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Cardiac

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Answer 50 questions in 15 minutes.
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1. With what disease is transposition of the great vessels associated?
Spontaneous
Maternal diabetes
Mitral insufficiency
Transesophageal echo

2. What is the rate of mitral valve prolapse in the US?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myocarditis
2-3%
Elevated ASO anti - DNase B titers

3. What causes unstable angina?
Systemic venous congestion
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
PGE
Sterile vegetations on mitral valve along lines of closure

4. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Sterile vegetations on surface and undersurface on mitral valve
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
RCA
LHF

5. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Systolic ejection click followed by crescendo - decrescendo murmur
Reperfusion injury
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

6. What are the clinical features of endocarditis? What causes each feature?
Chronic rheumatic heart disease
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
Trisomy 21
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

7. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Valve scarring that arises as a consequence of rheumatic fever
Volume overload and LHF
Congestive heart failure

8. What effect does aortic stenosis have on the chambers of the heart?
Ventricular arrhythmia
Concentric LV hypertophy
Nonbacterial thrombotic endocarditis (marantic endocarditis)
PDA

9. How does fibrinolysis/angioplasty tx MI?
Ischemic heart disease
Open blocked vessels
PDA
ACE inhibitor

10. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Infectious
1-3 days
Transposition of the great vessels
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

11. What effect does chronic rheumatic heart disease have the mitral valve?
IV drug users
4-6 hours - 24 hours - 72 hours
Thickening of chrodae tendinae and cusps - mitral stenosis
Infectious endocarditis - arrythmias - severe mitral regurg no

12. What is the gold standard blood marker for MI?
Troponin I
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Rhabdomyoma

13. What causes acute endocarditis?
Contraction band necrosis - reperfusion injury
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Large vegetations of S aureus
Bicuspid aortic valve

14. What is the most common valve infected by S aureus?
Tricuspid
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
Plump fibroblasts - collagen - blood vessels
Tuberous sclerosis

15. What gross and microscopic changes occur 1-3 weeks after an MI?
Myxoma - benign
Loss of fx
Harmartoma
Red border granulation tissue

16. What increases the volume of mitral regurg murmur?
Squatting - expiration
Myofiber hypertrophy with disarray
Chest pain <20 min brought on by exertion or emotional stress
Turner syndrome

17. What is the most common cause of dilated cardiomyopathy? What are other causes?
2-3%
Rupture of free wall - IV septum - or papillary muscle
>70%
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

18. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Loss of LV fx
Louder - increased systemic resistence decreases LV emptying
Chest pain <20 min brought on by exertion or emotional stress
NG or Ca channel blocker

19. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Day 1-7
S aureus
Streptococcus viridans

20. What is the tx for mitral valve prolapse?
Valve replacement
Cardiogenic shock - CHF - arrhythmia
Loss of fx
S aureus

21. What is a Quincke pulse?
Myxoid degeneration
Mitral valve prolapse
Pulsating nail bed
Fibrinous pericarditis

22. Which angina(s) show ST elevation on EKG? ST depression?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Shunt
Prinzmetal stable and unstable

23. How does ischemia cause LHF?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
4-7 days macrophage infiltration
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Loss of fx

24. How does restrictive cardiomyopathy present?
2-3%
Left -->right
Congestive heart failure
ASD - R-->L

25. When do neutrophils infiltrate the myocardium post MI?
Ostium primum
1-3 days
Troponin I
MI

26. What type of tumor is a rhabdomyoma?
Harmartoma
Endocardial fibroelastosis
CHF
Small vegetations along the line of closure

27. What endocarditis is commonly found in patients with colon cancer?
SLE
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
VSD
Streptococcus bovis/

28. What drug relieves stable angina?
Hypertrophic cardiomyopathy
Valve replacement once LV dysfx develops
Nitroglycerin
VSD

29. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Aschoff bodies
Spontaneous
RCA

30. What causes microangiopathic hemolytic anemia in aortic stenosis?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Chest pain <20 min brought on by exertion or emotional stress
Breast and lung carcinoma - melanoma - lymphoma
RBC damaged while crossing the calcified valve causing schistocytes

31. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Sterile vegetations on mitral valve along lines of closure
PDA
Congestive heart failure

32. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Plump fibroblasts - collagen - blood vessels
Tuberous sclerosis
Sterile vegetations on surface and undersurface on mitral valve

33. Pericarditis 6-8 wks post MI.
Chest pain <20 min brought on by exertion or emotional stress
Nitroglycerin
1-3 days out
Dressler syndrome

34. What is the rate of congenital heart defects?
Regurg vs stenosis
1%
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Systemic venous congestion

35. What is the JOneS mneumonic?
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea
R-->L
Holosystolic machine like murmur
Fetal alcohol syndrome

36. What always follows necrosis?
Acute inflammation
Myocarditis
Reactive histiocyte with caterpillar nucleus
Dressler syndrome

37. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Myocardium
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
20 min
Bicuspid aortic valve

38. What causes the nutmeg color in nutmeg liver?
Colon cancer
PDA
Congested central veins
PDA

39. What is dilated cardiomyopathy?
45%
Dilation of all four chambers of the heart
Reperfusion injury
Mitral regurg

40. What are the four defects in tetralogy of fallot?
Libman - Sacks endocarditis
Restrictive cardiomyopathy
Colon cancer
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

41. What is an important complication of ASD?
PDA
Paradoxical emboli
Dense layer of elastic and fibrotic tissue in the endocardium - children
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

42. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
3-8 wks
Myocarditis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

43. How does contraction band necrosis occur?
Prinzmetal angina
2-4 hours - 24 hours - 7-10 days
Aortic regurg
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

44. How do beta blockers tx MI?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Mitral valve prolapse
Slow HR - decreasing O2 demand and risk for arrhythmia

45. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Adult coarctation of the aorta
Trisomy 21
Tetralogy of fallot
Migratory polyarthritis

46. What is a common complication of cardiac metastasis?
Group A beta - hemolytic streptococci
Coexisting mitral stenosis and fusion of commisures exist
Pericardial effusion due to pericardial involvement
Plump fibroblasts - collagen - blood vessels

47. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
VSD
RHF
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

48. What are the complications of mitral valve prolapse? Are they common?
Shunt
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
Chronic ischemic heart disease
Infectious endocarditis - arrythmias - severe mitral regurg no

49. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Red border granulation tissue
Systolic dysfx leading to biventricular CHF
>60 years - bicuspid aortic valve
Months out fibrosis

50. What causes heart failure cells?
RBC damaged while crossing the calcified valve causing schistocytes
Infectious endocarditis
Osler nodes (ouch - ouch Osler)
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

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