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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. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Endocarditis of prosthetic valves
Anitschow cell
Pericarditits
Bacterial endocarditis

2. When does the heart have dark discoloration post MI?
4-24 hours
Troponin I
Chronic ischemic heart disease
Mitral and tricuspid regurg - arrhythmia

3. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Day 1-7
Erythematous nontender lesions on palms and soles.
Hypertophy of RV atrophy of LV

4. What are the major criteria of the Jones criteria?
Coexisting mitral stenosis and fusion of commisures exist
1%
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Transposition of the great vessels

5. Why would cardiac enzymes continue to increase after the initial MI?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
>70%
Reperfusion injury
Mitral valve prolapse

6. What is typically the mechanims of sudden cardiac death?
Autoimmune pericarditis 6-8 wks post MI
Ventricular arrhythmia
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Sterile vegetations on surface and undersurface on mitral valve

7. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Myocarditis in acute rheumatic heart fever
4-24 hours
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

8. How does O2 tx MI?
1-3 days
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Minimizes ischemia
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

9. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Tender lesions on fingers or toes.
Granulation tissue
Annular - non pruritic rash w/erythematous borders trunks and limbs

10. What drug relieves stable angina?
Type I
Nitroglycerin
>70%
Decrease preload -->lowers myocardial stress

11. Why are cardiac enzymes elevated after an MI?
Hypertrophic cardiomyopathy
Myxoma - benign
Membrane damage
Myocardium

12. How long after pharyngitis does acute rheumatic fever occur?
Contraction band necrosis - reperfusion injury
Transesophageal echo
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
2-3 weeks

13. EKG for stable angina?
ST- segment depression
Ventricular arrhythmia
Paradoxical emboli
Louder - increased systemic resistence decreases LV emptying

14. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Breast and lung carcinoma - melanoma - lymphoma
Acute inflammation

15. How do ACE inhibitors tx MI?
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
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Decreases LV dilation by decreasing volume
Decrease preload -->lowers myocardial stress

16. What is a water - hammer pulse?
Bounding pulse
Eisenmenger syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

17. What is molecular mimicry?
Spontaneous
Yellow pallor neutrophils
When a bacterial protein resembles a protein in human tissue
Infantile coarctation of the aorta PDA

18. What are the sx of PDA at birth?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Asymptomatic
Indomethacin - decreases PGE
Slow HR - decreasing O2 demand and risk for arrhythmia

19. What is the most common valve infected by S aureus?
Coronary artery vasospasm
MI
Tricuspid
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

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

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21. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
1%
Hypercoagulable state or underlying adenocarcinoma
Troponin I

22. What type of vegetations does Strep viridans cause?
Nitroglycerin
Mitral insufficiency
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
Small - nondestructive vegetations (subacute endocarditis)

23. How does restrictive cardiomyopathy present?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Congestive heart failure
Nitroglycerin
Ventricular arrhythmia

24. In which pts does S viridans cause endocarditits?
Aortic regurg
Pts w/previously damaged valves
ST- segment elevation
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

25. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Red border granulation tissue
LAD
Holosystolic blowing murmur

26. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Restrictive cardiomyopathy
Mitral and tricuspid regurg - arrhythmia
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Asymptomatic

27. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
3-8 wks
Systolic ejection click followed by crescendo - decrescendo murmur
Ventricles cannot pump
LHF

28. What causes the nutmeg color in nutmeg liver?
Congested central veins
Hypertrophic cardiomyopathy
Heart transplant
Aneurysm - mural thrombus - Dressler syndrome

29. What gross and microscopic changes occur 4-7 days after an MI?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Red border granulation tissue
Yellow pallor macrophages

30. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Adult coarctation of the aorta
Nitroglycerin
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

31. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Coxsackie A or B
VSD
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
RCA

32. How does asprin/heparin tx MI?
Cardiogenic shock - CHF - arrhythmia
Intercostal arteries enlarged due to collateral circulation
Louder - increased systemic resistence decreases LV emptying
Limits thrombosis

33. What is the most common cause of infectious endocarditis?
Shunt - PGE to maintain PDA until surgical repair can be performed
Transposition of the great vessels
Streptococcus viridans
Myocarditis in acute rheumatic heart fever

34. How does MI cause LHF?
SLE
Loss of LV fx
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Infantile coarctation of the aorta

35. What does rupture of the IV septum cause?
Ostium primum
Shunt
Pancarditis
4-7 days macrophage infiltration

36. Pericarditis 6-8 wks post MI.
Dressler syndrome
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
Troponin I
Annular - non pruritic rash w/erythematous borders trunks and limbs

37. What is diastolic dysfx?
Inability to fill ventricles
Day 1-7
Endocarditis of prosthetic valves
ST- segment depression

38. How does hypertension cause LHF?

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39. What congenital heart defect presents later in life with lower extremity cyanosis?
Holosystolic machine like murmur
PDA
Congenital rubella
Congested central veins

40. What is an Anitschow cell?
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
Heart can't fill
Reactive histiocyte with caterpillar nucleus
Large - destructive vegetations

41. What type of valvular vegetations does S aureus cause?
NG or Ca channel blocker
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Large - destructive vegetations
Fetal alcohol syndrome

42. With what disease is infantile coarctation of the aorta associated?
Ventricles cannot pump
Turner syndrome
Ehlers - Danlow and Marfan syndrome
Myocarditis

43. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
1-3 days out
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

44. What is the tx for LHF?
Infantile coarctation of the aorta PDA
Yellow pallor neutrophils
ACE inhibitor
Louder - increased systemic resistence decreases LV emptying

45. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Valve replacement
Chest pain <20 min brought on by exertion or emotional stress
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

46. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Erythematous nontender lesions on palms and soles.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Blood vessels coming in from normal tissue

47. How does ischemia cause LHF?
Friction rub and chest pain
1-3 days out
Reversible
Loss of fx

48. What % of MIs involve the LAD?
45%
Loeffler syndrome
Rhadbomyoma - benign
Gelatinous - abundant ground substance

49. What is eythema marginatum? What parts of the body does it commonly involve?
Within the first day
Infectious endocarditis - arrythmias - severe mitral regurg no
Annular - non pruritic rash w/erythematous borders trunks and limbs
LAD

50. What are the tx for MI?
Ostium primum
Colon cancer
Myocarditis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty