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Cardiac

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Answer 50 questions in 15 minutes.
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1. How do you prevent S viridans endocarditis?
Shunt - PGE to maintain PDA until surgical repair can be performed
Dressler syndrome
Prophylactic abx during dental procedures
Hypertrophic cardiomyopathy

2. How do nitrates tx MI?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Myocarditis
Decrease preload -->lowers myocardial stress

3. What heart sound manifest with an ASD?
Increased blood in right heart delays closure of P valve
Left -->right
Split S2 on auscultation
Posterior wall of LV - posterior septum - papillary muscles

4. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Degree of pulmonary artery stenosis
RCA
Tetralogy of fallot

5. What are the complications of mitral stenosis?
Left -->right
LHF
Myocardium
Backward LHF pulm htn and RHF - afib and associated mural thombis

6. What areas of the heart does the LAD supply?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
L->R
Anterior wall of LV and anterior septum

7. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
CHF
Myofiber hypertrophy with disarray
Myocardium

8. What is the tx for mitral valve prolapse?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Valve replacement
Infectious

9. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Atria and RV
Increased hydrostatic pressure

10. What type of vegetations form in nonbacterial thrombotic endocarditis?
Degree of pulmonary artery stenosis
Sterile vegetations on mitral valve along lines of closure
ST- segment depression
SLE

11. Dilated cardiomyopathy is a late complication of what illness?
Opening snap followed by diastolic rumble
Streptococcus bovis/
Dressler syndrome
Myocarditis

12. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Intercostal arteries enlarged due to collateral circulation
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
White scar fibrosis

13. How does asprin/heparin tx MI?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Bounding pulse
Limits thrombosis
IV drug users

14. How does restrictive cardiomyopathy present?
Fetal alcohol syndrome
Congestive heart failure
Stretched muscle loses contractility
Nitroglycerin

15. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Decreased forward perfusion pulmonary congestion
Mitral mitral+aortic
Volume overload and LHF

16. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
RBC damaged while crossing the calcified valve causing schistocytes
Reactive histiocyte with caterpillar nucleus
Granulation tissue

17. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Congested central veins
Dark discoloration coagulative necrosis
Myocarditis

18. How does restrictive cardiomyopathy cause LHF?

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19. What are the complications of aortic stenosis?
3-8 wks
R-->L
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Bicuspid aortic valve

20. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
Small vegetations along the line of closure
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Mitral mitral+aortic

21. Turner syndrome is associated with which congenital heart defect?
Myocarditis
Congenital rubella
Troponin I
Infantile coarctation of the aorta

22. What causes unstable angina?
Circumflex
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Squat in response to cyanotic spell
ASD - R-->L

23. What are Osler nodes?
Tender lesions on fingers or toes.
Reactive histiocyte with caterpillar nucleus
Mitral mitral+aortic
Erythematous nontender lesions on palms and soles.

24. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Troponin I
Reactive histiocyte with caterpillar nucleus

25. What gross and microscopic changes occur months after an MI?
White scar fibrosis
Kawasaki disease
ACE inhibitor
Within the first day

26. What is the tx for VSD?
Ventricles cannot pump
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Surgical closure small defects may close spontaneously
Posterior wall of LV - posterior septum - papillary muscles

27. What type of ischemia does stable angina cause?
Subendocardial
Nonspecific - eg fever and elevated ESR
First 4 hours
PDA

28. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Nonspecific - eg fever and elevated ESR
Trisomy 21
RHF
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

29. What are the forward and backward sx of LHF?
Tetralogy of fallot
Hypertrophic cardiomyopathy
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
Congested central veins

30. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
Day 1-7
Left -->right
Spontaneous

31. What is the leading cause of death in the US?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
4-7 days macrophage infiltration
Ischemic heart disease
Dark discoloration coagulative necrosis

32. What valves are involved in rhuematic endocarditis?
Aschoff bodies
Sterile vegetations on surface and undersurface on mitral valve
White scar fibrosis
Mitral mitral+aortic

33. What is the major cause of MI?
Months out fibrosis
Hemosiderin laden macrophages
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Acute inflammation

34. Vegetations on surface and undersurface of mitral valve.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Libman - Sacks endocarditis
4-7 days macrophage infiltration
Tuberous sclerosis

35. What causes the split S2 in ASD?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
VSD
Increased blood in right heart delays closure of P valve
Red border granulation tissue

36. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
1-3 days
Months out fibrosis
S aureus
Nitroglycerin

37. What are heart failure cells?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Hemosiderin laden macrophages
Atherosclerosis of coronary arteries
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

38. What is the most common cause of infectious endocarditis?
Stable and unstable prinzmetal
Streptococcus viridans
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Reperfusion injury

39. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Membrane damage
Louder - increased systemic resistence decreases LV emptying
Myocardium
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

40. What is migratory polyarthritis?
VSD
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Mitral insufficiency
Decrease in blood flow to an organ

41. Poor myocardial fx due to chronic ischemic damage?
Red border granulation tissue
Systemic venous congestion
Chronic ischemic heart disease
Mitral mitral+aortic

42. What are the two effects of ATII?
Dilated
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Hemosiderin laden macrophages

43. What is the characteristic finding on CXR in tetralogy of fallot?
Granulation tissue
3-8 wks
Boot shaped heart
Myxoma - benign

44. In which chamber of the heart are cardiac myxomas found?
Small vegetations along the line of closure
LA
Circumflex
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

45. With what virus is PDA associated?
Reperfusion injury
Congenital rubella
Valve replacement
RHF

46. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Squat in response to cyanotic spell
Right -->left
Loss of LV fx

47. What is the main cause of MV regurg? What are other causes?
Systolic dysfx leading to biventricular CHF
Myocarditis in acute rheumatic heart fever
2-4 hours - 24 hours - 7-10 days
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

48. What type of shunt does a VSD cause?
S viridans
Metastasis
L->R
Aneurysm - mural thrombus - Dressler syndrome

49. What is chronic rheumatic heart disease?
Infantile coarctation of the aorta
Valve scarring that arises as a consequence of rheumatic fever
Degree of pulmonary artery stenosis
Congestive heart failure

50. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Intercostal arteries enlarged due to collateral circulation
Hypertophy of RV atrophy of LV
LV dilation and eccentric hypertrophy

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