Commotiocordisis a lethal disruption of heart rhythm that occurs as a result ofa blow to the area directly over the heart at a critical time during the cycle ofa heart beat which results in ventricular fibrillation.Coronary artery disease resulting in inadequate myocardial perfusion is very rare at this age.Endocarditis presents with fever.chills and sweating.Hemosiderosis results from iron overload.Mitral valvular stenosis is a frequent complication of rheumatic heart disease.It presents clinically with signs and symptoms of heart failure such as dyspnea,orthopnea and paroxysmal nocturnal dyspnea. 10.A previously healthy 20 year old man develops heart failure over a period of several days.He is febrile and complains to his friends that he has chest pain,but he does not seek medical attention.He dies and an autopsy is performed.Examination of the heart shows that both ventricles are dilated but otherwise the myocardium appears normal by gross visual inspection.An H&E-stained histologic section shows numerous inflammatory cells in the myocard more than 80 individua round myocytes myocytes are necrotic. B.Acute myocardial C.Acute rheumatic fever D.Marantic endocarditis E.Viral myocarditis Ans:E Viral myocarditis ca heart failure use a mild disease without any symp opsy which sho eden mmatory es ver duals er or lymph ever is rare m mc uent popi rantlendocardn is ue ope vauon 11.A 31-year old woman has had increasing dyspnea for the past week.Physical examination shows temperature of 37.3C,pulse 85/min,respirations 20/min,and blood pressure 150/95 mm Hg.There is dullness to percussion over the lung bases.A chest radiograph shows large bilateral pleural effusions and a normal heart size.Laboratory findings include positive ANA and anti-double-stranded DNA antibody test results.Which of the following cardiac lesions is most likely to be present in this patient? A.Calcific aortic stenosis B.Constrictive pericarditis mn。 E.Rhabdomyoma Ans:D Libman-Sacks endocarditis is an uncommon complication of systemic lupus erythematosus (SLE)that has minimal clinical significance because the small vegetations are unlikely to embolize or cause fumctional flow problems.Calcific aortic stenosis may be seen in older persons with tricuspid valves or it may be a complication of bicuspid valves.Although pericardial effusions are common in SLE they do not cause scarring or constrictive pericarditis.Ischemic cardiomyopathy is unlikely in persons with autoimmune disease who have lessCommotiocordisis a lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart at a critical time during the cycle of a heart beat which results in ventricular fibrillation. Coronary artery disease resulting in inadequate myocardial perfusion is very rare at this age. Endocarditis presents with fever, chills and sweating. Hemosiderosis results from iron overload. Mitral valvular stenosis is a frequent complication of rheumatic heart disease. It presents clinically with signs and symptoms of heart failure such as dyspnea, orthopnea and paroxysmal nocturnal dyspnea, 10. A previously healthy 20 year old man develops heart failure over a period of several days. He is febrile and complains to his friends that he has chest pain, but he does not seek medical attention. He dies and an autopsy is performed. Examination of the heart shows that both ventricles are dilated but otherwise the myocardium appears normal by gross visual inspection. An H&E-stained histologic section shows numerous inflammatory cells in the myocardium, more than 80% lymphocytes, which expand the interstitial spaces between individual myocytes and surround myocytes. Most of the myocytes are structurally intact and appear viable, although scattered individual myocytes are necrotic. The most likely explanation for this finding is A. Acute fungal myocarditis B. Acute myocardial infarction C. Acute rheumatic fever D. Marantic endocarditis E. Viral myocarditis Ans: E Viral myocarditis can cause a mild disease without any symptoms that resolves itself, or it may cause chest pain, heart failure, or sudden death. Definitive diagnosis requires biopsy which shows edema and an inflammatory infiltrate of lymphocytes and macrophages. Focal destruction of myocytes causes myocardial pump failure.Acute fungal myocarditis is very uncommon in individuals with normal immune function.Acute myocardial infarction is not associated with fever or lymphocytic infiltrate of the myocardium.Acute rheumatic fever is rare in modern affluent populations. Marantic endocarditis is due to aseptic valularvegetations that develop in individuals with chronic debilitating illness. 11. A 31-year old woman has had increasing dyspnea for the past week. Physical examination shows temperature of 37.3ºC, pulse 85/min, respirations 20/min, and blood pressure 150/95 mm Hg. There is dullness to percussion over the lung bases. A chest radiograph shows large bilateral pleural effusions and a normal heart size. Laboratory findings include positive ANA and anti-double-stranded DNA antibody test results. Which of the following cardiac lesions is most likely to be present in this patient? A. Calcific aortic stenosis B. Constrictive pericarditis C. Ischemic cardiomyopathy D. Libman-Sacks endocarditis E. Rhabdomyoma Ans: D Libman-Sacks endocarditis is an uncommon complication of systemic lupus erythematosus (SLE)that has minimal clinical significance because the small vegetations are unlikely to embolize or cause functional flow problems.Calcific aortic stenosis may be seen in older persons with tricuspid valves or it may be a complication of bicuspid valves. Although pericardial effusions are common in SLE they do not cause scarring or constrictive pericarditis. Ischemic cardiomyopathy is unlikely in persons with autoimmune disease who have less