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Cardiac

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Answer 50 questions in 15 minutes.
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1. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
PGE
Louder - increased systemic resistence decreases LV emptying
Concentric LV hypertophy

2. What is the leading cause of death in the US?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Membrane damage
Ischemic heart disease
Minimizes ischemia

3. What type of vegetations are associated with Libman - Sacks endocarditis?
Nitroglycerin
Sterile vegetations on surface and undersurface on mitral valve
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
Left -->right

4. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Metastasis
LHF
Contraction band necrosis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

5. What effect does chronic rheumatic heart disease have the mitral valve?
Papillary muscle - free wall - IV septum
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Thickening of chrodae tendinae and cusps - mitral stenosis
Pancarditis

6. In which pts does S viridans cause endocarditits?
Intercostal arteries enlarged due to collateral circulation
Pts w/previously damaged valves
Congestive heart failure
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

7. Infects predamaged valves after transient bacteremia?
S viridans
Group A beta - hemolytic streptococci
R-->L
RCA

8. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
Increased hydrostatic pressure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Prinzmetal

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

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10. What are the clinical features of RHF?
Acute inflammation
Surgical closure small defects may close spontaneously
Slow HR - decreasing O2 demand and risk for arrhythmia
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

11. What are the minor critera of the Jones criteria?
Pericarditits
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Nonspecific - eg fever and elevated ESR
Restrictive cardiomyopathy

12. When do macrophagess infiltrate the myocardium post MI?
Mitral regurg
4-7 days
Restrictive cardiomyopathy
Indomethacin - decreases PGE

13. What is the tx for aortic stenosis?
Infantile coarctation of the aorta
Migratory polyarthritis
Valve replacement AFTER the onset of complications
Granulation tissue

14. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Anitschow cell
LHF
NG or Ca channel blocker
Turner syndrome

15. What is chronic rheumatic heart disease?
Adult coarctation of the aorta
Streptococcus bovis/
Valve scarring that arises as a consequence of rheumatic fever
Breast and lung carcinoma - melanoma - lymphoma

16. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Aortic regurg
Shunt - PGE to maintain PDA until surgical repair can be performed
Heart can't fill

17. What is the most common type of endocarditis?
Bacterial endocarditis
Infectious
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
LA dilation

18. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
>70%
Congestive heart failure
Infectious

19. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
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
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Bacterial endocarditis
Aneurysm - mural thrombus - Dressler syndrome

20. Tx for PDA?
Louder - increased systemic resistence decreases LV emptying
Mitral stenosis
Holosystolic machine like murmur
Indomethacin - decreases PGE

21. When does the heart have dark discoloration post MI?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
4-24 hours
Boot shaped heart
Systolic dysfx leading to biventricular CHF

22. What increases the risk for chronic rheumatic heart disease?
VSD
ST- segment depression
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Tuberous sclerosis

23. What is a water - hammer pulse?
Prinzmetal stable and unstable
Cyanosis - RV hypertrophy - polycythemia - clubbing
ST- segment depression
Bounding pulse

24. Which artery is most often occluded in an MI?
Holosystolic blowing murmur
Hypercoagulable state or underlying adenocarcinoma
Surgical closure small defects may close spontaneously
LAD

25. What is the etiology of S viridans endocarditis?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Cardiogenic shock - CHF - arrhythmia
Dressler syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

26. What % of MIs involve the LAD?
Tender lesions on fingers or toes.
Mitral regurgitation due to vegetations
45%
Membrane damage

27. Holosystolic blowing murmur that increases w/expiration?
White scar fibrosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Mitral regurg

28. What is the classic EKG finding of restrictive cardiomyopathy?
Low voltage EKG w/diminished QRS amplitude
Metastasis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Gelatinous - abundant ground substance

29. What are heart failure cells?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Aortic regurg
Hemosiderin laden macrophages
Infectious endocarditis - arrythmias - severe mitral regurg no

30. How does asprin/heparin tx MI?
Reactive histiocyte with caterpillar nucleus
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Limits thrombosis
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

31. What are the sx of right - to - left shunt?
IV drug users
Cyanosis - RV hypertrophy - polycythemia - clubbing
Indomethacin - decreases PGE
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

32. What increases the volume of mitral regurg murmur?
Elevated ASO anti - DNase B titers
Squatting - expiration
Ehlers - Danlow and Marfan syndrome
Bicuspid aortic valve

33. What tests show prior group A beta - hemolytic strep infection?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Heart can't fill
Tuberous sclerosis
Elevated ASO anti - DNase B titers

34. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Holosystolic machine like murmur
Loeffler syndrome
ASD - R-->L
Reperfusion injury

35. What congenital heart defect often is present with infantile coarctation of the aorta?
Streptococcus bovis/
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
PDA
2-4 hours - 24 hours - 7-10 days

36. Where is the coarctation in infantile coarctation of the aorta?
Ostium primum
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Preductal - post aortic arch
Mitral regurgitation due to vegetations

37. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Infectious
Hypertrophic cardiomyopathy
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

38. What are the sx of PDA at birth?
Asymptomatic
Large - destructive vegetations
Dark discoloration coagulative necrosis
PDA

39. Which coronary artery supplies the anterior wall and anterior septum?
Right -->left
LAD
Infectious endocarditis - arrythmias - severe mitral regurg no
Small - nondestructive vegetations (subacute endocarditis)

40. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Decreases LV dilation by decreasing volume
Nitroglycerin
Mitral regurgitation due to vegetations

41. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Split S2 on auscultation
Streptococcus bovis/
Yellow pallor macrophages

42. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Ischemic heart disease
Hypertrophic cardiomyopathy
IV drug users

43. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Ostium primum
Infectious
Type I

44. EKG for stable angina?
ST- segment depression
Endocardial fibroelastosis
Holosystolic blowing murmur
ACE inhibitor

45. What causes angina and syncope in aortic stenosis?

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46. What are complications of dilated cardiomyopathy?
Degree of pulmonary artery stenosis
Mitral and tricuspid regurg - arrhythmia
Backward LHF pulm htn and RHF - afib and associated mural thombis
Hypertophy of RV atrophy of LV

47. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
Valve replacement once LV dysfx develops
Congenital rubella
Tetralogy of fallot

48. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Shunt - PGE to maintain PDA until surgical repair can be performed
Hemosiderin laden macrophages
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

49. How does ischemia cause LHF?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Loss of fx
Rhadbomyoma - benign

50. How does aortic regurg affect the heart chambers?
Ostium secundum (90%)
Infectious
LV dilation and eccentric hypertrophy
Nitroglycerin

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