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Cardiac

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Answer 50 questions in 15 minutes.
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1. At what point in development do congenital heart defects arise?
3-8 wks
Myxoid degeneration
Restrictive cardiomyopathy
PGE

2. Which artery is most often occluded in an MI?
Osler nodes (ouch - ouch Osler)
Increased hydrostatic pressure
LAD
Ehlers - Danlow and Marfan syndrome

3. What % stenosis causes stable angina?
Systolic dysfx leading to biventricular CHF
Subendocardial
Large - destructive vegetations
>70%

4. Turner syndrome is associated with which congenital heart defect?
PDA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Small - nondestructive vegetations (subacute endocarditis)
Infantile coarctation of the aorta

5. How do you tx prinzmetal angina?
Regurg vs stenosis
NG or Ca channel blocker
Limits thrombosis
VSD

6. Which angina is relieved by Ca channel blockers?
Group A beta - hemolytic streptococci
SLE
Decreased forward perfusion pulmonary congestion
Prinzmetal

7. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Reperfusion injury
RBC damaged while crossing the calcified valve causing schistocytes
S viridans
Mitral regurg

8. What causes mitral valve prolapse?
Contraction band necrosis - reperfusion injury
IV drug users
Myxoid degeneration
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

9. What gross and microscopic changes occur months after an MI?
LAD
1%
Loss of LV fx
White scar fibrosis

10. How do nitrates tx MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Decrease preload -->lowers myocardial stress
Thickening of chrodae tendinae and cusps - mitral stenosis
Colon cancer

11. What are the causes of LHF?
LA
Blood vessels coming in from normal tissue
Circumflex
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

12. What is endocardial fibroelastosis? In what population is it found?
PDA
Coxsackie A or B
Dense layer of elastic and fibrotic tissue in the endocardium - children
Heart transplant

13. What is a water - hammer pulse?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Fibrinous pericarditis
Right to left
Bounding pulse

14. What congenital heart defect does indomethacin tx?
Rhabdomyoma
Ventricles cannot pump
Chronic ischemic heart disease
PDA

15. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
SLE
PDA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

16. What makes the MV prolapse murmur louder? Why?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Ehlers - Danlow and Marfan syndrome
Squatting - increased systemic resistence decreases LV emptying
Indomethacin - decreases PGE

17. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
1%
S viridans
Large vegetations of S aureus

18. What are the laboratory findings of bacterial endocarditis?
Nitroglycerin
Positive blood cultures anemia of chronic disease
Yellow pallor macrophages
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

19. How does Eisenmeger syndrome occur?
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
CHF
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
RCA

20. Are most congenital heart defects spontaneous or inherited?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Spontaneous
White scar fibrosis
Large - destructive vegetations

21. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Infectious
RCA
Sudden cardiac death
Aortic regurg

22. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Surgical closure small defects may close spontaneously
Minimizes ischemia
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

23. What gross and microscopic changes occur 4-24 hours after an MI?
Nonspecific - eg fever and elevated ESR
Concentric LV hypertophy
ST- segment elevation
Dark discoloration coagulative necrosis

24. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Acute inflammation
Anitschow cell
Spontaneous
R-->L

25. Which chambers of the heart are generally spared in an MI?
Stable angina
CK- MB
RHF
Atria and RV

26. What does rupture of the IV septum cause?
Shunt
Chronic rheumatic heart disease
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Regurg vs stenosis

27. What tests show prior group A beta - hemolytic strep infection?
Ventricular arrhythmia
Dressler syndrome
Sudden cardiac death
Elevated ASO anti - DNase B titers

28. What are the clinical features of LHF due to?
PDA
AD mutation in sarcomere proteins
Coronary artery vasospasm - emboli - vasculitis
Decreased forward perfusion pulmonary congestion

29. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Right to left
Mitral mitral+aortic
Colon cancer

30. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Systolic ejection click followed by crescendo - decrescendo murmur
Decreased forward perfusion pulmonary congestion
Aortic stenosis

31. What is the most common cause of endocarditis in IV drug users?
Group A beta - hemolytic streptococci
S aureus
Heart can't fill
Mitral regurg

32. What are the minor critera of the Jones criteria?
Autoimmune pericarditis 6-8 wks post MI
Positive blood cultures anemia of chronic disease
Nonspecific - eg fever and elevated ESR
Prinzmetal stable and unstable

33. 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.
Osler nodes (ouch - ouch Osler)
Stable angina
Pericarditits
Valve scarring that arises as a consequence of rheumatic fever

34. What does nonbacterial thrombotic endocarditis cause?
VSD
Mitral valve prolapse
Mitral regurg
Shunt - PGE to maintain PDA until surgical repair can be performed

35. What type of ASD is associated w/Down syndrome?
Ostium secundum (90%)
Doxorubicin - cocaine
Ostium primum
Holosystolic blowing murmur

36. What are Osler nodes?
RBC damaged while crossing the calcified valve causing schistocytes
Tender lesions on fingers or toes.
Months out fibrosis
ST- segment depression

37. With what disease is transposition of the great vessels associated?
Loss of fx
Membrane damage
Nitroglycerin
Maternal diabetes

38. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
Sterile vegetations on mitral valve along lines of closure
Systolic ejection click followed by crescendo - decrescendo murmur
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

39. What is the characteristic murmur of aortic stenosis?
Months out fibrosis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Systolic ejection click followed by crescendo - decrescendo murmur
Sudden cardiac death

40. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
AD mutation in sarcomere proteins
Shunt - PGE to maintain PDA until surgical repair can be performed
Ventricles cannot pump
MI

41. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Dark discoloration coagulative necrosis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Tender lesions on fingers or toes.
Aschoff bodies

42. What are Janeway lesions?
Loeffler syndrome
Bounding pulse
Erythematous nontender lesions on palms and soles.
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

43. What is the characteristic murmurr of mitral stenosis?
Degree of pulmonary artery stenosis
Coronary artery vasospasm - emboli - vasculitis
Opening snap followed by diastolic rumble
Minimizes ischemia

44. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
Endocardial fibroelastosis (rare)
Decreases LV dilation by decreasing volume
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

45. What always follows necrosis?
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Acute inflammation
Myocarditis
Cardiogenic shock - CHF - arrhythmia

46. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Left -->right
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
Erythematous nontender lesions on palms and soles.

47. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Granulation tissue
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dense layer of elastic and fibrotic tissue in the endocardium - children

48. What are heart failure cells?
Hemosiderin laden macrophages
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Anitschow cell
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

49. How does dilated cardiomyopathy cause LHF?
Squatting - expiration
Shunt - PGE to maintain PDA until surgical repair can be performed
SLE
Stretched muscle loses contractility

50. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
>70%
Metastasis

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