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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 minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Small vegetations along the line of closure
Paradoxical emboli

2. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Large - destructive vegetations
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Migratory polyarthritis

3. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Anitschow cell
Libman - Sacks endocarditis
Sudden cardiac death
ACE inhibitor

4. What structures are susceptible to rupture post MI?
Myxoid degeneration
Bicuspid aortic valve
Papillary muscle - free wall - IV septum
Degree of pulmonary artery stenosis

5. What increases the volume of mitral regurg murmur?
Preductal - post aortic arch
Anterior wall of LV and anterior septum
Sterile vegetations on surface and undersurface on mitral valve
Squatting - expiration

6. What conditions can cause nonbacterial thrombotic endocarditis?
ST- segment depression
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Erythematous nontender lesions on palms and soles.
Hypercoagulable state or underlying adenocarcinoma

7. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Dilation of all four chambers of the heart

8. When do troponin levels rise - peak - and return to normal?
Coronary artery vasospasm - emboli - vasculitis
L->R
2-4 hours - 24 hours - 7-10 days
Atria and RV

9. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Positive blood cultures anemia of chronic disease
Valve replacement AFTER the onset of complications
Congenital rubella

10. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Heart can't fill
RHF
Janeway lesions
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

11. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
3-8 wks
4-24 hours
ST- segment depression

12. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
20 min
Squatting - expiration
VSD

13. What are the laboratory findings of bacterial endocarditis?
Right to left
Decreased forward perfusion pulmonary congestion
Positive blood cultures anemia of chronic disease
Right -->left

14. L- to - R shunt switching to R- to - L shunt.
Eisenmenger syndrome
LHF
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
2-3 weeks

15. What congenital heart defect does indomethacin tx?
Ventricular arrhythmia
Asymptomatic
Small vegetations along the line of closure
PDA

16. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
LA dilation
CHF
20 min
RCA

17. What is a water - hammer pulse?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Asymptomatic
Volume overload and LHF
Bounding pulse

18. With what endocarditis is S epidermidis associated?
Shunt - PGE to maintain PDA until surgical repair can be performed
Intercostal arteries enlarged due to collateral circulation
Endocarditis of prosthetic valves
Minimizes ischemia

19. What maintains patency of the PDA?
Asymptomatic
Months out fibrosis
PGE
SLE

20. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Heart transplant
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Dressler syndrome

21. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Small - nondestructive vegetations (subacute endocarditis)
4-7 days macrophage infiltration
Endocarditis of prosthetic valves

22. How does O2 tx MI?
Small - nondestructive vegetations (subacute endocarditis)
Minimizes ischemia
Rupture of free wall - IV septum - or papillary muscle
Heart transplant

23. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
MI
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
RBC damaged while crossing the calcified valve causing schistocytes
Mitral mitral+aortic

24. What is a common complication of cardiac metastasis?
Bacterial endocarditis
Stretched muscle loses contractility
Pericardial effusion due to pericardial involvement
Mitral insufficiency

25. When do neutrophils infiltrate the myocardium post MI?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
1-3 days
Cyanosis - RV hypertrophy - polycythemia - clubbing
Trisomy 21

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

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27. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Anitschow cell
Dilated
Sterile vegetations on mitral valve along lines of closure
ASD - R-->L

28. What is the major cause of MI?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal angina
Yellow pallor macrophages
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

29. What are the HACEK organisms? With what condition are they associated?
Nitroglycerin
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Hypertrophic cardiomyopathy
Stable angina

30. With what disease is infantile coarctation of the aorta associated?
Asymptomatic
>70%
Turner syndrome
Fetal alcohol syndrome

31. At what point in development do congenital heart defects arise?
VSD
3-8 wks
Mid - systolic click followed by regurgitation murmur
LAD

32. How does aortic regurg affect the heart chambers?
RCA
LA
LV dilation and eccentric hypertrophy
Erythematous nontender lesions on palms and soles.

33. Myofiber hypertrophy with disarray.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Mitral mitral+aortic
2-3 weeks
Hypertrophic cardiomyopathy

34. When is an MI pt at greatest risk for cardiogenic shock?
Degree of pulmonary artery stenosis
ST- segment depression
Tricuspid
First 4 hours

35. What does a biopsy of hypertrophic cardiomyopathy look like?
Increased hydrostatic pressure
Myofiber hypertrophy with disarray
Aneurysm - mural thrombus - Dressler syndrome
4-6 hours - 24 hours - 72 hours

36. What causes mitral valve prolapse?
Myxoid degeneration
4-6 hours - 24 hours - 72 hours
Dense layer of elastic and fibrotic tissue in the endocardium - children
Stretched muscle loses contractility

37. What are the complications of aortic stenosis?
Prinzmetal stable and unstable
PDA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Turner syndrome

38. What is Loeffler syndrome?
Troponin I
Tender lesions on fingers or toes.
Decrease in blood flow to an organ
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

39. What is typically the mechanims of sudden cardiac death?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
2-4 hours - 24 hours - 7-10 days
Ventricular arrhythmia
Nonbacterial thrombotic endocarditis (marantic endocarditis)

40. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Dark discoloration coagulative necrosis
Holosystolic machine like murmur
Fibrosis and dystrophic calcification

41. What is the murmur of mitral regurg?
Kawasaki disease
Valve replacement
Holosystolic blowing murmur
Small - nondestructive vegetations (subacute endocarditis)

42. What does granulation tissue contain?
Erythematous nontender lesions on palms and soles.
Plump fibroblasts - collagen - blood vessels
Louder - increased systemic resistence decreases LV emptying
Spontaneous

43. Is scar tissue or myocardium stronger?
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
Boot shaped heart
Myocardium
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

44. What are the forward and backward sx of LHF?
S aureus
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Heart transplant
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

45. How does contraction band necrosis occur?
Friction rub and chest pain
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Bicuspid aortic valve
R-->L

46. What is an important complication of ASD?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Paradoxical emboli
Infectious endocarditis - arrythmias - severe mitral regurg no
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

47. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Increased blood in right heart delays closure of P valve
Split S2 on auscultation
Within the first day
Reperfusion injury

48. Where is the coarctation in infantile coarctation of the aorta?
Rhadbomyoma - benign
Gelatinous - abundant ground substance
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Preductal - post aortic arch

49. What type of endocarditis is associated with SLE?
Systolic ejection click followed by crescendo - decrescendo murmur
Libman - Sacks endocarditis
Prinzmetal stable and unstable
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

50. What are the sx of aortic regurg?
1-3 days
Ventricles cannot pump
RCA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing