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Cardiac

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Answer 50 questions in 15 minutes.
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1. What disesase has Aschoff bodies?
Systolic ejection click followed by crescendo - decrescendo murmur
Myocarditis in acute rheumatic heart fever
Prophylactic abx during dental procedures
Tuberous sclerosis

2. What are the sx of PDA at birth?
Hypertophy of RV atrophy of LV
Small vegetations along the line of closure
Asymptomatic
Ostium primum

3. Pericarditis 6-8 wks post MI.
Congestive heart failure
Dressler syndrome
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Adult coarctation of the aorta

4. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
ASD - R-->L
2-3%
Boot shaped heart
Months out fibrosis

5. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Aortic regurg
Rhabdomyoma

6. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Pedunculated mass in the LA that causes syncope due to obstruction of MV
3-8 wks
Restrictive cardiomyopathy

7. What heart sound manifest with an ASD?
Nitroglycerin
Doxorubicin - cocaine
Split S2 on auscultation
Inability to fill ventricles

8. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Infantile coarctation of the aorta
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Nonspecific - eg fever and elevated ESR
Transesophageal echo

9. What is migratory polyarthritis?
Indomethacin - decreases PGE
Mitral regurg
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Pedunculated mass in the LA that causes syncope due to obstruction of MV

10. How do nitrates tx MI?
Nitroglycerin
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
When a bacterial protein resembles a protein in human tissue
Decrease preload -->lowers myocardial stress

11. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Pericardial effusion due to pericardial involvement
Sterile vegetations on surface and undersurface on mitral valve
Nitroglycerin

12. Turner syndrome is associated with which congenital heart defect?
White scar fibrosis
1%
Pts w/previously damaged valves
Infantile coarctation of the aorta

13. What are Janeway lesions?
Chronic ischemic heart disease
Aschoff bodies
Erythematous nontender lesions on palms and soles.
Squatting - expiration

14. What does rupture of a papillary muscle cause?
Mitral insufficiency
LHF
Annular - non pruritic rash w/erythematous borders trunks and limbs
PDA

15. What increases the volume of mitral regurg murmur?
Pts w/previously damaged valves
VSD
Squatting - expiration
Prinzmetal

16. How does hypertension cause LHF?

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17. What is the rate of mitral valve prolapse in the US?
2-3%
Dressler syndrome
PDA
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

18. What generally causes ischemic heart disease?
LA
Ostium primum
Friction rub and chest pain
Atherosclerosis of coronary arteries

19. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Yellow pallor neutrophils
LHF
Libman - Sacks endocarditis

20. When do neutrophils infiltrate the myocardium post MI?
1-3 days
SLE
Dilated
Hypertrophic cardiomyopathy

21. What two things cause coronary artery vasospasm?
Migratory polyarthritis
Squatting - increased systemic resistence decreases LV emptying
Decreased forward perfusion pulmonary congestion
Prinzmetal angina - cocaine

22. What is eythema marginatum? What parts of the body does it commonly involve?
Infectious endocarditis
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pericardial effusion due to pericardial involvement
Mitral valve prolapse

23. What is the murmur of mitral valve prolapse?
Chronic rheumatic heart disease
Mid - systolic click followed by regurgitation murmur
Yellow pallor macrophages
45%

24. What are other (not atherosclerotic) causes of MI?
Reactive histiocyte with caterpillar nucleus
MI
Coronary artery vasospasm - emboli - vasculitis
Myofiber hypertrophy with disarray

25. What effect does transposition of the great vessels have on the ventricles?
Low voltage EKG w/diminished QRS amplitude
Hypertophy of RV atrophy of LV
Membrane damage
Hypercoagulable state or underlying adenocarcinoma

26. What areas of the heart does the RCA supply?
Nitroglycerin
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
White scar fibrosis
Posterior wall of LV - posterior septum - papillary muscles

27. With what disease is Libman - Sacks endocarditis associated?
S aureus
SLE
Right -->left
Streptococcus viridans

28. What type of vegetations form in nonbacterial thrombotic endocarditis?
VSD
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Sterile vegetations on mitral valve along lines of closure
Pump failure

29. Which vasculitis can cause MI?
Inability to maintain systemic pressure w/lack of O2 to vital organs
L->R
Kawasaki disease
Ventricular arrhythmia

30. Sudden death in a young athlete.
Low voltage EKG w/diminished QRS amplitude
Hypertrophic cardiomyopathy
Mitral mitral+aortic
Prinzmetal

31. What is the etiology of S viridans endocarditis?
Rhabdomyoma
Troponin I
Aortic regurg
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

32. Is injury due angina reversible or irreversible?
Sterile vegetations on surface and undersurface on mitral valve
Infectious
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Reversible

33. What is the most common cause of endocarditis in IV drug users?
Ostium primum
Myocarditis in acute rheumatic heart fever
S aureus
Indomethacin - decreases PGE

34. What does a biopsy of hypertrophic cardiomyopathy look like?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Open blocked vessels
Myofiber hypertrophy with disarray
Anitschow cell

35. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
PDA
Dilation of all four chambers of the heart

36. What are the forward and backward sx of LHF?
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
Autoimmune pericarditis 6-8 wks post MI
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
L->R

37. What are the complications that occur months after an MI?
4-24 hours
Aneurysm - mural thrombus - Dressler syndrome
First 4 hours
S aureus

38. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Prinzmetal angina
Wear and tear
Myofiber hypertrophy with disarray

39. What gross and microscopic changes occur 4-24 hours after an MI?
Limits thrombosis
PDA
Dark discoloration coagulative necrosis
Chest pain <20 min brought on by exertion or emotional stress

40. What is the most common cause of aortic stenosis?
4-6 hours - 24 hours - 72 hours
Blood vessels coming in from normal tissue
Wear and tear
Mitral valve prolapse

41. What is the leading cause of death in the US?
Atria and RV
Increased hydrostatic pressure
Ischemic heart disease
Myocarditis

42. What side of the heart do carcinoid tumors affect? Why?
1-3 days
Right side - serotonin and other secretory products detoxified in the lung
Osler nodes (ouch - ouch Osler)
Small - nondestructive vegetations (subacute endocarditis)

43. Lower extremity cyanosis later in life - holostystolic machine like murmur.
ST- segment depression
PDA
Mitral regurg
Slow HR - decreasing O2 demand and risk for arrhythmia

44. When do macrophagess infiltrate the myocardium post MI?
Indomethacin - decreases PGE
4-7 days
S viridans
2-4 hours - 24 hours - 7-10 days

45. How does transmural MI/ischemia present on EKG?
First 4 hours
ST- segment elevation
LV dilation and eccentric hypertrophy
Decreases LV dilation by decreasing volume

46. What type of ischemia does stable angina cause?
Subendocardial
Streptococcus viridans
Atherosclerosis of coronary arteries
R-->L

47. What always follows necrosis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
20 min
Loss of fx
Acute inflammation

48. 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.
Granulation tissue
Stable angina
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Aortic regurg

49. What causes an early - blowing diastolic murmur?
VSD
R-->L
Aortic regurg
Chronic ischemic heart disease

50. Which artery is most often occluded in an MI?
Open blocked vessels
Ventricular arrhythmia
LAD
20 min

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