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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is an Anitschow cell?
Holosystolic blowing murmur
Autoimmune pericarditis 6-8 wks post MI
Concentric LV hypertophy
Reactive histiocyte with caterpillar nucleus

2. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
NG or Ca channel blocker
Mitral mitral+aortic
LA

3. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Atherosclerosis of coronary arteries
Months out fibrosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

4. What cardiac disease is associated with tuberous sclerosis?
White scar fibrosis
Mitral regurgitation due to vegetations
Rhabdomyoma
Acute inflammation

5. What effect does chronic rheumatic heart disease have on the aortic valve?

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6. What iis the tx for aortic regurg?
Granulation tissue
>70%
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Valve replacement once LV dysfx develops

7. What are the HACEK organisms? With what condition are they associated?
Tetralogy of fallot
Subendocardial
Doxorubicin - cocaine
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

8. What type of shunt does transposition of the great vessels cause?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
R-->L
Atherosclerosis of coronary arteries
Indomethacin - decreases PGE

9. What does chronic ischemic heart disease progress to?
CHF
Ostium primum
ST- segment elevation
Contraction band necrosis - reperfusion injury

10. Dilated cardiomyopathy is a late complication of what illness?
Blood vessels coming in from normal tissue
Myocarditis
Hypertrophic cardiomyopathy
Right side - serotonin and other secretory products detoxified in the lung

11. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Months out fibrosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Limits thrombosis

12. What is the rate of mitral valve prolapse in the US?
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
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
2-3%
PDA

13. How does asprin/heparin tx MI?
Bicuspid aortic valve
Limits thrombosis
VSD
Myocarditis

14. What does granulation tissue contain?
Myofiber hypertrophy with disarray
Positive blood cultures anemia of chronic disease
ST- segment elevation
Plump fibroblasts - collagen - blood vessels

15. What is cardiogenic shock?
Prinzmetal
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
Inability to maintain systemic pressure w/lack of O2 to vital organs
RCA

16. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Reactive histiocyte with caterpillar nucleus
LAD

17. What is the leading cause of death in the US?
Ischemic heart disease
Chest pain <20 min brought on by exertion or emotional stress
Loeffler syndrome
Gelatinous - abundant ground substance

18. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Coxsackie A or B
Streptococcus bovis/
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Nonbacterial thrombotic endocarditis (marantic endocarditis)

19. Opening snap followed by diastolic rumble.
Small vegetations along the line of closure
Transesophageal echo
Low voltage EKG w/diminished QRS amplitude
Mitral stenosis

20. Dense layer of elastic and fibrotic tissue in the endocardium.
Loeffler syndrome
Endocardial fibroelastosis
Low voltage EKG w/diminished QRS amplitude
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

21. How does MI cause LHF?
Loss of LV fx
Mitral valve prolapse
Day 1-7
Myocarditis

22. Which coronary artery supplies the anterior wall and anterior septum?
Reperfusion injury
Granulation tissue
LAD
Elevated ASO anti - DNase B titers

23. What is migratory polyarthritis?
Left -->right
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
1-3 days
S aureus

24. What causes the nutmeg color in nutmeg liver?
Months out fibrosis
Prinzmetal stable and unstable
Months out fibrosis
Congested central veins

25. What causes angina and syncope in aortic stenosis?

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26. In which chamber of the heart are cardiac myxomas found?
LA
Concentric LV hypertophy
Regurg vs stenosis
Endocardial fibroelastosis (rare)

27. What are the complications of aortic stenosis?
Squatting - expiration
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Plump fibroblasts - collagen - blood vessels
Kawasaki disease

28. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Myocarditis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Aortic stenosis

29. When does the heart have a yellow pallor post MI?
Day 1-7
Posterior wall of LV - posterior septum - papillary muscles
Sudden cardiac death
Infectious endocarditis

30. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
1%
Colon cancer
Acute inflammation
Ostium primum

31. With what disease is transposition of the great vessels associated?
Paradoxical emboli
White scar fibrosis
Mid - systolic click followed by regurgitation murmur
Maternal diabetes

32. What congenital heart defect often is present with infantile coarctation of the aorta?
Infectious endocarditis - arrythmias - severe mitral regurg no
Hemosiderin laden macrophages
PDA
Mitral insufficiency

33. How do beta blockers tx MI?
Ischemic heart disease
Prinzmetal stable and unstable
Coronary artery vasospasm
Slow HR - decreasing O2 demand and risk for arrhythmia

34. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
PDA
LHF
Mitral and tricuspid regurg - arrhythmia
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

35. What is the cause of restrictive cardiomyopathy in children?
Open blocked vessels
45%
Endocardial fibroelastosis (rare)
Transposition of the great vessels

36. What type of shunt dose PDA cause?
Left -->right
Myocarditis in acute rheumatic heart fever
Valve replacement once LV dysfx develops
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

37. How does hypertension cause LHF?

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38. What congenital heart defect is associated with fetal alcohol syndrome?
ST- segment elevation
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
VSD
Annular - non pruritic rash w/erythematous borders trunks and limbs

39. What is the characteristic murmur of aortic stenosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Systolic ejection click followed by crescendo - decrescendo murmur
Trisomy 21
Cardiogenic shock - CHF - arrhythmia

40. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Coronary artery vasospasm
Janeway lesions
Systolic dysfx leading to biventricular CHF
Migratory polyarthritis

41. What causes endocarditis of prosthetic valves?
S epidermidis
Streptococcus bovis/
Spontaneous
Osler nodes (ouch - ouch Osler)

42. When do troponin levels rise - peak - and return to normal?
Sudden cardiac death
2-4 hours - 24 hours - 7-10 days
Myofiber hypertrophy with disarray
Erythematous nontender lesions on palms and soles.

43. Turner syndrome is associated with which congenital heart defect?
Right to left
2-3%
Systemic venous congestion
Infantile coarctation of the aorta

44. What is Loeffler syndrome?
Anterior wall of LV and anterior septum
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Right -->left
Squatting - increased systemic resistence decreases LV emptying

45. What drugs can cause dilated cardiomyopathy?
Pancarditis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Stable and unstable prinzmetal
Doxorubicin - cocaine

46. What are the causes of restrictive cardiomyopathy in adults?
Coronary artery vasospasm
PDA
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

47. When do macrophagess infiltrate the myocardium post MI?
Surgical closure small defects may close spontaneously
45%
Shunt
4-7 days

48. What cardiac enzyme is useful for detecting reinfarction?
S epidermidis
Degree of pulmonary artery stenosis
Increased blood in right heart delays closure of P valve
CK- MB

49. Where is the coarctation in infantile coarctation of the aorta?
Low voltage EKG w/diminished QRS amplitude
Endocardial fibroelastosis (rare)
NG or Ca channel blocker
Preductal - post aortic arch

50. What typically causes hypertrophic cardiomyopathy?
Holosystolic machine like murmur
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Congested central veins
AD mutation in sarcomere proteins

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