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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is the most common cause of dilated cardiomyopathy? What are other causes?
Ventricles cannot pump
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Rhabdomyoma
Left -->right

2. What endocarditis is commonly found in patients with colon cancer?
Sterile vegetations on mitral valve along lines of closure
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Breast and lung carcinoma - melanoma - lymphoma
Streptococcus bovis/

3. What is diastolic dysfx?
Fetal alcohol syndrome
Fibrosis and dystrophic calcification
Inability to fill ventricles
Breast and lung carcinoma - melanoma - lymphoma

4. What is an Aschoff body?
Valve replacement AFTER the onset of complications
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
LHF
Inability to maintain systemic pressure w/lack of O2 to vital organs

5. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Colon cancer
3-8 wks
Valve replacement once LV dysfx develops

6. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
Loss of LV fx
Loeffler syndrome
Pump failure

7. What causes prinzmetal angina?
Months out fibrosis
3-8 wks
2-4 hours - 24 hours - 7-10 days
Coronary artery vasospasm

8. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Rhabdomyoma
PGE
Degree of pulmonary artery stenosis
RHF

9. What is the tx for LHF?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Shunt - PGE to maintain PDA until surgical repair can be performed
ACE inhibitor
LAD

10. When do troponin levels rise - peak - and return to normal?
Group A beta - hemolytic streptococci
Atherosclerosis of coronary arteries
Prophylactic abx during dental procedures
2-4 hours - 24 hours - 7-10 days

11. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Yellow pallor macrophages
Aschoff bodies
Stable angina
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

12. What causes notching of the ribs in adult coarctation of the aorta?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Decreased forward perfusion pulmonary congestion
Preductal - post aortic arch
Intercostal arteries enlarged due to collateral circulation

13. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
S viridans
Decrease in blood flow to an organ
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Harmartoma

14. What is the most common cause of endocarditis in IV drug users?
S aureus
Hypertrophic cardiomyopathy
Coronary artery vasospasm
Tricuspid

15. What type of ASD is associated w/Down syndrome?
Large vegetations of S aureus
Ostium primum
Group A beta - hemolytic streptococci
Membrane damage

16. Opening snap followed by diastolic rumble.
Mitral stenosis
Minimizes ischemia
Myocarditis
Volume overload and LHF

17. EKG for stable angina?
ST- segment depression
Myxoid degeneration
Hypertophy of RV atrophy of LV
Stable and unstable prinzmetal

18. What causes angina and syncope in aortic stenosis?

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19. What is the tx for dilated cardiomyopathy?
Group A beta - hemolytic streptococci
Degree of pulmonary artery stenosis
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Heart transplant

20. What are Osler nodes?
Myocardium
Tender lesions on fingers or toes.
Heart can't fill
Osler nodes (ouch - ouch Osler)

21. What causes acute endocarditis?
Heart transplant
Large vegetations of S aureus
Infantile coarctation of the aorta PDA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

22. Large vegetations on tricuspid valve?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Papillary muscle - free wall - IV septum
S aureus
Pulsating nail bed

23. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Dilation of all four chambers of the heart
Fibrosis and dystrophic calcification
Positive blood cultures anemia of chronic disease

24. Poor myocardial fx due to chronic ischemic damage?
Reversible
Chronic ischemic heart disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
1%

25. What are heart failure cells?
Streptococcus viridans
Opening snap followed by diastolic rumble
>60 years - bicuspid aortic valve
Hemosiderin laden macrophages

26. What type of vegetations form in nonbacterial thrombotic endocarditis?
Libman - Sacks endocarditis
Sterile vegetations on mitral valve along lines of closure
Small vegetations along the line of closure
Loss of LV fx

27. What is the characteristic finding on CXR in tetralogy of fallot?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Boot shaped heart
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Endocardial fibroelastosis

28. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Maternal diabetes
Anitschow cell
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Aneurysm - mural thrombus - Dressler syndrome

29. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Cardiac tamponade
Erythematous nontender lesions on palms and soles.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

30. What is the most common cause of death during the acute phase of rheumatic fever?
Stable and unstable prinzmetal
Aortic stenosis
Myocarditis
Nonspecific - eg fever and elevated ESR

31. Which congenital heart defect is associated with congenital rubella?
Bicuspid aortic valve
Migratory polyarthritis
Yellow pallor neutrophils
PDA

32. What gross and microscopic changes occur 4-24 hours after an MI?
Ischemic heart disease
Dark discoloration coagulative necrosis
Months out fibrosis
Left -->right

33. 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
Hemosiderin laden macrophages
Systolic dysfx leading to biventricular CHF

34. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Wear and tear
Small - nondestructive vegetations (subacute endocarditis)
LAD

35. What type of shunt does truncus arteriosus cause?
R-->L
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
LAD
PDA

36. What type of valvular vegetations does S aureus cause?
>60 years - bicuspid aortic valve
LA dilation
Large - destructive vegetations
Boot shaped heart

37. Which vasculitis can cause MI?
IV drug users
Kawasaki disease
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nonspecific - eg fever and elevated ESR

38. What two things cause coronary artery vasospasm?
Aortic regurg
Prinzmetal angina - cocaine
Endocardial fibroelastosis (rare)
Sudden cardiac death

39. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
RHF
Opening snap followed by diastolic rumble
Louder - increased systemic resistence decreases LV emptying
Prinzmetal angina

40. Which artery is most often occluded in an MI?
Decreased forward perfusion pulmonary congestion
Fibrosis and dystrophic calcification
LAD
Shunt

41. What is endocardial fibroelastosis? In what population is it found?
Fibrosis and dystrophic calcification
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ehlers - Danlow and Marfan syndrome
Valve replacement once LV dysfx develops

42. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
RCA
Rhadbomyoma - benign
Within the first day
Nonbacterial thrombotic endocarditis (marantic endocarditis)

43. How does MI cause LHF?
Coronary artery vasospasm
PDA
Decreases LV dilation by decreasing volume
Loss of LV fx

44. What is the tx for VSD?
Bounding pulse
>70%
Small vegetations along the line of closure
Surgical closure small defects may close spontaneously

45. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Mitral regurg
Months out fibrosis
NG or Ca channel blocker

46. What valves are most commonly involved in chronic rheumatic heart disease?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Holosystolic machine like murmur
Mitral mitral+aortic
Harmartoma

47. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Rhadbomyoma - benign
Systolic dysfx leading to biventricular CHF
Type I

48. What is the most common cause of aortic stenosis?
Erythematous nontender lesions on palms and soles.
Positive blood cultures anemia of chronic disease
Wear and tear
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

49. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
45%
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

50. In which chamber of the heart are cardiac myxomas found?
Eisenmenger syndrome
LA
Doxorubicin - cocaine
Yellow pallor macrophages

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