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Cardiac

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Answer 50 questions in 15 minutes.
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1. When would arrhythmia occur after MI?
Within the first day
Intercostal arteries enlarged due to collateral circulation
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
First 4 hours

2. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Left -->right
Degree of pulmonary artery stenosis
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
Intercostal arteries enlarged due to collateral circulation

3. How does hypertension cause LHF?

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4. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
R-->L
Hypertrophic cardiomyopathy
Mitral regurgitation due to vegetations

5. When does the heart have dark discoloration post MI?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
PGE
Valve scarring that arises as a consequence of rheumatic fever
4-24 hours

6. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Pts w/previously damaged valves
Blood vessels coming in from normal tissue
Left -->right

7. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
45%
Right to left
LHF
Anitschow cell

8. What conditions can cause nonbacterial thrombotic endocarditis?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Hypercoagulable state or underlying adenocarcinoma
PDA
Rhabdomyoma

9. Infects predamaged valves after transient bacteremia?
Heart can't fill
PDA
S viridans
Myxoid degeneration

10. What causes prinzmetal angina?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Coronary artery vasospasm
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Fibrinous pericarditis

11. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Ventricle
Valve replacement
Stable angina

12. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Adult coarctation of the aorta
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

13. What complications occur 4-7 days post MI?
Dark discoloration coagulative necrosis
Breast and lung carcinoma - melanoma - lymphoma
Myocarditis
Rupture of free wall - IV septum - or papillary muscle

14. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Dressler syndrome
Prinzmetal stable and unstable
Tender lesions on fingers or toes.

15. What areas of the heart does the RCA supply?
Janeway lesions
Reactive histiocyte with caterpillar nucleus
Posterior wall of LV - posterior septum - papillary muscles
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

16. In transposition of the great vessels - What is required for survival? How is this achieved?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Tuberous sclerosis
Contraction band necrosis - reperfusion injury
Shunt - PGE to maintain PDA until surgical repair can be performed

17. What is the most common cause of aortic stenosis?
Right -->left
Wear and tear
Large vegetations of S aureus
Contraction band necrosis

18. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Erythematous nontender lesions on palms and soles.
Rhabdomyoma
Streptococcus viridans
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

19. What causes the split S2 in ASD?
Metastasis
Valve scarring that arises as a consequence of rheumatic fever
Transesophageal echo
Increased blood in right heart delays closure of P valve

20. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Circumflex
VSD
Decrease preload -->lowers myocardial stress

21. What is an Anitschow cell?
45%
Reactive histiocyte with caterpillar nucleus
Nonspecific - eg fever and elevated ESR
Myocarditis

22. What is the murmur of mitral valve prolapse?
Thickening of chrodae tendinae and cusps - mitral stenosis
Loss of LV fx
Mid - systolic click followed by regurgitation murmur
AD mutation in sarcomere proteins

23. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Ischemic heart disease
Mitral regurg
Bounding pulse
Nitroglycerin

24. What cardiac enzyme is useful for detecting reinfarction?
Stretched muscle loses contractility
CK- MB
Infantile coarctation of the aorta
20 min

25. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Coronary artery vasospasm - emboli - vasculitis
Osler nodes (ouch - ouch Osler)
Myxoma - benign

26. What is Dressler syndrome? When does it occur?
Pulsating nail bed
Autoimmune pericarditis 6-8 wks post MI
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rhabdomyoma

27. Systolic ejection click followed by crescendo - decrescendo murmur.
Fibrosis and dystrophic calcification
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Aortic stenosis

28. What is the definition of ischemia?
Decrease in blood flow to an organ
Adult coarctation of the aorta
Yellow pallor macrophages
Papillary muscle - free wall - IV septum

29. What are the sx of pericardiits?
Friction rub and chest pain
Red border granulation tissue
Valve replacement once LV dysfx develops
Tuberous sclerosis

30. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Limits thrombosis
Libman - Sacks endocarditis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

31. How do ACE inhibitors tx MI?
AD mutation in sarcomere proteins
PGE
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Decreases LV dilation by decreasing volume

32. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Cardiogenic shock - CHF - arrhythmia
20 min
Opening snap followed by diastolic rumble
Rupture of free wall - IV septum - or papillary muscle

33. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
VSD
Sudden cardiac death
Pulsating nail bed
Myofiber hypertrophy with disarray

34. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Ostium secundum (90%)
LV dilation and eccentric hypertrophy
RCA
Dark discoloration coagulative necrosis

35. Large vegetations on tricuspid valve?
Hypercoagulable state or underlying adenocarcinoma
S aureus
Concentric LV hypertophy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

36. What does chronic ischemic heart disease progress to?
When a bacterial protein resembles a protein in human tissue
CHF
Mitral regurg
Congested central veins

37. What is the most common congenital heart defect?
Small - nondestructive vegetations (subacute endocarditis)
CHF
VSD
Endocardial fibroelastosis (rare)

38. What is the tx for dilated cardiomyopathy?
S epidermidis
Heart transplant
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
L->R

39. What is migratory polyarthritis?
Bounding pulse
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
PGE

40. Are most congenital heart defects spontaneous or inherited?
Group A beta - hemolytic streptococci
Spontaneous
Myocarditis
Cardiogenic shock - CHF - arrhythmia

41. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Low voltage EKG w/diminished QRS amplitude
When a bacterial protein resembles a protein in human tissue
Stable and unstable prinzmetal
Reperfusion injury

42. What are the four defects in tetralogy of fallot?
Migratory polyarthritis
LA dilation
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Myocarditis

43. What is the only Jones criteria that doesn't resolve with time?
Prinzmetal angina - cocaine
Congestive heart failure
Pericarditits
Pancarditis

44. Holosystolic blowing murmur that increases w/expiration?
Pump failure
Turner syndrome
Mitral regurg
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

45. 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
Low voltage EKG w/diminished QRS amplitude
Stable and unstable prinzmetal
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

46. What is the JOneS mneumonic?
LHF
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Concentric LV hypertophy
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

47. L- to - R shunt switching to R- to - L shunt.
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Eisenmenger syndrome
Valve scarring that arises as a consequence of rheumatic fever
Mitral regurgitation due to vegetations

48. With what disease is Libman - Sacks endocarditis associated?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Louder - increased systemic resistence decreases LV emptying
SLE
Type I

49. What is an Aschoff body?
Infantile coarctation of the aorta PDA
Surgical closure small defects may close spontaneously
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Mitral valve prolapse

50. Is injury due angina reversible or irreversible?
Reversible
Infantile coarctation of the aorta PDA
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Tetralogy of fallot

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