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Cardiac

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Answer 50 questions in 15 minutes.
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1. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Erythematous nontender lesions on palms and soles.
Yellow pallor neutrophils
Reperfusion injury

2. What valves are involved in rhuematic endocarditis?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Mitral mitral+aortic
Coronary artery vasospasm - emboli - vasculitis

3. What % stenosis causes stable angina?
Mitral insufficiency
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
>70%
Congested central veins

4. What causes the dependent pitting edema in RHF?
Anterior wall of LV and anterior septum
S viridans
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Increased hydrostatic pressure

5. What are the tx for MI?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Coronary artery vasospasm - emboli - vasculitis

6. What are the sx of PDA at birth?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Asymptomatic
ST- segment depression
Split S2 on auscultation

7. What gross and microscopic changes occur months after an MI?
4-7 days macrophage infiltration
Trisomy 21
White scar fibrosis
Ostium primum

8. What causes an early - blowing diastolic murmur?
Valve scarring that arises as a consequence of rheumatic fever
Mitral mitral+aortic
Mitral insufficiency
Aortic regurg

9. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Infectious endocarditis
Mid - systolic click followed by regurgitation murmur
Contraction band necrosis

10. How does Eisenmeger syndrome occur?
Type I
Papillary muscle - free wall - IV septum
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
Systolic dysfx leading to biventricular CHF

11. What genetic conditions predispose a pt to mitral valve prolapse?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Prinzmetal angina - cocaine
L->R
Ehlers - Danlow and Marfan syndrome

12. What are the two effects of ATII?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Myocarditis
LAD

13. What type of shunt does truncus arteriosus cause?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mid - systolic click followed by regurgitation murmur
R-->L

14. What are the major criteria of the Jones criteria?
PDA
Atria and RV
LA dilation
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

15. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Ischemic heart disease
Decreased forward perfusion pulmonary congestion
Indomethacin - decreases PGE

16. Sudden death in a young athlete.
CHF
Troponin I
Intercostal arteries enlarged due to collateral circulation
Hypertrophic cardiomyopathy

17. When is an MI patent at highest risk for fibrionous pericarditis?
Decreased forward perfusion pulmonary congestion
1-3 days out
Day 1-7
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

18. What is the murmur of mitral valve prolapse?
Mitral mitral+aortic
Mid - systolic click followed by regurgitation murmur
Myocardium
1-3 days out

19. What is an important complication of ASD?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Paradoxical emboli
Coronary artery vasospasm
Annular - non pruritic rash w/erythematous borders trunks and limbs

20. What congenital heart defect often is present with infantile coarctation of the aorta?
RCA
PDA
Low voltage EKG w/diminished QRS amplitude
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

21. Large vegetations on tricuspid valve?
S aureus
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
1-3 days
R-->L

22. How do ACE inhibitors tx MI?
Type I
PDA
Decreases LV dilation by decreasing volume
Infantile coarctation of the aorta

23. How does asprin/heparin tx MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Limits thrombosis
Maternal diabetes
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

24. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Slow HR - decreasing O2 demand and risk for arrhythmia
LHF
Nonspecific - eg fever and elevated ESR
Yellow pallor neutrophils

25. What maintains patency of the PDA?
Increased hydrostatic pressure
PGE
Large - destructive vegetations
Mitral valve prolapse

26. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
LA dilation
ST- segment depression
Aschoff bodies
Prinzmetal

27. What is molecular mimicry?
Holosystolic machine like murmur
Valve replacement once LV dysfx develops
When a bacterial protein resembles a protein in human tissue
Aortic stenosis

28. Which angina is relieved by Ca channel blockers?
RBC damaged while crossing the calcified valve causing schistocytes
Prinzmetal
PDA
PGE

29. What conditions can cause nonbacterial thrombotic endocarditis?
Group A beta - hemolytic streptococci
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Hypercoagulable state or underlying adenocarcinoma
Infectious endocarditis

30. What are the four defects in tetralogy of fallot?
Holosystolic blowing murmur
Degree of pulmonary artery stenosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Infantile coarctation of the aorta PDA

31. What coronary artery supplies the mitral valve papillary muscles?
RCA
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
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
Within the first day

32. In what pt population does S aureus commonly cause valvular disease?
Stable and unstable prinzmetal
Eisenmenger syndrome
Pump failure
IV drug users

33. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Spontaneous
Cardiac tamponade
MI

34. What congenital heart defect is associated with fetal alcohol syndrome?
MI
Boot shaped heart
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
VSD

35. What causes unstable angina?
Mitral insufficiency
Holosystolic blowing murmur
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

36. What are the complications of mitral valve prolapse? Are they common?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Plump fibroblasts - collagen - blood vessels
3-8 wks
Infectious endocarditis - arrythmias - severe mitral regurg no

37. Is injury due angina reversible or irreversible?
RCA
Reversible
Congested central veins
Valve replacement

38. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Intercostal arteries enlarged due to collateral circulation
RHF
Bacterial endocarditis
20 min

39. What shunt does tetralogy of fallot produce?
Right -->left
Cardiogenic shock - CHF - arrhythmia
S aureus
Nonbacterial thrombotic endocarditis (marantic endocarditis)

40. What is the tx for mitral valve prolapse?
Large - destructive vegetations
Valve replacement
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

41. What is dilated cardiomyopathy?
Prinzmetal stable and unstable
Dilation of all four chambers of the heart
Pericardial effusion due to pericardial involvement
RBC damaged while crossing the calcified valve causing schistocytes

42. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
LV dilation and eccentric hypertrophy
Blood vessels coming in from normal tissue
Circumflex

43. What is diastolic dysfx?
Small - nondestructive vegetations (subacute endocarditis)
Rupture of free wall - IV septum - or papillary muscle
Inability to fill ventricles
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

44. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Pump failure

45. In transposition of the great vessels - What is required for survival? How is this achieved?
Ostium secundum (90%)
Metastasis
Shunt - PGE to maintain PDA until surgical repair can be performed
Right side - serotonin and other secretory products detoxified in the lung

46. What does chronic ischemic heart disease progress to?
CHF
RHF
Colon cancer
Yellow pallor neutrophils

47. What gross and microscopic changes occur 1-3 weeks after an MI?
Myocarditis in acute rheumatic heart fever
Large - destructive vegetations
Red border granulation tissue
Wear and tear

48. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Shunt
Ventricular arrhythmia

49. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Heart transplant
4-7 days macrophage infiltration
Fibrinous pericarditis
Rupture of free wall - IV septum - or papillary muscle

50. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Friction rub and chest pain
Infectious endocarditis
Regurg vs stenosis
S aureus

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