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Cardiac

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Answer 50 questions in 15 minutes.
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1. What areas of the heart does the LAD supply?
Large vegetations of S aureus
Anterior wall of LV and anterior septum
Endocardial fibroelastosis (rare)
Myocarditis

2. How does Eisenmeger syndrome occur?
Within the first day
R-->L
Rupture of free wall - IV septum - or papillary muscle
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

3. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Boot shaped heart
S epidermidis
Decrease in blood flow to an organ
ASD - R-->L

4. What is the most common valve infected by S aureus?
Bicuspid aortic valve
Dilation of all four chambers of the heart
Tricuspid
NG or Ca channel blocker

5. What is the most common cause of aortic stenosis?
Fibrinous pericarditis
Wear and tear
Pts w/previously damaged valves
Heart can't fill

6. What is an Anitschow cell?
Blood vessels coming in from normal tissue
Congested central veins
Reactive histiocyte with caterpillar nucleus
Valve replacement AFTER the onset of complications

7. What is the basic principle of CHF?
Right side - serotonin and other secretory products detoxified in the lung
20 min
Pump failure
Metastasis

8. What imaging test is useful for detecting lesions on valves?
Preductal - post aortic arch
Friction rub and chest pain
Fibrosis and dystrophic calcification
Transesophageal echo

9. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Squatting - increased systemic resistence decreases LV emptying
Hypercoagulable state or underlying adenocarcinoma
Prinzmetal angina
Infantile coarctation of the aorta

10. What tests show prior group A beta - hemolytic strep infection?
Myocarditis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
ASD - R-->L
Elevated ASO anti - DNase B titers

11. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
When a bacterial protein resembles a protein in human tissue
CHF
Aortic regurg

12. What is the main cause of MV regurg? What are other causes?
Pulsating nail bed
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Membrane damage

13. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Ventricular arrhythmia
Yellow pallor macrophages
Pump failure
Nonbacterial thrombotic endocarditis (marantic endocarditis)

14. What are the sx of aortic regurg?
Dilation of all four chambers of the heart
Systolic ejection click followed by crescendo - decrescendo murmur
Mitral insufficiency
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

15. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Contraction band necrosis - reperfusion injury
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

16. What type of shunt does ASD cause?
Fetal alcohol syndrome
AD mutation in sarcomere proteins
Left -->right
Sterile vegetations on mitral valve along lines of closure

17. In which chamber of the heart are cardiac myxomas found?
LA
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
SLE

18. What type of ASD is associated w/Down syndrome?
Opening snap followed by diastolic rumble
4-6 hours - 24 hours - 72 hours
Ostium primum
Reperfusion injury

19. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Papillary muscle - free wall - IV septum
ST- segment elevation
Months out fibrosis

20. What causes the nutmeg color in nutmeg liver?
Congested central veins
Libman - Sacks endocarditis
Loss of fx
Positive blood cultures anemia of chronic disease

21. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Streptococcus viridans
Osler nodes (ouch - ouch Osler)
Congestive heart failure

22. With what disease is infantile coarctation of the aorta associated?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Turner syndrome
Sudden cardiac death
LHF

23. What type of shunt does transposition of the great vessels cause?
Prophylactic abx during dental procedures
Rhabdomyoma
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
R-->L

24. What type of tumor is a rhabdomyoma?
Harmartoma
RHF
Mitral regurg
First 4 hours

25. What is an important complication of ASD?
Paradoxical emboli
Pts w/previously damaged valves
Dark discoloration coagulative necrosis
Pedunculated mass in the LA that causes syncope due to obstruction of MV

26. What are the causes of restrictive cardiomyopathy in adults?
Ischemic heart disease
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Large vegetations of S aureus
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

27. What are the HACEK organisms? With what condition are they associated?
Hemosiderin laden macrophages
AD mutation in sarcomere proteins
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

28. When do troponin levels rise - peak - and return to normal?
1-3 days out
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Volume overload and LHF
2-4 hours - 24 hours - 7-10 days

29. What is the effect of mitral regurg on the heart?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
S viridans
Trisomy 21
Volume overload and LHF

30. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Elevated ASO anti - DNase B titers
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Chronic rheumatic heart disease
Nitroglycerin

31. What heart sound manifest with an ASD?
Nonspecific - eg fever and elevated ESR
Preductal - post aortic arch
Split S2 on auscultation
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

32. What does Libman - Sacks endocarditis cause?
Mitral regurg
Streptococcus viridans
Mid - systolic click followed by regurgitation murmur
Sterile vegetations on surface and undersurface on mitral valve

33. What % of MIs involve the LAD?
Cardiac tamponade
VSD
Thickening of chrodae tendinae and cusps - mitral stenosis
45%

34. What shunt does tetralogy of fallot produce?
Right -->left
Anterior wall of LV and anterior septum
Mitral regurg
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

35. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
RHF
Hypertophy of RV atrophy of LV
Loeffler syndrome
VSD

36. Is scar tissue or myocardium stronger?
Myocardium
RBC damaged while crossing the calcified valve causing schistocytes
Within the first day
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

37. What always follows necrosis?
R-->L
Systolic dysfx leading to biventricular CHF
Acute inflammation
Autoimmune pericarditis 6-8 wks post MI

38. What type of shunt does truncus arteriosus cause?
Metastasis
R-->L
4-7 days macrophage infiltration
Right side - serotonin and other secretory products detoxified in the lung

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

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40. What gross and microscopic changes occur 1-3 days after an MI?
Dilation of all four chambers of the heart
Aortic regurg
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Yellow pallor neutrophils

41. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Bacterial endocarditis
Transposition of the great vessels
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

42. What are the minor critera of the Jones criteria?
PDA
Janeway lesions
Dense layer of elastic and fibrotic tissue in the endocardium - children
Nonspecific - eg fever and elevated ESR

43. 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
S aureus
Regurg vs stenosis
Bacterial endocarditis

44. When do neutrophils infiltrate the myocardium post MI?
Mitral regurgitation due to vegetations
Ischemic heart disease
1-3 days
Systemic venous congestion

45. What is the foundation of a scar?
Atherosclerosis of coronary arteries
PDA
Granulation tissue
Colon cancer

46. What is the major cause of MI?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Membrane damage

47. How does restrictive cardiomyopathy present?
Squat in response to cyanotic spell
Congestive heart failure
Mitral valve prolapse
Valve scarring that arises as a consequence of rheumatic fever

48. How does adult coarctation of the aorta present?
Congested central veins
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Transposition of the great vessels
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

49. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
3-8 wks
Prophylactic abx during dental procedures
Transesophageal echo

50. What does rupture of the LV free wall cause?
>70%
Minimizes ischemia
Cardiac tamponade
LA

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