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Cardiac

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Answer 50 questions in 15 minutes.
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1. What are the complications of mitral valve prolapse? Are they common?
ST- segment depression
Janeway lesions
Squat in response to cyanotic spell
Infectious endocarditis - arrythmias - severe mitral regurg no

2. In what pt population does S aureus commonly cause valvular disease?
NG or Ca channel blocker
IV drug users
ST- segment depression
Stretched muscle loses contractility

3. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
S epidermidis
Nitroglycerin
Preductal - post aortic arch

4. How does stable angina present?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Dense layer of elastic and fibrotic tissue in the endocardium - children
Chest pain <20 min brought on by exertion or emotional stress

5. What type of shunt dose PDA cause?
Bicuspid aortic valve
Left -->right
Congenital rubella
Coexisting mitral stenosis and fusion of commisures exist

6. What drug relieves stable angina?
Intercostal arteries enlarged due to collateral circulation
Myxoma - benign
S viridans
Nitroglycerin

7. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
LA dilation
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
Squatting - expiration

8. When does the heart have a yellow pallor post MI?
Stable angina
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Increased blood in right heart delays closure of P valve
Day 1-7

9. What cardiac disease is associated with tuberous sclerosis?
S epidermidis
Rhabdomyoma
Holosystolic blowing murmur
Nitroglycerin

10. What is a water - hammer pulse?
Regurg vs stenosis
Anitschow cell
Bounding pulse
Ventricles cannot pump

11. What drugs can cause dilated cardiomyopathy?
S viridans
Doxorubicin - cocaine
Myocarditis in acute rheumatic heart fever
CHF

12. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
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
Libman - Sacks endocarditis
Systolic ejection click followed by crescendo - decrescendo murmur

13. What is the most common cause of endocarditis in IV drug users?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Endocardial fibroelastosis (rare)
PDA
S aureus

14. What type of shunt does transposition of the great vessels cause?
Infectious
R-->L
Systolic dysfx leading to biventricular CHF
4-24 hours

15. What is endocardial fibroelastosis? In what population is it found?
Increased hydrostatic pressure
Dense layer of elastic and fibrotic tissue in the endocardium - children
Stretched muscle loses contractility
Janeway lesions

16. What areas of the heart does the RCA supply?
Within the first day
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Infectious endocarditis - arrythmias - severe mitral regurg no
Posterior wall of LV - posterior septum - papillary muscles

17. What % stenosis causes stable angina?
LAD
RCA
>70%
Stretched muscle loses contractility

18. What causes an early - blowing diastolic murmur?
Aortic regurg
IV drug users
Myocardium
Systolic dysfx leading to biventricular CHF

19. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Systemic venous congestion
1-3 days
Fibrosis and dystrophic calcification
RHF

20. What gross and microscopic changes occur months after an MI?
Eisenmenger syndrome
Mitral regurg
PDA
White scar fibrosis

21. What always follows necrosis?
Acute inflammation
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Endocarditis of prosthetic valves
Rupture of free wall - IV septum - or papillary muscle

22. What causes microangiopathic hemolytic anemia in aortic stenosis?
S aureus
RBC damaged while crossing the calcified valve causing schistocytes
Right to left
Coexisting mitral stenosis and fusion of commisures exist

23. In which chamber of the heart are cardiac myxomas found?
Pts w/previously damaged valves
LA
Mitral mitral+aortic
ST- segment depression

24. Holosystolic blowing murmur that increases w/expiration?
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
4-7 days macrophage infiltration
Breast and lung carcinoma - melanoma - lymphoma
Mitral regurg

25. What is the characteristic murmur of aortic stenosis?
Increased hydrostatic pressure
Decrease preload -->lowers myocardial stress
Systolic ejection click followed by crescendo - decrescendo murmur
Chronic rheumatic heart disease

26. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Mitral and tricuspid regurg - arrhythmia
Hemosiderin laden macrophages
Stable and unstable prinzmetal
Ventricle

27. What type of shunt does truncus arteriosus cause?
RBC damaged while crossing the calcified valve causing schistocytes
Trisomy 21
Ehlers - Danlow and Marfan syndrome
R-->L

28. 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.
R-->L
Myocarditis in acute rheumatic heart fever
ST- segment depression
Stable angina

29. What is the rate of congenital heart defects?
1%
PDA
Valve scarring that arises as a consequence of rheumatic fever
CK- MB

30. With what developmental disorder is VSD associated?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Fetal alcohol syndrome
Atherosclerosis of coronary arteries
Valve replacement once LV dysfx develops

31. What is dilated cardiomyopathy?
Osler nodes (ouch - ouch Osler)
Valve scarring that arises as a consequence of rheumatic fever
Dilation of all four chambers of the heart
LHF

32. What characterizes acute rheumatic fever endocarditiis?
Contraction band necrosis
Small vegetations along the line of closure
R-->L
Dilation of all four chambers of the heart

33. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Holosystolic machine like murmur
ASD - R-->L
Myocarditis in acute rheumatic heart fever

34. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Shunt - PGE to maintain PDA until surgical repair can be performed
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Within the first day

35. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Mitral insufficiency
Hypertrophic cardiomyopathy
S aureus

36. What is the definition of ischemia?
4-24 hours
Systolic ejection click followed by crescendo - decrescendo murmur
Decrease in blood flow to an organ
Coronary artery vasospasm

37. What is the gross and microscopic appearance of cardiac myxomas?
Hypertrophic cardiomyopathy
Loss of fx
Hypercoagulable state or underlying adenocarcinoma
Gelatinous - abundant ground substance

38. Low voltage EKG w/diminished QRS amplitude.
SLE
Concentric LV hypertophy
Restrictive cardiomyopathy
Valve replacement AFTER the onset of complications

39. How does Eisenmeger syndrome occur?
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
Myxoid degeneration
Left -->right
Inability to maintain systemic pressure w/lack of O2 to vital organs

40. When would arrhythmia occur after MI?
Within the first day
LAD
Coronary artery vasospasm
Small - nondestructive vegetations (subacute endocarditis)

41. What valves are most commonly involved in chronic rheumatic heart disease?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Mitral mitral+aortic
Dilation of all four chambers of the heart
Kawasaki disease

42. How does hypertension cause LHF?

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43. Large vegetations on tricuspid valve?
ACE inhibitor
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
S aureus
Aortic regurg

44. What is the most common type of ASD? What %?
Mitral and tricuspid regurg - arrhythmia
Ostium secundum (90%)
RCA
Cardiac tamponade

45. Which congenital heart defect is associated with congenital rubella?
Inability to maintain systemic pressure w/lack of O2 to vital organs
PDA
Blood vessels coming in from normal tissue
LA dilation

46. What is the 1day-1wk -1mo mneumonic for MI?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Pericardial effusion due to pericardial involvement
Anitschow cell
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

47. What effect does mitral stenosis have on the heart chambers?
Infectious
LA dilation
Chest pain <20 min brought on by exertion or emotional stress
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

48. Friction rub and chest pain.
When a bacterial protein resembles a protein in human tissue
R-->L
S aureus
Pericarditits

49. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Ostium secundum (90%)
Aschoff bodies
Anitschow cell
Boot shaped heart

50. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Friction rub and chest pain
PDA
Janeway lesions

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