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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?
RCA
45%
Migratory polyarthritis
VSD

2. When does the heart have a yellow pallor post MI?
Squatting - expiration
Day 1-7
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

3. What shunt does tetralogy of fallot produce?
Hypercoagulable state or underlying adenocarcinoma
Right -->left
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Dark discoloration coagulative necrosis

4. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Right -->left
Transesophageal echo
Prophylactic abx during dental procedures

5. What are the sx of cardiac myxoma?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

6. What valves are most commonly involved in chronic rheumatic heart disease?
Valve replacement
Harmartoma
Mitral mitral+aortic
Thickening of chrodae tendinae and cusps - mitral stenosis

7. Tx for PDA?
Indomethacin - decreases PGE
White scar fibrosis
Systemic venous congestion
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

8. Which coronary artery supplies the anterior wall and anterior septum?
Adult coarctation of the aorta
LAD
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Anitschow cell

9. How does stable angina present?
CK- MB
Chest pain <20 min brought on by exertion or emotional stress
ST- segment depression
Rupture of free wall - IV septum - or papillary muscle

10. What is the tx for LHF?
MI
AD mutation in sarcomere proteins
Large vegetations of S aureus
ACE inhibitor

11. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Split S2 on auscultation
Myxoma - benign
Regurg vs stenosis
Holosystolic blowing murmur

12. What is diastolic dysfx?
Pulsating nail bed
Reversible
Loss of fx
Inability to fill ventricles

13. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Gelatinous - abundant ground substance
ST- segment depression
Paradoxical emboli

14. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
PDA
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Stretched muscle loses contractility

15. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
ACE inhibitor
Dressler syndrome
Loeffler syndrome

16. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Contraction band necrosis - reperfusion injury
Tetralogy of fallot
Intercostal arteries enlarged due to collateral circulation

17. When does the heart have dark discoloration post MI?
Nitroglycerin
4-24 hours
1-3 days
Pedunculated mass in the LA that causes syncope due to obstruction of MV

18. What are the sx/complications of myocarditis?
Months out fibrosis
Tuberous sclerosis
45%
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

19. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small - nondestructive vegetations (subacute endocarditis)
MI
IV drug users

20. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Louder - increased systemic resistence decreases LV emptying
Small - nondestructive vegetations (subacute endocarditis)

21. What are the laboratory findings of bacterial endocarditis?
Nonspecific - eg fever and elevated ESR
Atherosclerosis of coronary arteries
Positive blood cultures anemia of chronic disease
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

22. Tender lesions on fingers or toes.
Mitral regurg
Right to left
Osler nodes (ouch - ouch Osler)
ST- segment elevation

23. When do CK- MB levels rise - peak - and return to normal?
Degree of pulmonary artery stenosis
Autoimmune pericarditis 6-8 wks post MI
4-6 hours - 24 hours - 72 hours
Mitral mitral+aortic

24. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
ACE inhibitor
Congestive heart failure
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

25. What cardiac enzyme is useful for detecting reinfarction?
>70%
Sudden cardiac death
MI
CK- MB

26. What two things happen when a blocked vessel is opened after an MI?
PDA
Contraction band necrosis - reperfusion injury
LA dilation
Dilation of all four chambers of the heart

27. When do neutrophils infiltrate the myocardium post MI?
Coronary artery vasospasm - emboli - vasculitis
1-3 days
Prinzmetal angina - cocaine
Eisenmenger syndrome

28. What is Dressler syndrome? When does it occur?
Pump failure
Congested central veins
PDA
Autoimmune pericarditis 6-8 wks post MI

29. What are the two effects of ATII?
PDA
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Endocardial fibroelastosis (rare)
Heart transplant

30. What is an Aschoff body?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Nitroglycerin
Contraction band necrosis - reperfusion injury
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

31. Which chambers of the heart are generally spared in an MI?
Pts w/previously damaged valves
Months out fibrosis
Atria and RV
3-8 wks

32. Large vegetations on tricuspid valve?
Hypercoagulable state or underlying adenocarcinoma
S aureus
Coexisting mitral stenosis and fusion of commisures exist
Turner syndrome

33. How does ischemia cause LHF?
Loss of fx
Loss of LV fx
RBC damaged while crossing the calcified valve causing schistocytes
Mitral and tricuspid regurg - arrhythmia

34. EKG for stable angina?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
PDA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
ST- segment depression

35. What type of shunt results in cyanosis at birth?
Right to left
Right side - serotonin and other secretory products detoxified in the lung
Mitral insufficiency
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

36. What is the tx for mitral valve prolapse?
Valve replacement
Libman - Sacks endocarditis
45%
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

37. What is the definition of ischemia?
Transposition of the great vessels
Right -->left
Decrease in blood flow to an organ
Gelatinous - abundant ground substance

38. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Aortic regurg
Coxsackie A or B
Months out fibrosis

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

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40. What is endocardial fibroelastosis? In what population is it found?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Holosystolic blowing murmur
Dense layer of elastic and fibrotic tissue in the endocardium - children
Red border granulation tissue

41. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Holosystolic machine like murmur
Mitral regurg
Rhadbomyoma - benign
Coexisting mitral stenosis and fusion of commisures exist

42. What are Janeway lesions?
Kawasaki disease
Small - nondestructive vegetations (subacute endocarditis)
Erythematous nontender lesions on palms and soles.
Ventricle

43. How do you tx prinzmetal angina?
CK- MB
Mitral stenosis
Anitschow cell
NG or Ca channel blocker

44. Systolic ejection click followed by crescendo - decrescendo murmur.
Congested central veins
Infantile coarctation of the aorta PDA
Squat in response to cyanotic spell
Aortic stenosis

45. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
IV drug users
Small vegetations along the line of closure
Concentric LV hypertophy

46. What are the clinical features of RHF due to?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
PDA
Systemic venous congestion
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

47. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Limits thrombosis
Tender lesions on fingers or toes.
Tuberous sclerosis

48. What causes an early - blowing diastolic murmur?
Aortic regurg
Plump fibroblasts - collagen - blood vessels
Heart transplant
Prinzmetal angina - cocaine

49. What congenital heart defect presents later in life with lower extremity cyanosis?
Decrease in blood flow to an organ
Holosystolic machine like murmur
Louder - increased systemic resistence decreases LV emptying
PDA

50. What are the complications that occur months after an MI?
Regurg vs stenosis
Mitral regurg
Aneurysm - mural thrombus - Dressler syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

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