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Cardiac

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Answer 50 questions in 15 minutes.
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1. Which artery is most often occluded in an MI?
LAD
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Rhadbomyoma - benign
Mitral and tricuspid regurg - arrhythmia

2. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Slow HR - decreasing O2 demand and risk for arrhythmia
Positive blood cultures anemia of chronic disease
Myocarditis

3. Is injury due angina reversible or irreversible?
Red border granulation tissue
Reversible
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

4. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Congested central veins
Aschoff bodies
4-7 days macrophage infiltration
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

5. What gross and microscopic changes occur 4-7 days after an MI?
Pulsating nail bed
Yellow pallor macrophages
Bounding pulse
ST- segment elevation

6. What type of shunt does truncus arteriosus cause?
Valve replacement once LV dysfx develops
R-->L
Infectious endocarditis - arrythmias - severe mitral regurg no
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

7. What is the leading cause of death in the US?
Myocarditis in acute rheumatic heart fever
Ischemic heart disease
Decreased forward perfusion pulmonary congestion
VSD

8. What is the most common type of endocarditis?
Inability to maintain systemic pressure w/lack of O2 to vital organs
First 4 hours
Infectious
1-3 days

9. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Opening snap followed by diastolic rumble
Granulation tissue
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

10. What causes microangiopathic hemolytic anemia in aortic stenosis?
Ehlers - Danlow and Marfan syndrome
RBC damaged while crossing the calcified valve causing schistocytes
Turner syndrome
Atria and RV

11. What is the most common cause of aortic stenosis?
Wear and tear
Loeffler syndrome
S viridans
1%

12. What effect does aortic regurg have on the pulse pressure? Why?
Reversible
Low voltage EKG w/diminished QRS amplitude
Ventricular arrhythmia
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

13. What is migratory polyarthritis?
Squat in response to cyanotic spell
Increased blood in right heart delays closure of P valve
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Prinzmetal angina - cocaine

14. With what disease is infantile coarctation of the aorta associated?
PDA
Turner syndrome
Congested central veins
Surgical closure small defects may close spontaneously

15. What cardiac enzyme is useful for detecting reinfarction?
Valve replacement AFTER the onset of complications
Pulsating nail bed
CK- MB
4-24 hours

16. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Friction rub and chest pain
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
MI
Valve scarring that arises as a consequence of rheumatic fever

17. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Streptococcus bovis/
Chest pain <20 min brought on by exertion or emotional stress
4-7 days macrophage infiltration

18. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Split S2 on auscultation
Ostium secundum (90%)
Aortic stenosis
LHF

19. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Subendocardial
Myxoid degeneration
Infantile coarctation of the aorta PDA

20. How does ischemia cause LHF?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
When a bacterial protein resembles a protein in human tissue
Red border granulation tissue
Loss of fx

21. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Mitral regurgitation due to vegetations
20 min
Aortic stenosis
Prinzmetal angina

22. Which vasculitis can cause MI?
Limits thrombosis
PGE
Kawasaki disease
Stable angina

23. What type of ischemia does stable angina cause?
Anterior wall of LV and anterior septum
L->R
Subendocardial
Tender lesions on fingers or toes.

24. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Systolic ejection click followed by crescendo - decrescendo murmur
Months out fibrosis
Mid - systolic click followed by regurgitation murmur
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

25. Is scar tissue or myocardium stronger?
Regurg vs stenosis
Infectious endocarditis
Myocardium
AD mutation in sarcomere proteins

26. What is the basic principle of CHF?
Sterile vegetations on surface and undersurface on mitral valve
Pump failure
PGE
Asymptomatic

27. What genetic conditions predispose a pt to mitral valve prolapse?
Inability to fill ventricles
Ehlers - Danlow and Marfan syndrome
Turner syndrome
Granulation tissue

28. Why would cardiac enzymes continue to increase after the initial MI?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Tetralogy of fallot
Small vegetations along the line of closure
Reperfusion injury

29. What causes an early - blowing diastolic murmur?
Asymptomatic
Squat in response to cyanotic spell
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Aortic regurg

30. Myofiber hypertrophy with disarray.
Prinzmetal angina
Hypertrophic cardiomyopathy
Mitral mitral+aortic
Nonspecific - eg fever and elevated ESR

31. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Adult coarctation of the aorta
Decrease in blood flow to an organ
Rhabdomyoma

32. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
1%
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

33. What type of ASD is associated w/Down syndrome?
Dark discoloration coagulative necrosis
Ostium primum
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Opening snap followed by diastolic rumble

34. How does MI cause LHF?
Prinzmetal angina
Split S2 on auscultation
Libman - Sacks endocarditis
Loss of LV fx

35. When do macrophagess infiltrate the myocardium post MI?
Transposition of the great vessels
Increased blood in right heart delays closure of P valve
Bicuspid aortic valve
4-7 days

36. L- to - R shunt switching to R- to - L shunt.
White scar fibrosis
Opening snap followed by diastolic rumble
Eisenmenger syndrome
Rhadbomyoma - benign

37. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Decreases LV dilation by decreasing volume
4-7 days
Cardiogenic shock - CHF - arrhythmia

38. What tests show prior group A beta - hemolytic strep infection?
Aortic stenosis
Elevated ASO anti - DNase B titers
Chest pain <20 min brought on by exertion or emotional stress
Right side - serotonin and other secretory products detoxified in the lung

39. How does fibrinolysis/angioplasty tx MI?
Ischemic heart disease
S aureus
Open blocked vessels
4-7 days

40. What is the classic EKG finding of restrictive cardiomyopathy?
Membrane damage
Infantile coarctation of the aorta PDA
Squatting - increased systemic resistence decreases LV emptying
Low voltage EKG w/diminished QRS amplitude

41. What is the most common type of ASD? What %?
LAD
Ostium secundum (90%)
Months out fibrosis
Inability to maintain systemic pressure w/lack of O2 to vital organs

42. What is the most common valve infected by S aureus?
Aortic stenosis
Tricuspid
Streptococcus viridans
Loeffler syndrome

43. With what congenital heart defect is ADULT coarctation of the aorta associated?
Reactive histiocyte with caterpillar nucleus
Bicuspid aortic valve
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Valve scarring that arises as a consequence of rheumatic fever

44. In which pts does S viridans cause endocarditits?
Surgical closure small defects may close spontaneously
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Stretched muscle loses contractility
Pts w/previously damaged valves

45. With what virus is PDA associated?
Valve replacement once LV dysfx develops
ACE inhibitor
Mitral insufficiency
Congenital rubella

46. Large vegetations on tricuspid valve?
S aureus
Decreases LV dilation by decreasing volume
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

47. How do beta blockers tx MI?
Boot shaped heart
Valve replacement once LV dysfx develops
Troponin I
Slow HR - decreasing O2 demand and risk for arrhythmia

48. What are the sx/complications of myocarditis?
1%
Hypertophy of RV atrophy of LV
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Chest pain <20 min brought on by exertion or emotional stress

49. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
VSD
Pericardial effusion due to pericardial involvement
Cardiac tamponade
Anitschow cell

50. What is the most common congenital heart defect?
Hypertrophic cardiomyopathy
VSD
Turner syndrome
4-7 days

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