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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is a water - hammer pulse?
Reperfusion injury
Bacterial endocarditis
Bounding pulse
R-->L

2. What causes an early - blowing diastolic murmur?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Aortic regurg
Yellow pallor macrophages
PDA

3. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
PDA
Wear and tear

4. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Pericardial effusion due to pericardial involvement
Right side - serotonin and other secretory products detoxified in the lung
45%

5. Which vasculitis can cause MI?
>70%
Endocardial fibroelastosis
Kawasaki disease
Ostium secundum (90%)

6. What type of valvular vegetations does S aureus cause?
MI
Large - destructive vegetations
Elevated ASO anti - DNase B titers
Contraction band necrosis

7. What gross and microscopic changes occur months after an MI?
Systolic dysfx leading to biventricular CHF
Rhabdomyoma
Left -->right
White scar fibrosis

8. In transposition of the great vessels - What is required for survival? How is this achieved?
Systemic venous congestion
Stable and unstable prinzmetal
Shunt - PGE to maintain PDA until surgical repair can be performed
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

9. What is the 1day-1wk -1mo mneumonic for MI?
When a bacterial protein resembles a protein in human tissue
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Maternal diabetes
Mitral stenosis

10. What are the clinical features of endocarditis? What causes each feature?
Systemic venous congestion
Infantile coarctation of the aorta
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
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

11. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Thickening of chrodae tendinae and cusps - mitral stenosis
LV dilation and eccentric hypertrophy

12. Sudden death in a young athlete.
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Hypertrophic cardiomyopathy
4-7 days
Positive blood cultures anemia of chronic disease

13. What typically causes hypertrophic cardiomyopathy?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
AD mutation in sarcomere proteins
Blood vessels coming in from normal tissue

14. What causes prinzmetal angina?
Coronary artery vasospasm
Ischemic heart disease
Right -->left
RCA

15. Why are cardiac enzymes elevated after an MI?
RCA
Subendocardial
Cyanosis - RV hypertrophy - polycythemia - clubbing
Membrane damage

16. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Eisenmenger syndrome
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hypercoagulable state or underlying adenocarcinoma

17. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Elevated ASO anti - DNase B titers
Harmartoma

18. What are the complications that occur months after an MI?
Systolic dysfx leading to biventricular CHF
Aneurysm - mural thrombus - Dressler syndrome
S aureus
Papillary muscle - free wall - IV septum

19. How does transmural MI/ischemia present on EKG?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
ST- segment elevation
Chronic ischemic heart disease
Autoimmune pericarditis 6-8 wks post MI

20. How does restrictive cardiomyopathy cause LHF?

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21. Which congenital heart defect is associated with congenital rubella?
R-->L
PDA
Nonspecific - eg fever and elevated ESR
Streptococcus bovis/

22. What are the clinical features of RHF?
Ostium secundum (90%)
Mitral regurg
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myocarditis

23. What causes endocarditis of prosthetic valves?
Squat in response to cyanotic spell
S epidermidis
Coxsackie A or B
3-8 wks

24. What are the two effects of ATII?
Myocarditis
Gelatinous - abundant ground substance
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Concentric LV hypertophy

25. What does rupture of a papillary muscle cause?
Mitral insufficiency
Thickening of chrodae tendinae and cusps - mitral stenosis
Doxorubicin - cocaine
Mitral mitral+aortic

26. What is chronic rheumatic heart disease?
Group A beta - hemolytic streptococci
Papillary muscle - free wall - IV septum
Valve scarring that arises as a consequence of rheumatic fever
Prophylactic abx during dental procedures

27. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
2-3%
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Inability to maintain systemic pressure w/lack of O2 to vital organs
Contraction band necrosis

28. With what disease is Libman - Sacks endocarditis associated?
Stretched muscle loses contractility
ST- segment depression
SLE
Mitral insufficiency

29. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Tricuspid
Myocarditis
LAD

30. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Decrease preload -->lowers myocardial stress
First 4 hours
Dense layer of elastic and fibrotic tissue in the endocardium - children

31. What congenital heart defect presents later in life with lower extremity cyanosis?
Day 1-7
PDA
Nitroglycerin
Valve replacement once LV dysfx develops

32. What type of vegetations form in nonbacterial thrombotic endocarditis?
Ischemic heart disease
Wear and tear
Sterile vegetations on mitral valve along lines of closure
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

33. In which chamber of the heart are rhabdomyomas found?
Aortic regurg
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Pancarditis
Ventricle

34. What is the most common cause of myocarditis?
Nitroglycerin
Coxsackie A or B
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

35. What are complications of dilated cardiomyopathy?
2-3%
Reperfusion injury
Mitral and tricuspid regurg - arrhythmia
Adult coarctation of the aorta

36. How does aortic regurg affect the heart chambers?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
ST- segment depression
LV dilation and eccentric hypertrophy
Reactive histiocyte with caterpillar nucleus

37. How does fibrinolysis/angioplasty tx MI?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Open blocked vessels
Coxsackie A or B
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

38. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Mitral stenosis
Autoimmune pericarditis 6-8 wks post MI
Metastasis
>60 years - bicuspid aortic valve

39. How does ischemia cause LHF?
When a bacterial protein resembles a protein in human tissue
Loss of fx
Endocardial fibroelastosis (rare)
Maternal diabetes

40. What is the most common cause of dilated cardiomyopathy? What are other causes?
1-3 days
Trisomy 21
Stable angina
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

41. What is the definition of ischemia?
Holosystolic machine like murmur
Pedunculated mass in the LA that causes syncope due to obstruction of MV
CHF
Decrease in blood flow to an organ

42. Is scar tissue or myocardium stronger?
Stretched muscle loses contractility
Myocardium
RBC damaged while crossing the calcified valve causing schistocytes
Reversible

43. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Friction rub and chest pain
Volume overload and LHF
Annular - non pruritic rash w/erythematous borders trunks and limbs

44. What causes notching of the ribs in adult coarctation of the aorta?
Streptococcus bovis/
Intercostal arteries enlarged due to collateral circulation
Ventricles cannot pump
20 min

45. What iis the tx for aortic regurg?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Systolic ejection click followed by crescendo - decrescendo murmur
Valve replacement once LV dysfx develops
Myocarditis

46. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Turner syndrome
Large - destructive vegetations
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

47. Large vegetations on tricuspid valve?
S aureus
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Group A beta - hemolytic streptococci
Split S2 on auscultation

48. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Chronic ischemic heart disease
Within the first day
RCA

49. Tender lesions on fingers or toes.
Red border granulation tissue
Osler nodes (ouch - ouch Osler)
Infantile coarctation of the aorta
Inability to maintain systemic pressure w/lack of O2 to vital organs

50. How do you tx prinzmetal angina?
NG or Ca channel blocker
Hemosiderin laden macrophages
Paradoxical emboli
Streptococcus bovis/

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