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Cardiac

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Answer 50 questions in 15 minutes.
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1. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Aschoff bodies
Breast and lung carcinoma - melanoma - lymphoma
4-7 days macrophage infiltration

2. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
LHF
Tricuspid
Restrictive cardiomyopathy

3. What is the etiology of S viridans endocarditis?
Type I
Open blocked vessels
R-->L
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

4. Which coronary artery supplies the posterior wall of the LV and posterior septum?
>60 years - bicuspid aortic valve
RCA
Prophylactic abx during dental procedures
L->R

5. What is diastolic dysfx?
Streptococcus bovis/
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
Inability to fill ventricles
Fibrinous pericarditis

6. What does rupture of the IV septum cause?
Positive blood cultures anemia of chronic disease
Shunt
Eisenmenger syndrome
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

7. What type of valvular vegetations does S aureus cause?
Ventricle
Large - destructive vegetations
SLE
4-6 hours - 24 hours - 72 hours

8. What does rupture of a papillary muscle cause?
Degree of pulmonary artery stenosis
Mitral insufficiency
LV dilation and eccentric hypertrophy
Breast and lung carcinoma - melanoma - lymphoma

9. How does hypertension cause LHF?

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10. What is the foundation of a scar?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Granulation tissue
Membrane damage
Breast and lung carcinoma - melanoma - lymphoma

11. What is the most common cause of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Chronic rheumatic heart disease
Louder - increased systemic resistence decreases LV emptying
1%

12. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Osler nodes (ouch - ouch Osler)
Tetralogy of fallot
Janeway lesions
Migratory polyarthritis

13. Which coronary artery supplies the anterior wall and anterior septum?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small - nondestructive vegetations (subacute endocarditis)
LAD
NG or Ca channel blocker

14. What causes heart failure cells?
Infectious endocarditis - arrythmias - severe mitral regurg no
Boot shaped heart
Positive blood cultures anemia of chronic disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

15. What is endocardial fibroelastosis? In what population is it found?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Dense layer of elastic and fibrotic tissue in the endocardium - children
Decreases LV dilation by decreasing volume
Transposition of the great vessels

16. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
LHF
Posterior wall of LV - posterior septum - papillary muscles
Prinzmetal angina
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

17. In what pt population does S aureus commonly cause valvular disease?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Infectious endocarditis - arrythmias - severe mitral regurg no
Transposition of the great vessels
IV drug users

18. Opening snap followed by diastolic rumble.
Mitral stenosis
LA
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
LAD

19. What causes the nutmeg color in nutmeg liver?
Ehlers - Danlow and Marfan syndrome
Congested central veins
Streptococcus viridans
S aureus

20. What is migratory polyarthritis?
Months out fibrosis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

21. What causes acute endocarditis?
Infectious
Shunt - PGE to maintain PDA until surgical repair can be performed
Dilation of all four chambers of the heart
Large vegetations of S aureus

22. What are the major criteria of the Jones criteria?
Squat in response to cyanotic spell
Inability to maintain systemic pressure w/lack of O2 to vital organs
MI
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

23. What type of shunt does ASD cause?
Heart can't fill
Left -->right
Limits thrombosis
Kawasaki disease

24. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
S aureus
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Hypertophy of RV atrophy of LV
Stable and unstable prinzmetal

25. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Small vegetations along the line of closure
Left -->right
Colon cancer
Surgical closure small defects may close spontaneously

26. How does restrictive cardiomyopathy cause LHF?

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27. What disesase has Aschoff bodies?
Paradoxical emboli
Annular - non pruritic rash w/erythematous borders trunks and limbs
Myocarditis in acute rheumatic heart fever
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

28. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Valve replacement
ST- segment elevation
Osler nodes (ouch - ouch Osler)

29. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Contraction band necrosis - reperfusion injury
Myofiber hypertrophy with disarray
Coronary artery vasospasm

30. What gross and microscopic changes occur months after an MI?
Squatting - expiration
White scar fibrosis
Reactive histiocyte with caterpillar nucleus
Coexisting mitral stenosis and fusion of commisures exist

31. What is the most common cause of RHF? What are others?
Rupture of free wall - IV septum - or papillary muscle
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Reactive histiocyte with caterpillar nucleus

32. Poor myocardial fx due to chronic ischemic damage?
Gelatinous - abundant ground substance
Chronic ischemic heart disease
Friction rub and chest pain
Dense layer of elastic and fibrotic tissue in the endocardium - children

33. What tests show prior group A beta - hemolytic strep infection?
Stable and unstable prinzmetal
Elevated ASO anti - DNase B titers
Janeway lesions
PDA

34. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Pericarditits
Doxorubicin - cocaine
Rupture of free wall - IV septum - or papillary muscle

35. When would arrhythmia occur after MI?
Coronary artery vasospasm
Within the first day
Volume overload and LHF
Reperfusion injury

36. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Troponin I
Dilated
Metastasis

37. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Janeway lesions
Endocardial fibroelastosis (rare)
Erythematous nontender lesions on palms and soles.

38. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Right -->left
Months out fibrosis
Decrease preload -->lowers myocardial stress

39. What congenital heart defect is associated with fetal alcohol syndrome?
Heart can't fill
VSD
Type I
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

40. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Prinzmetal angina
MI
Mitral mitral+aortic

41. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
S aureus
>70%
>60 years - bicuspid aortic valve
Friction rub and chest pain

42. How does fibrinolysis/angioplasty tx MI?
Months out fibrosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Open blocked vessels
PDA

43. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Cardiogenic shock - CHF - arrhythmia
Reperfusion injury
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Myofiber hypertrophy with disarray

44. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Slow HR - decreasing O2 demand and risk for arrhythmia
Coexisting mitral stenosis and fusion of commisures exist
1%
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

45. What effect does transposition of the great vessels have on the ventricles?
LA dilation
Hypertophy of RV atrophy of LV
Decreased forward perfusion pulmonary congestion
Infectious endocarditis - arrythmias - severe mitral regurg no

46. What is the 1day-1wk -1mo mneumonic for MI?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Trisomy 21
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

47. What are the sx of PDA at birth?
White scar fibrosis
Troponin I
Dilated
Asymptomatic

48. What conditions can cause nonbacterial thrombotic endocarditis?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Open blocked vessels
Hypertrophic cardiomyopathy
Hypercoagulable state or underlying adenocarcinoma

49. What is an Aschoff body?
Reactive histiocyte with caterpillar nucleus
Positive blood cultures anemia of chronic disease
Preductal - post aortic arch
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

50. When do macrophagess infiltrate the myocardium post MI?
4-7 days
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
ACE inhibitor
Troponin I

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