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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 sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
IV drug users
Myocardium
Dark discoloration coagulative necrosis

2. How does fibrinolysis/angioplasty tx MI?
Aschoff bodies
Open blocked vessels
Regurg vs stenosis
RHF

3. Dense layer of elastic and fibrotic tissue in the endocardium.
Breast and lung carcinoma - melanoma - lymphoma
Anitschow cell
Endocardial fibroelastosis
2-3 weeks

4. With what congenital heart defect is ADULT coarctation of the aorta associated?
Nitroglycerin
Bicuspid aortic valve
Open blocked vessels
Pts w/previously damaged valves

5. What congenital heart defect does indomethacin tx?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Ehlers - Danlow and Marfan syndrome
PDA
Dense layer of elastic and fibrotic tissue in the endocardium - children

6. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Plump fibroblasts - collagen - blood vessels
Slow HR - decreasing O2 demand and risk for arrhythmia

7. What type of ischemia does stable angina cause?
ST- segment elevation
1%
Subendocardial
Tuberous sclerosis

8. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
CHF
Contraction band necrosis
4-7 days
ASD - R-->L

9. What is the rate of congenital heart defects?
Papillary muscle - free wall - IV septum
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
1%
RHF

10. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Coexisting mitral stenosis and fusion of commisures exist
Systemic venous congestion
2-4 hours - 24 hours - 7-10 days

11. What type of vegetations are associated with Libman - Sacks endocarditis?
Months out fibrosis
Dressler syndrome
Sterile vegetations on surface and undersurface on mitral valve
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

12. What murmur ccan be heard in PDA?
Hemosiderin laden macrophages
Nitroglycerin
Holosystolic machine like murmur
Regurg vs stenosis

13. What is the most common cause of aortic stenosis?
Wear and tear
LAD
Indomethacin - decreases PGE
Membrane damage

14. What does nonbacterial thrombotic endocarditis cause?
Fetal alcohol syndrome
Loeffler syndrome
LA dilation
Mitral regurg

15. Which vasculitis can cause MI?
Aortic regurg
Pancarditis
Stable angina
Kawasaki disease

16. Low voltage EKG w/diminished QRS amplitude.
Posterior wall of LV - posterior septum - papillary muscles
Reversible
Plump fibroblasts - collagen - blood vessels
Restrictive cardiomyopathy

17. What is a complication of chronic rheumatic heart disease?
Pts w/previously damaged valves
Infectious endocarditis
Heart can't fill
4-7 days macrophage infiltration

18. What maintains patency of the PDA?
PGE
VSD
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Myxoid degeneration

19. Opening snap followed by diastolic rumble.
Membrane damage
2-3 weeks
Minimizes ischemia
Mitral stenosis

20. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Adult coarctation of the aorta
Boot shaped heart
Anitschow cell
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

21. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Endocardial fibroelastosis
Papillary muscle - free wall - IV septum
LV dilation and eccentric hypertrophy

22. What is an Anitschow cell?
>60 years - bicuspid aortic valve
S aureus
Endocardial fibroelastosis (rare)
Reactive histiocyte with caterpillar nucleus

23. What are the four defects in tetralogy of fallot?
PGE
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Aortic stenosis
Yellow pallor macrophages

24. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Infantile coarctation of the aorta
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Left -->right

25. What type of collagen is involved in fibrosis?
Open blocked vessels
Mitral mitral+aortic
Type I
CHF

26. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Stretched muscle loses contractility
Concentric LV hypertophy
Prinzmetal angina

27. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Stable and unstable prinzmetal
Pulsating nail bed
Type I
>60 years - bicuspid aortic valve

28. With what developmental disorder is VSD associated?
Volume overload and LHF
First 4 hours
Fetal alcohol syndrome
Nonspecific - eg fever and elevated ESR

29. What characterizes acute rheumatic fever endocarditiis?
Troponin I
Small vegetations along the line of closure
Limits thrombosis
Myocarditis

30. What gross and microscopic changes occur 4-24 hours after an MI?
Adult coarctation of the aorta
Dense layer of elastic and fibrotic tissue in the endocardium - children
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Dark discoloration coagulative necrosis

31. What is the cause of restrictive cardiomyopathy in children?
4-6 hours - 24 hours - 72 hours
Endocardial fibroelastosis (rare)
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Hypertophy of RV atrophy of LV

32. What causes the nutmeg color in nutmeg liver?
Bacterial endocarditis
2-4 hours - 24 hours - 7-10 days
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Congested central veins

33. How do you tx prinzmetal angina?
NG or Ca channel blocker
Congenital rubella
Opening snap followed by diastolic rumble
45%

34. When do troponin levels rise - peak - and return to normal?
Mid - systolic click followed by regurgitation murmur
Nonspecific - eg fever and elevated ESR
2-4 hours - 24 hours - 7-10 days
LV dilation and eccentric hypertrophy

35. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Aneurysm - mural thrombus - Dressler syndrome
R-->L
Chronic ischemic heart disease

36. What gross and microscopic changes occur 1-3 weeks after an MI?
Ehlers - Danlow and Marfan syndrome
Nonspecific - eg fever and elevated ESR
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Red border granulation tissue

37. What is the etiology of S viridans endocarditis?
LHF
Bounding pulse
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Wear and tear

38. How does aortic regurg affect the heart chambers?
Positive blood cultures anemia of chronic disease
Libman - Sacks endocarditis
VSD
LV dilation and eccentric hypertrophy

39. What are heart failure cells?
Mitral regurgitation due to vegetations
Hemosiderin laden macrophages
Limits thrombosis
Maternal diabetes

40. What type of shunt dose PDA cause?
Left -->right
Contraction band necrosis - reperfusion injury
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
PDA

41. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Hypertrophic cardiomyopathy
RBC damaged while crossing the calcified valve causing schistocytes
Transesophageal echo

42. What does rupture of the LV free wall cause?
RHF
Cardiac tamponade
Decrease in blood flow to an organ
Inability to fill ventricles

43. How does restrictive cardiomyopathy cause LHF?

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44. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
LA dilation
Prinzmetal
Shunt - PGE to maintain PDA until surgical repair can be performed
Adult coarctation of the aorta

45. How do you prevent S viridans endocarditis?
Circumflex
Left -->right
Stretched muscle loses contractility
Prophylactic abx during dental procedures

46. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Valve replacement
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Backward LHF pulm htn and RHF - afib and associated mural thombis

47. Is scar tissue or myocardium stronger?
Myocardium
CK- MB
IV drug users
Contraction band necrosis

48. What areas of the heart does the RCA supply?
Congestive heart failure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Posterior wall of LV - posterior septum - papillary muscles
Red border granulation tissue

49. What is the most comon cause of aortic regurg? What are the other causes?
Squatting - increased systemic resistence decreases LV emptying
Increased hydrostatic pressure
Infectious endocarditis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

50. Large vegetations on tricuspid valve?
White scar fibrosis
S aureus
Congested central veins
4-7 days