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Cardiac

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Answer 50 questions in 15 minutes.
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1. What % of MIs involve the LAD?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
45%
Spontaneous
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

2. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
LAD
Mitral and tricuspid regurg - arrhythmia
Opening snap followed by diastolic rumble

3. What are the major criteria of the Jones criteria?
Reperfusion injury
Ventricles cannot pump
Nitroglycerin
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

4. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Months out fibrosis
Pericardial effusion due to pericardial involvement
Rhabdomyoma
Prinzmetal angina

5. L- to - R shunt switching to R- to - L shunt.
Nitroglycerin
Heart transplant
Boot shaped heart
Eisenmenger syndrome

6. What coronary artery supplies the mitral valve papillary muscles?
RCA
Reversible
Posterior wall of LV - posterior septum - papillary muscles
LA

7. What is systolic dysfx?
Ventricles cannot pump
Decrease in blood flow to an organ
Day 1-7
Tender lesions on fingers or toes.

8. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Mitral valve prolapse
Mitral regurg
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

9. What type of shunt results in cyanosis at birth?
Nonspecific - eg fever and elevated ESR
>70%
Right to left
Small vegetations along the line of closure

10. What are the laboratory findings of bacterial endocarditis?
Transesophageal echo
Right -->left
Subendocardial
Positive blood cultures anemia of chronic disease

11. What effect does dilated cardiomyopathy have on the heart?
Large - destructive vegetations
Systolic dysfx leading to biventricular CHF
Blood vessels coming in from normal tissue
Pts w/previously damaged valves

12. What does a biopsy of hypertrophic cardiomyopathy look like?
Mitral mitral+aortic
Friction rub and chest pain
Reversible
Myofiber hypertrophy with disarray

13. What is a Quincke pulse?
1%
White scar fibrosis
RCA
Pulsating nail bed

14. Boot - shaped heart on x- ray?
1-3 days
Congestive heart failure
Tetralogy of fallot
Heart can't fill

15. What generally causes ischemic heart disease?
Dressler syndrome
Atherosclerosis of coronary arteries
Aneurysm - mural thrombus - Dressler syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

16. What causes mitral valve prolapse?
When a bacterial protein resembles a protein in human tissue
VSD
Myxoid degeneration
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

17. What drug relieves stable angina?
Intercostal arteries enlarged due to collateral circulation
PDA
Within the first day
Nitroglycerin

18. How does squating decrease hypoxemia in tetralogy of fallot?
L->R
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Backward LHF pulm htn and RHF - afib and associated mural thombis
RBC damaged while crossing the calcified valve causing schistocytes

19. What causes microangiopathic hemolytic anemia in aortic stenosis?
S epidermidis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
RBC damaged while crossing the calcified valve causing schistocytes

20. When does the heart have dark discoloration post MI?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Harmartoma
Aneurysm - mural thrombus - Dressler syndrome
4-24 hours

21. What is the characteristic finding on CXR in tetralogy of fallot?
Wear and tear
Boot shaped heart
AD mutation in sarcomere proteins
Hemosiderin laden macrophages

22. What congenital heart defect often is present with infantile coarctation of the aorta?
RCA
Congenital rubella
PDA
Mitral regurgitation due to vegetations

23. Which chambers of the heart are generally spared in an MI?
Bicuspid aortic valve
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Atria and RV

24. What vavular defect results from acute rheumatic fever?
S aureus
Valve replacement once LV dysfx develops
Decreases LV dilation by decreasing volume
Mitral regurgitation due to vegetations

25. How do nitrates tx MI?
Red border granulation tissue
Decrease preload -->lowers myocardial stress
Fibrinous pericarditis
Yellow pallor neutrophils

26. What compensatory mechanism do tetralogy of fallot pts learn?
Dilation of all four chambers of the heart
Small vegetations along the line of closure
Squat in response to cyanotic spell
Hemosiderin laden macrophages

27. What type of shunt does ASD cause?
Right -->left
Left -->right
Anterior wall of LV and anterior septum
Rhabdomyoma

28. What are the sx of aortic regurg?
Aschoff bodies
Autoimmune pericarditis 6-8 wks post MI
>60 years - bicuspid aortic valve
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

29. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Holosystolic blowing murmur
Shunt - PGE to maintain PDA until surgical repair can be performed
Anitschow cell
Nitroglycerin

30. How does contraction band necrosis occur?
Hypertophy of RV atrophy of LV
Congested central veins
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Small - nondestructive vegetations (subacute endocarditis)

31. What are the HACEK organisms? With what condition are they associated?
Preductal - post aortic arch
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Small vegetations along the line of closure
Congested central veins

32. What causes endocarditis of prosthetic valves?
RCA
Sterile vegetations on mitral valve along lines of closure
Squatting - expiration
S epidermidis

33. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Janeway lesions
Mitral valve prolapse
Fetal alcohol syndrome

34. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Ventricle
Infectious endocarditis
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

35. Infects predamaged valves after transient bacteremia?
2-3%
Decreases LV dilation by decreasing volume
Sterile vegetations on mitral valve along lines of closure
S viridans

36. Myofiber hypertrophy with disarray.
Elevated ASO anti - DNase B titers
Hypertrophic cardiomyopathy
PDA
Aortic regurg

37. What effect does aortic stenosis have on the chambers of the heart?
RCA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral valve prolapse
Concentric LV hypertophy

38. What is the etiology of S viridans endocarditis?
PDA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Degree of pulmonary artery stenosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

39. What is endocardial fibroelastosis? In what population is it found?
Eisenmenger syndrome
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Reperfusion injury
Dense layer of elastic and fibrotic tissue in the endocardium - children

40. What drugs can cause dilated cardiomyopathy?
Trisomy 21
Doxorubicin - cocaine
20 min
Endocardial fibroelastosis (rare)

41. What are the complications that occur months after an MI?
Migratory polyarthritis
Dense layer of elastic and fibrotic tissue in the endocardium - children
Aneurysm - mural thrombus - Dressler syndrome
ST- segment depression

42. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Squatting - increased systemic resistence decreases LV emptying
Libman - Sacks endocarditis
Holosystolic blowing murmur

43. Which coronary artery supplies the anterior wall and anterior septum?
Loeffler syndrome
LAD
VSD
Tricuspid

44. What causes unstable angina?
RHF
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
4-24 hours
Low voltage EKG w/diminished QRS amplitude

45. When do CK- MB levels rise - peak - and return to normal?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
4-6 hours - 24 hours - 72 hours
Aortic regurg
RCA

46. What is the rate of mitral valve prolapse in the US?
2-3%
Pancarditis
L->R
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

47. What complication occurs 1-3 days post MI?
ST- segment elevation
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Fibrinous pericarditis

48. What congenital heart defect does indomethacin tx?
Coronary artery vasospasm - emboli - vasculitis
LHF
PDA
Tender lesions on fingers or toes.

49. How does restrictive cardiomyopathy present?
Red border granulation tissue
Congestive heart failure
Prinzmetal
Libman - Sacks endocarditis

50. What effect does aortic regurg have on the pulse pressure? Why?
Dressler syndrome
Coxsackie A or B
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

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