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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is molecular mimicry?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
When a bacterial protein resembles a protein in human tissue
Wear and tear
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

2. What is Loeffler syndrome?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myofiber hypertrophy with disarray
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
RCA

3. What gross and microscopic changes occur 4-7 days after an MI?
Right side - serotonin and other secretory products detoxified in the lung
Posterior wall of LV - posterior septum - papillary muscles
Yellow pallor macrophages
Ostium primum

4. What two things happen when a blocked vessel is opened after an MI?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Decrease preload -->lowers myocardial stress
Open blocked vessels
Contraction band necrosis - reperfusion injury

5. What is the tx for dilated cardiomyopathy?
Months out fibrosis
Heart transplant
Nonspecific - eg fever and elevated ESR
Adult coarctation of the aorta

6. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Small vegetations along the line of closure
Valve scarring that arises as a consequence of rheumatic fever
LHF
Large - destructive vegetations

7. What are complications of dilated cardiomyopathy?
Dilated
Right side - serotonin and other secretory products detoxified in the lung
1-3 days
Mitral and tricuspid regurg - arrhythmia

8. What are the sx of right - to - left shunt?
Granulation tissue
Prinzmetal
When a bacterial protein resembles a protein in human tissue
Cyanosis - RV hypertrophy - polycythemia - clubbing

9. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
CHF
Day 1-7
RHF

10. What is a complication of chronic rheumatic heart disease?
Hemosiderin laden macrophages
Infectious endocarditis
Endocardial fibroelastosis
Contraction band necrosis - reperfusion injury

11. What is the characteristic murmur of aortic stenosis?
Coronary artery vasospasm
2-3%
Systolic ejection click followed by crescendo - decrescendo murmur
Turner syndrome

12. What type of ischemia does stable angina cause?
Mitral mitral+aortic
Subendocardial
Annular - non pruritic rash w/erythematous borders trunks and limbs
Cardiogenic shock - CHF - arrhythmia

13. What shunt does tetralogy of fallot produce?
Right to left
Squatting - expiration
Right -->left
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

14. What are the complications of mitral stenosis?
Squatting - expiration
Cardiac tamponade
Endocardial fibroelastosis
Backward LHF pulm htn and RHF - afib and associated mural thombis

15. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Decrease in blood flow to an organ
Loss of fx
ASD - R-->L

16. What is the most common type of endocarditis?
Infectious
Colon cancer
Surgical closure small defects may close spontaneously
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

17. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Rupture of free wall - IV septum - or papillary muscle
2-4 hours - 24 hours - 7-10 days
Mitral regurg

18. Why would cardiac enzymes continue to increase after the initial MI?
Rhadbomyoma - benign
Reperfusion injury
Loss of LV fx
Dressler syndrome

19. What cardiac disease is associated with tuberous sclerosis?
LHF
Paradoxical emboli
Rhabdomyoma
Hypercoagulable state or underlying adenocarcinoma

20. What imaging test is useful for detecting lesions on valves?
Nitroglycerin
Valve replacement AFTER the onset of complications
VSD
Transesophageal echo

21. What generally causes ischemic heart disease?
Colon cancer
Within the first day
Atherosclerosis of coronary arteries
3-8 wks

22. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Mitral stenosis
Erythematous nontender lesions on palms and soles.
Intercostal arteries enlarged due to collateral circulation

23. What areas of the heart does the RCA supply?
Prinzmetal
Posterior wall of LV - posterior septum - papillary muscles
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Asymptomatic

24. What is an important complication of ASD?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Paradoxical emboli
Harmartoma
Loeffler syndrome

25. What iis the tx for aortic regurg?
Mitral and tricuspid regurg - arrhythmia
Aortic regurg
Valve replacement once LV dysfx develops
Infantile coarctation of the aorta PDA

26. What causes unstable angina?
Bicuspid aortic valve
Rhabdomyoma
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Congestive heart failure

27. When is an MI patent at highest risk for fibrionous pericarditis?
Sterile vegetations on surface and undersurface on mitral valve
Type I
1-3 days out
Tuberous sclerosis

28. When does the heart have dark discoloration post MI?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Acute inflammation
LHF
4-24 hours

29. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Inability to fill ventricles
Aortic regurg
Stable and unstable prinzmetal
Day 1-7

30. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Aortic stenosis
Nonspecific - eg fever and elevated ESR
LA dilation

31. Boot - shaped heart on x- ray?
LAD
Tetralogy of fallot
2-3%
Months out fibrosis

32. What is the most common congenital heart defect?
Harmartoma
Acute inflammation
Mitral mitral+aortic
VSD

33. What are the clinical features of RHF?
Endocardial fibroelastosis (rare)
Red border granulation tissue
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

34. What is the tx for mitral valve prolapse?
Intercostal arteries enlarged due to collateral circulation
Mitral and tricuspid regurg - arrhythmia
Heart transplant
Valve replacement

35. What are the forward and backward sx of LHF?
Mitral and tricuspid regurg - arrhythmia
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
LV dilation and eccentric hypertrophy
Ischemic heart disease

36. What disesase has Aschoff bodies?
>70%
Infantile coarctation of the aorta
Myocarditis in acute rheumatic heart fever
Ostium secundum (90%)

37. What does chronic ischemic heart disease progress to?
PDA
CHF
Chronic ischemic heart disease
Pulsating nail bed

38. Which congenital heart defect is associated with maternal diabetes?
PGE
Rhabdomyoma
NG or Ca channel blocker
Transposition of the great vessels

39. What is the most common form of cardiomyopathy?
Myocarditis
Dilated
Janeway lesions
Pedunculated mass in the LA that causes syncope due to obstruction of MV

40. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
VSD
Subendocardial
Loss of LV fx

41. What is endocardial fibroelastosis? In what population is it found?
Fetal alcohol syndrome
Reperfusion injury
Ischemic heart disease
Dense layer of elastic and fibrotic tissue in the endocardium - children

42. What complications occur within 4 hrs post MI?
Chronic rheumatic heart disease
Prophylactic abx during dental procedures
Cardiogenic shock - CHF - arrhythmia
Small vegetations along the line of closure

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

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44. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Yellow pallor neutrophils
20 min
>60 years - bicuspid aortic valve

45. What murmur ccan be heard in PDA?
Erythematous nontender lesions on palms and soles.
Stable angina
Holosystolic machine like murmur
Group A beta - hemolytic streptococci

46. What two things cause coronary artery vasospasm?
1%
Prinzmetal angina - cocaine
Transposition of the great vessels
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

47. Is scar tissue or myocardium stronger?
Transesophageal echo
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Myocardium
Infectious

48. How does MI cause LHF?
Loss of fx
Small vegetations along the line of closure
1-3 days out
Loss of LV fx

49. What drug relieves stable angina?
Split S2 on auscultation
Nitroglycerin
Anterior wall of LV and anterior septum
Ostium secundum (90%)

50. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Turner syndrome
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

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