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Cardiac

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1. What is the main cause of MV regurg? What are other causes?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Aschoff bodies
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Sudden cardiac death

2. What is the tx for LHF?
ACE inhibitor
Harmartoma
3-8 wks
PDA

3. What is the characteristic murmurr of mitral stenosis?
Fetal alcohol syndrome
Opening snap followed by diastolic rumble
Mitral regurg
Louder - increased systemic resistence decreases LV emptying

4. How does reperfusion injury occur?
Hypertrophic cardiomyopathy
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Gelatinous - abundant ground substance
Prinzmetal

5. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Reperfusion injury
Myocardium
Valve replacement

6. How does restrictive cardiomyopathy cause LHF?

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7. How does transmural MI/ischemia present on EKG?
Increased blood in right heart delays closure of P valve
ST- segment elevation
Dense layer of elastic and fibrotic tissue in the endocardium - children
Holosystolic blowing murmur

8. What is the cause of the red border around granulation tissue?
Aortic regurg
2-3 weeks
Blood vessels coming in from normal tissue
Membrane damage

9. What is the tx for VSD?
Slow HR - decreasing O2 demand and risk for arrhythmia
Surgical closure small defects may close spontaneously
Stable and unstable prinzmetal
Loeffler syndrome

10. Are most congenital heart defects spontaneous or inherited?
Spontaneous
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Inability to fill ventricles
Infectious endocarditis

11. What drug relieves stable angina?
Shunt - PGE to maintain PDA until surgical repair can be performed
Acute inflammation
Shunt
Nitroglycerin

12. How does asprin/heparin tx MI?
Reperfusion injury
Maternal diabetes
Limits thrombosis
Prinzmetal angina - cocaine

13. What drugs can cause dilated cardiomyopathy?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Doxorubicin - cocaine
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

14. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Myxoma - benign
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Hypertophy of RV atrophy of LV

15. What is the characteristic finding on CXR in tetralogy of fallot?
Cardiogenic shock - CHF - arrhythmia
Mid - systolic click followed by regurgitation murmur
Pericarditits
Boot shaped heart

16. With what endocarditis is S epidermidis associated?
>60 years - bicuspid aortic valve
PDA
Positive blood cultures anemia of chronic disease
Endocarditis of prosthetic valves

17. Erythematous nontender lesions on palms and soles.
Sterile vegetations on surface and undersurface on mitral valve
Janeway lesions
Shunt - PGE to maintain PDA until surgical repair can be performed
Mitral valve prolapse

18. What is the most common type of endocarditis?
Infectious
Anitschow cell
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Boot shaped heart

19. How does Eisenmeger syndrome occur?
Dilated
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
Endocardial fibroelastosis
Endocardial fibroelastosis (rare)

20. What are the two effects of ATII?
Aschoff bodies
When a bacterial protein resembles a protein in human tissue
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Atria and RV

21. In which chamber of the heart are rhabdomyomas found?
RBC damaged while crossing the calcified valve causing schistocytes
Ventricle
Migratory polyarthritis
Wear and tear

22. What gross and microscopic changes occur 4-24 hours after an MI?
Split S2 on auscultation
Kawasaki disease
Dark discoloration coagulative necrosis
Chronic ischemic heart disease

23. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
3-8 wks
LA
Infectious
Stable and unstable prinzmetal

24. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
S epidermidis
Decrease in blood flow to an organ
Decrease preload -->lowers myocardial stress

25. What type of tumor is a rhabdomyoma?
Valve replacement
Congenital rubella
Harmartoma
Mitral regurg

26. In transposition of the great vessels - What is required for survival? How is this achieved?
Loss of fx
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
ST- segment depression
Shunt - PGE to maintain PDA until surgical repair can be performed

27. What is the foundation of a scar?
Loss of LV fx
PGE
Granulation tissue
Surgical closure small defects may close spontaneously

28. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral regurg
LAD
Chronic ischemic heart disease

29. What does chronic ischemic heart disease progress to?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Dilated
Streptococcus bovis/
CHF

30. What cardiac enzyme is useful for detecting reinfarction?
VSD
CK- MB
Endocardial fibroelastosis (rare)
Coronary artery vasospasm

31. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
ST- segment elevation
Endocarditis of prosthetic valves
Rhadbomyoma - benign

32. Opening snap followed by diastolic rumble.
Endocardial fibroelastosis
Circumflex
Mitral stenosis
Months out fibrosis

33. With what disease is transposition of the great vessels associated?
RCA
Left -->right
Maternal diabetes
Congenital rubella

34. What is the most common cause of myocarditis?
RCA
PDA
Subendocardial
Coxsackie A or B

35. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
VSD
Mitral insufficiency
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
When a bacterial protein resembles a protein in human tissue

36. With what virus is PDA associated?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Prinzmetal
LAD
Congenital rubella

37. What is the murmur of mitral regurg?
Open blocked vessels
Holosystolic blowing murmur
Yellow pallor macrophages
Contraction band necrosis

38. What % of MIs involve the LAD?
Libman - Sacks endocarditis
45%
VSD
Preductal - post aortic arch

39. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Louder - increased systemic resistence decreases LV emptying
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Loss of fx

40. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
Fibrosis and dystrophic calcification
Mitral regurg
Stable and unstable prinzmetal

41. EKG for stable angina?
Reversible
>70%
4-7 days
ST- segment depression

42. Which artery is most often occluded in an MI?
Heart transplant
LAD
Granulation tissue
Left -->right

43. What is the major cause of MI?
Infantile coarctation of the aorta
Pericardial effusion due to pericardial involvement
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Paradoxical emboli

44. Is injury due angina reversible or irreversible?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myxoma - benign
Reversible
Endocardial fibroelastosis (rare)

45. Tender lesions on fingers or toes.
Infectious endocarditis - arrythmias - severe mitral regurg no
Osler nodes (ouch - ouch Osler)
Congested central veins
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

46. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Hypertrophic cardiomyopathy
1-3 days
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

47. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
AD mutation in sarcomere proteins
Decrease in blood flow to an organ
CK- MB

48. What causes the nutmeg color in nutmeg liver?
Infectious endocarditis - arrythmias - severe mitral regurg no
Stable and unstable prinzmetal
Congested central veins
Eisenmenger syndrome

49. What is chronic rheumatic heart disease?
Prophylactic abx during dental procedures
Cyanosis - RV hypertrophy - polycythemia - clubbing
Friction rub and chest pain
Valve scarring that arises as a consequence of rheumatic fever

50. At what point in development do congenital heart defects arise?
Yellow pallor macrophages
PDA
3-8 wks
Endocardial fibroelastosis

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