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Cardiac

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Answer 50 questions in 15 minutes.
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1. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Left -->right
Streptococcus viridans
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

2. What causes prinzmetal angina?
Contraction band necrosis - reperfusion injury
Coronary artery vasospasm
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
White scar fibrosis

3. What is the most common valve infected by S aureus?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Asymptomatic
Tricuspid
Tetralogy of fallot

4. What murmur ccan be heard in PDA?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Pts w/previously damaged valves
Pancarditis
Holosystolic machine like murmur

5. Low voltage EKG w/diminished QRS amplitude.
Hypertrophic cardiomyopathy
Volume overload and LHF
Restrictive cardiomyopathy
Limits thrombosis

6. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Open blocked vessels
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

7. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Aortic regurg
Concentric LV hypertophy
Regurg vs stenosis
Mitral regurg

8. What is the most common cause of infectious endocarditis?
Papillary muscle - free wall - IV septum
PDA
Streptococcus viridans
Autoimmune pericarditis 6-8 wks post MI

9. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Bicuspid aortic valve
Nitroglycerin
Nonspecific - eg fever and elevated ESR
2-3 weeks

10. Sudden death in a young athlete.
>70%
Hypertrophic cardiomyopathy
Anitschow cell
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

11. What are the sx of hypertrophic cardiomyopathy?
Decrease preload -->lowers myocardial stress
PDA
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Myocarditis

12. What are the laboratory findings of bacterial endocarditis?
Holosystolic blowing murmur
Stable and unstable prinzmetal
Aneurysm - mural thrombus - Dressler syndrome
Positive blood cultures anemia of chronic disease

13. With what disease is Libman - Sacks endocarditis associated?
SLE
PDA
Fetal alcohol syndrome
Dilated

14. How does Eisenmeger syndrome occur?
Breast and lung carcinoma - melanoma - lymphoma
Tender lesions on fingers or toes.
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

15. What iis the tx for aortic regurg?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
S epidermidis
Valve replacement once LV dysfx develops
MI

16. What are the sx of right - to - left shunt?
Metastasis
Membrane damage
Cyanosis - RV hypertrophy - polycythemia - clubbing
RCA

17. What is the only Jones criteria that doesn't resolve with time?
Prinzmetal
Pancarditis
Anitschow cell
Transposition of the great vessels

18. What are the forward and backward sx of LHF?
Libman - Sacks endocarditis
Erythematous nontender lesions on palms and soles.
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
Pulsating nail bed

19. What heart sound manifest with an ASD?
Myocarditis
Colon cancer
Split S2 on auscultation
Mitral stenosis

20. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
2-4 hours - 24 hours - 7-10 days
Infantile coarctation of the aorta PDA
Eisenmenger syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

21. What generally causes ischemic heart disease?
Indomethacin - decreases PGE
Atherosclerosis of coronary arteries
Aneurysm - mural thrombus - Dressler syndrome
Bacterial endocarditis

22. What causes wear and tear aortic stenosis?
Endocardial fibroelastosis (rare)
Ventricular arrhythmia
Fibrosis and dystrophic calcification
Holosystolic machine like murmur

23. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Systolic ejection click followed by crescendo - decrescendo murmur
Stretched muscle loses contractility
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Inability to fill ventricles

24. What type of shunt results in cyanosis at birth?
Hemosiderin laden macrophages
Dark discoloration coagulative necrosis
Right to left
Myxoid degeneration

25. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Mitral mitral+aortic
Mitral regurgitation due to vegetations
Colon cancer
Split S2 on auscultation

26. What causes an early - blowing diastolic murmur?
Prophylactic abx during dental procedures
ASD - R-->L
20 min
Aortic regurg

27. What is the murmur of mitral regurg?
Transesophageal echo
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Holosystolic blowing murmur

28. What type of endocarditis is associated with SLE?
AD mutation in sarcomere proteins
Valve scarring that arises as a consequence of rheumatic fever
Transesophageal echo
Libman - Sacks endocarditis

29. What are the complications of mitral valve prolapse? Are they common?
AD mutation in sarcomere proteins
Infectious endocarditis - arrythmias - severe mitral regurg no
1-3 days
Rupture of free wall - IV septum - or papillary muscle

30. What gross and microscopic changes occur 1-3 days after an MI?
Valve replacement AFTER the onset of complications
Congestive heart failure
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Yellow pallor neutrophils

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

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32. What two things cause coronary artery vasospasm?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Ostium primum
Plump fibroblasts - collagen - blood vessels
Prinzmetal angina - cocaine

33. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Myxoid degeneration
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
SLE
RHF

34. What is the tx for mitral valve prolapse?
Valve replacement
Mitral regurg
Aortic stenosis
Harmartoma

35. What are the sx of PDA at birth?
3-8 wks
S viridans
Aschoff bodies
Asymptomatic

36. How does restrictive cardiomyopathy present?
Thickening of chrodae tendinae and cusps - mitral stenosis
Congestive heart failure
Posterior wall of LV - posterior septum - papillary muscles
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

37. L- to - R shunt switching to R- to - L shunt.
45%
LA dilation
Mitral regurgitation due to vegetations
Eisenmenger syndrome

38. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
LA dilation
4-7 days macrophage infiltration
Mitral stenosis

39. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Small vegetations along the line of closure
Pump failure
Circumflex

40. What causes the nutmeg color in nutmeg liver?
Congested central veins
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hypertrophic cardiomyopathy
4-7 days macrophage infiltration

41. With what condition are rhabdomyomas associated?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Holosystolic machine like murmur
Tuberous sclerosis
Decreases LV dilation by decreasing volume

42. What areas of the heart does the LAD supply?
LA
Anterior wall of LV and anterior septum
4-7 days
Bounding pulse

43. What is the characteristic finding on CXR in tetralogy of fallot?
Streptococcus bovis/
Boot shaped heart
Right to left
Dilation of all four chambers of the heart

44. Lower extremity cyanosis in infants? In adults?
SLE
Infantile coarctation of the aorta PDA
LA dilation
Aortic regurg

45. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Myocarditis
PGE
Paradoxical emboli

46. How do you prevent S viridans endocarditis?
Streptococcus viridans
Prophylactic abx during dental procedures
Months out fibrosis
4-7 days macrophage infiltration

47. How does reperfusion injury occur?
Rhadbomyoma - benign
Colon cancer
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
PDA

48. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myocarditis
Myxoma - benign
4-7 days macrophage infiltration
Harmartoma

49. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Troponin I
Louder - increased systemic resistence decreases LV emptying
Loeffler syndrome
Valve scarring that arises as a consequence of rheumatic fever

50. Infects predamaged valves after transient bacteremia?
S viridans
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Mitral regurg
RCA

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