2-4 hours - 24 hours - 7-10 days
Prophylactic abx during dental procedures
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Dilated

21. With what developmental disorder is VSD associated?
Pump failure
Fetal alcohol syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Congenital rubella

22. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Within the first day
Preductal - post aortic arch
S viridans
Nonbacterial thrombotic endocarditis (marantic endocarditis)

23. What is the rate of mitral valve prolapse in the US?
2-3%
Osler nodes (ouch - ouch Osler)
Elevated ASO anti - DNase B titers
Mitral regurg

24. What does rupture of the LV free wall cause?
NG or Ca channel blocker
RBC damaged while crossing the calcified valve causing schistocytes
Cardiac tamponade
Slow HR - decreasing O2 demand and risk for arrhythmia

25. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Volume overload and LHF
Small - nondestructive vegetations (subacute endocarditis)
Endocarditis of prosthetic valves
MI

26. What type of shunt dose PDA cause?
Loss of fx
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
R-->L
Left -->right

27. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Posterior wall of LV - posterior septum - papillary muscles
Months out fibrosis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
MI

28. What are the clinical features of LHF due to?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Prinzmetal
Decreased forward perfusion pulmonary congestion
Mitral mitral+aortic

29. What is the most common cause of RHF? What are others?
Coxsackie A or B
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Reperfusion injury
Autoimmune pericarditis 6-8 wks post MI

30. What imaging test is useful for detecting lesions on valves?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Elevated ASO anti - DNase B titers
Transesophageal echo

31. Vegetations on surface and undersurface of mitral valve.
Reperfusion injury
4-6 hours - 24 hours - 72 hours
Large vegetations of S aureus
Libman - Sacks endocarditis

32. How does restrictive cardiomyopathy cause LHF?

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33. What increases the volume of mitral regurg murmur?
Squatting - expiration
Eisenmenger syndrome
Reactive histiocyte with caterpillar nucleus
Transesophageal echo

34. What valves are most commonly involved in chronic rheumatic heart disease?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reactive histiocyte with caterpillar nucleus
Mitral mitral+aortic
Autoimmune pericarditis 6-8 wks post MI

35. What is the cause of restrictive cardiomyopathy in children?
Mitral regurg
RCA
Squat in response to cyanotic spell
Endocardial fibroelastosis (rare)

36. What are the cancers that most commonly metastasize to the heart?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Breast and lung carcinoma - melanoma - lymphoma
Paradoxical emboli
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

37. What tests show prior group A beta - hemolytic strep infection?
Hemosiderin laden macrophages
Large vegetations of S aureus
Elevated ASO anti - DNase B titers
PDA

38. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Metastasis
Reperfusion injury
4-24 hours

39. What effect does aortic stenosis have on the chambers of the heart?
Kawasaki disease
Concentric LV hypertophy
Maternal diabetes
Prinzmetal angina - cocaine

40. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Libman - Sacks endocarditis
Mitral regurgitation due to vegetations
Months out fibrosis

41. What gross and microscopic changes occur 1-3 days after an MI?
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
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
RCA
Yellow pallor neutrophils

42. What causes a mid - systolic click followed by a regurgitation murmur?
Sudden cardiac death
Chest pain <20 min brought on by exertion or emotional stress
Right side - serotonin and other secretory products detoxified in the lung
Mitral valve prolapse

43. With what endocarditis is S epidermidis associated?
Nitroglycerin
Endocarditis of prosthetic valves
Decreases LV dilation by decreasing volume
Chest pain <20 min brought on by exertion or emotional stress

44. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
LAD
Right -->left
RHF
Regurg vs stenosis

45. What is the most common congenital heart defect?
Bacterial endocarditis
VSD
R-->L
Stable and unstable prinzmetal

46. How does O2 tx MI?
Minimizes ischemia
Coronary artery vasospasm
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Fibrosis and dystrophic calcification

47. What two things happen when a blocked vessel is opened after an MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Contraction band necrosis - reperfusion injury
Infectious

48. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Atherosclerosis of coronary arteries
Decreased forward perfusion pulmonary congestion

49. What type of collagen is involved in fibrosis?
Type I
4-7 days
Infectious
Streptococcus viridans

50. What is the most common primary cardiac tumor in children? Is it malignant or benign?
LV dilation and eccentric hypertrophy
Systolic ejection click followed by crescendo - decrescendo murmur
Rhadbomyoma - benign
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

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