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Cardiac

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Answer 50 questions in 15 minutes.
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1. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

2. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
R-->L
Volume overload and LHF
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

3. What is dilated cardiomyopathy?
Mid - systolic click followed by regurgitation murmur
Mitral regurg
Kawasaki disease
Dilation of all four chambers of the heart

4. What complications occur within 4 hrs post MI?
Infantile coarctation of the aorta
Cardiogenic shock - CHF - arrhythmia
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ventricles cannot pump

5. What effect does aortic stenosis have on the chambers of the heart?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Concentric LV hypertophy
Heart can't fill
Hypertophy of RV atrophy of LV

6. In transposition of the great vessels - What is required for survival? How is this achieved?
Low voltage EKG w/diminished QRS amplitude
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Left -->right
Shunt - PGE to maintain PDA until surgical repair can be performed

7. What coronary arterysupplies the lateral wall of the LV?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Circumflex
Myocardium

8. What is the most common cause of dilated cardiomyopathy? What are other causes?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Osler nodes (ouch - ouch Osler)
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

9. What are Osler nodes?
Tuberous sclerosis
CK- MB
Tender lesions on fingers or toes.
Indomethacin - decreases PGE

10. What creates the immune reaction in acute rhuematic fever?

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11. How does O2 tx MI?
Limits thrombosis
Hemosiderin laden macrophages
Minimizes ischemia
Eisenmenger syndrome

12. What valves are involved in rhuematic endocarditis?
Right to left
Papillary muscle - free wall - IV septum
Mitral mitral+aortic
Ventricles cannot pump

13. What type of ASD is associated w/Down syndrome?
Months out fibrosis
Elevated ASO anti - DNase B titers
Streptococcus viridans
Ostium primum

14. What are the minor critera of the Jones criteria?
AD mutation in sarcomere proteins
Nonspecific - eg fever and elevated ESR
Mid - systolic click followed by regurgitation murmur
Endocardial fibroelastosis (rare)

15. What are the complications of mitral stenosis?
Wear and tear
Mitral insufficiency
Annular - non pruritic rash w/erythematous borders trunks and limbs
Backward LHF pulm htn and RHF - afib and associated mural thombis

16. At what point in development do congenital heart defects arise?
Streptococcus viridans
Right to left
3-8 wks
Prinzmetal angina

17. What type of shunt does ASD cause?
Volume overload and LHF
Left -->right
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Contraction band necrosis - reperfusion injury

18. What is the rate of congenital heart defects?
Dressler syndrome
1%
Blood vessels coming in from normal tissue
Small vegetations along the line of closure

19. What are the forward and backward sx of LHF?
SLE
Dense layer of elastic and fibrotic tissue in the endocardium - children
Myocarditis
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

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

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21. What is the 1day-1wk -1mo mneumonic for MI?
Adult coarctation of the aorta
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Congenital rubella
Volume overload and LHF

22. What does rupture of a papillary muscle cause?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Mitral insufficiency
Pericarditits
Mitral regurg

23. Which vasculitis can cause MI?
Kawasaki disease
Annular - non pruritic rash w/erythematous borders trunks and limbs
Low voltage EKG w/diminished QRS amplitude
Mitral regurgitation due to vegetations

24. EKG for stable angina?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
ST- segment depression
Myocarditis in acute rheumatic heart fever
Ehlers - Danlow and Marfan syndrome

25. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Asymptomatic
Subendocardial
Colon cancer

26. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
Minimizes ischemia
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
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

27. How do ACE inhibitors tx MI?
Myocarditis
When a bacterial protein resembles a protein in human tissue
Decreases LV dilation by decreasing volume
Troponin I

28. What heart sound manifest with an ASD?
Ostium primum
Split S2 on auscultation
SLE
>60 years - bicuspid aortic valve

29. What is the only Jones criteria that doesn't resolve with time?
IV drug users
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Pancarditis
Aneurysm - mural thrombus - Dressler syndrome

30. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Split S2 on auscultation
Hypertophy of RV atrophy of LV
Rhadbomyoma - benign

31. Myofiber hypertrophy with disarray.
Tricuspid
Hypertrophic cardiomyopathy
Chronic rheumatic heart disease
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

32. What maintains patency of the PDA?
Squatting - expiration
PGE
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
ST- segment elevation

33. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
4-6 hours - 24 hours - 72 hours
Subendocardial
CHF
Months out fibrosis

34. What type of tumor is a rhabdomyoma?
Prinzmetal angina
Inability to fill ventricles
Minimizes ischemia
Harmartoma

35. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Pericardial effusion due to pericardial involvement
RCA
Subendocardial

36. Sudden death in a young athlete.
Congested central veins
Hypertrophic cardiomyopathy
Mitral regurgitation due to vegetations
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

37. L- to - R shunt switching to R- to - L shunt.
Bounding pulse
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Prinzmetal
Eisenmenger syndrome

38. Are most congenital heart defects spontaneous or inherited?
Mitral and tricuspid regurg - arrhythmia
RCA
Spontaneous
PGE

39. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Anitschow cell
Decrease preload -->lowers myocardial stress
Infectious endocarditis

40. What type of valvular vegetations does S aureus cause?
Boot shaped heart
Type I
Large - destructive vegetations
PGE

41. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Systemic venous congestion
Prinzmetal
Stable and unstable prinzmetal
2-3%

42. What congenital heart defect presents later in life with lower extremity cyanosis?
Pulsating nail bed
Red border granulation tissue
IV drug users
PDA

43. What type of ischemia does stable angina cause?
Subendocardial
Cardiogenic shock - CHF - arrhythmia
4-24 hours
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

44. What is a Quincke pulse?
Granulation tissue
Asymptomatic
Pulsating nail bed
Increased hydrostatic pressure

45. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Tuberous sclerosis
Loss of fx
Gelatinous - abundant ground substance
Regurg vs stenosis

46. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Aortic stenosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Turner syndrome
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

47. Which angina(s) show ST elevation on EKG? ST depression?
Shunt - PGE to maintain PDA until surgical repair can be performed
Opening snap followed by diastolic rumble
Prinzmetal stable and unstable
>60 years - bicuspid aortic valve

48. Lower extremity cyanosis in infants? In adults?
Dark discoloration coagulative necrosis
Prinzmetal stable and unstable
Infantile coarctation of the aorta PDA
Thickening of chrodae tendinae and cusps - mitral stenosis

49. Erythematous nontender lesions on palms and soles.
Janeway lesions
Type I
Turner syndrome
Hypertrophic cardiomyopathy

50. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Streptococcus bovis/
4-7 days macrophage infiltration
ST- segment elevation
Cardiogenic shock - CHF - arrhythmia

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