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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 cause of restrictive cardiomyopathy in children?
Prinzmetal stable and unstable
20 min
Endocardial fibroelastosis (rare)
Libman - Sacks endocarditis

2. What murmur ccan be heard in PDA?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mitral regurg
Holosystolic machine like murmur
Dilation of all four chambers of the heart

3. What is diastolic dysfx?
Inability to fill ventricles
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Minimizes ischemia
Endocardial fibroelastosis (rare)

4. With what condition are rhabdomyomas associated?
Tuberous sclerosis
4-7 days macrophage infiltration
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
PDA

5. What creates the immune reaction in acute rhuematic fever?

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6. What type of ischemia does stable angina cause?
Endocarditis of prosthetic valves
Subendocardial
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Granulation tissue

7. What is the most common cause of myocarditis?
Contraction band necrosis
VSD
Coxsackie A or B
Small - nondestructive vegetations (subacute endocarditis)

8. What is the definition of ischemia?
Decrease in blood flow to an organ
Pulsating nail bed
Posterior wall of LV - posterior septum - papillary muscles
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

9. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Mitral stenosis
Loeffler syndrome
Prinzmetal
Louder - increased systemic resistence decreases LV emptying

10. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Paradoxical emboli
Pts w/previously damaged valves
Louder - increased systemic resistence decreases LV emptying

11. What are the forward and backward sx of LHF?
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
Endocardial fibroelastosis (rare)
Subendocardial
S aureus

12. What structures are susceptible to rupture post MI?
Mitral and tricuspid regurg - arrhythmia
Rhabdomyoma
Blood vessels coming in from normal tissue
Papillary muscle - free wall - IV septum

13. What does Libman - Sacks endocarditis cause?
Reperfusion injury
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Volume overload and LHF
Mitral regurg

14. What type of shunt results in cyanosis at birth?
Systemic venous congestion
Spontaneous
PDA
Right to left

15. What genetic conditions predispose a pt to mitral valve prolapse?
Metastasis
Ehlers - Danlow and Marfan syndrome
LHF
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

16. What is an Aschoff body?
Ostium secundum (90%)
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Shunt
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

17. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Myocardium
Type I
Trisomy 21

18. What does nonbacterial thrombotic endocarditis cause?
Ventricular arrhythmia
Adult coarctation of the aorta
Preductal - post aortic arch
Mitral regurg

19. When does the heart have a yellow pallor post MI?
Atherosclerosis of coronary arteries
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Chest pain <20 min brought on by exertion or emotional stress
Day 1-7

20. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Shunt
Thickening of chrodae tendinae and cusps - mitral stenosis
Stable angina

21. Pericarditis 6-8 wks post MI.
Dressler syndrome
Erythematous nontender lesions on palms and soles.
Mitral regurg
Ostium primum

22. How does reperfusion injury occur?
Tricuspid
Opening snap followed by diastolic rumble
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Circumflex

23. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Valve replacement
Janeway lesions
Myofiber hypertrophy with disarray

24. What are the major criteria of the Jones criteria?
Heart transplant
Slow HR - decreasing O2 demand and risk for arrhythmia
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
R-->L

25. What are Osler nodes?
Mitral regurg
Bounding pulse
Tender lesions on fingers or toes.
Infantile coarctation of the aorta

26. What effect does transposition of the great vessels have on the ventricles?
Hemosiderin laden macrophages
Hypertophy of RV atrophy of LV
R-->L
When a bacterial protein resembles a protein in human tissue

27. At what point in development do congenital heart defects arise?
Endocardial fibroelastosis
4-6 hours - 24 hours - 72 hours
3-8 wks
Libman - Sacks endocarditis

28. 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.
Stable angina
Myocarditis
Coronary artery vasospasm
Ventricles cannot pump

29. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Tuberous sclerosis
Asymptomatic

30. What is systolic dysfx?
4-6 hours - 24 hours - 72 hours
Ventricles cannot pump
Cardiogenic shock - CHF - arrhythmia
Maternal diabetes

31. What is the tx for mitral valve prolapse?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Endocardial fibroelastosis
Valve replacement
Kawasaki disease

32. How do you tx prinzmetal angina?
NG or Ca channel blocker
Pump failure
Doxorubicin - cocaine
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

33. Ostium primum ASD is associated with what congenital disorder?
Heart can't fill
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
MI
Trisomy 21

34. How does dilated cardiomyopathy cause LHF?
Elevated ASO anti - DNase B titers
Stretched muscle loses contractility
Hemosiderin laden macrophages
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

35. What is an important complication of ASD?
Breast and lung carcinoma - melanoma - lymphoma
Paradoxical emboli
Colon cancer
Months out fibrosis

36. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Heart can't fill
Mitral valve prolapse
Tricuspid
Louder - increased systemic resistence decreases LV emptying

37. Boot - shaped heart on x- ray?
Tetralogy of fallot
Elevated ASO anti - DNase B titers
Volume overload and LHF
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

38. What causes a mid - systolic click followed by a regurgitation murmur?
MI
Low voltage EKG w/diminished QRS amplitude
Mitral valve prolapse
Circumflex

39. What gross and microscopic changes occur 1-3 weeks after an MI?
Right side - serotonin and other secretory products detoxified in the lung
Endocardial fibroelastosis
Red border granulation tissue
Chronic ischemic heart disease

40. Tender lesions on fingers or toes.
Membrane damage
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
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Osler nodes (ouch - ouch Osler)

41. What increases the volume of mitral regurg murmur?
Squatting - expiration
First 4 hours
Mitral insufficiency
Congested central veins

42. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
2-3%
Small - nondestructive vegetations (subacute endocarditis)
R-->L
Aortic regurg

43. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Pulsating nail bed
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Increased hydrostatic pressure

44. What gross and microscopic changes occur 4-7 days after an MI?
Anterior wall of LV and anterior septum
Fibrinous pericarditis
Yellow pallor macrophages
PDA

45. What cardiac disease is associated with tuberous sclerosis?
Cardiac tamponade
Rhabdomyoma
RCA
Congested central veins

46. What is the major cause of MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Harmartoma

47. What causes mitral valve prolapse?
20 min
Myxoid degeneration
VSD
ST- segment depression

48. What are the Jones criteria?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Increased hydrostatic pressure
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
2-4 hours - 24 hours - 7-10 days

49. How does restrictive cardiomyopathy present?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Congestive heart failure
Hypertrophic cardiomyopathy

50. What are the complications of mitral valve prolapse? Are they common?
Infectious
Infectious endocarditis - arrythmias - severe mitral regurg no
Tender lesions on fingers or toes.
Sterile vegetations on mitral valve along lines of closure