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Cardiac

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Answer 50 questions in 15 minutes.
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1. With what developmental disorder is VSD associated?
Slow HR - decreasing O2 demand and risk for arrhythmia
Fetal alcohol syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
2-4 hours - 24 hours - 7-10 days

2. What are the Jones criteria?
Surgical closure small defects may close spontaneously
Circumflex
Mitral insufficiency
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

3. How does reperfusion injury occur?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Months out fibrosis
Harmartoma
Yellow pallor neutrophils

4. Which congenital heart defect is associated with congenital rubella?
Streptococcus viridans
Turner syndrome
Valve scarring that arises as a consequence of rheumatic fever
PDA

5. What are the sx of hypertrophic cardiomyopathy?
Erythematous nontender lesions on palms and soles.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Reversible
Reperfusion injury

6. What type of collagen is involved in fibrosis?
Type I
Anitschow cell
Libman - Sacks endocarditis
Inability to maintain systemic pressure w/lack of O2 to vital organs

7. Dense layer of elastic and fibrotic tissue in the endocardium.
Kawasaki disease
Adult coarctation of the aorta
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
Endocardial fibroelastosis

8. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Blood vessels coming in from normal tissue
Increased blood in right heart delays closure of P valve

9. What cardiac disease is associated with tuberous sclerosis?
Left -->right
Valve replacement once LV dysfx develops
Rhabdomyoma
LAD

10. Vegetations on surface and undersurface of mitral valve.
Bacterial endocarditis
Reversible
Libman - Sacks endocarditis
R-->L

11. Why are cardiac enzymes elevated after an MI?
LV dilation and eccentric hypertrophy
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Months out fibrosis
Membrane damage

12. What type of ASD is associated w/Down syndrome?
Ostium primum
Hemosiderin laden macrophages
Reversible
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

13. What are the complications of mitral valve prolapse? Are they common?
RCA
Open blocked vessels
Valve scarring that arises as a consequence of rheumatic fever
Infectious endocarditis - arrythmias - severe mitral regurg no

14. What causes the dependent pitting edema in RHF?
LA
Endocardial fibroelastosis
Valve replacement once LV dysfx develops
Increased hydrostatic pressure

15. What type of shunt dose PDA cause?
Stretched muscle loses contractility
Left -->right
Blood vessels coming in from normal tissue
Indomethacin - decreases PGE

16. When does the heart have dark discoloration post MI?
Membrane damage
Troponin I
4-24 hours
Systemic venous congestion

17. What is the classic EKG finding of restrictive cardiomyopathy?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Myocarditis
Low voltage EKG w/diminished QRS amplitude

18. What is the JOneS mneumonic?
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
Doxorubicin - cocaine
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Systemic venous congestion

19. Is scar tissue or myocardium stronger?
Blood vessels coming in from normal tissue
Aortic stenosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Myocardium

20. What is an Aschoff body?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Reversible
Squat in response to cyanotic spell
Contraction band necrosis - reperfusion injury

21. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Valve replacement
Atria and RV
Libman - Sacks endocarditis

22. What type of shunt does a VSD cause?
S viridans
Regurg vs stenosis
L->R
LHF

23. What does a biopsy of hypertrophic cardiomyopathy look like?
Paradoxical emboli
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Myofiber hypertrophy with disarray
Minimizes ischemia

24. What is the cause of restrictive cardiomyopathy in children?
Subendocardial
Elevated ASO anti - DNase B titers
Endocardial fibroelastosis (rare)
MI

25. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
RCA
Reactive histiocyte with caterpillar nucleus

26. What effect does transposition of the great vessels have on the ventricles?
RBC damaged while crossing the calcified valve causing schistocytes
Janeway lesions
Boot shaped heart
Hypertophy of RV atrophy of LV

27. What type of tumor is a rhabdomyoma?
Stretched muscle loses contractility
Harmartoma
LAD
Mitral valve prolapse

28. When would arrhythmia occur after MI?
Atria and RV
Within the first day
First 4 hours
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

29. 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.
1-3 days out
S epidermidis
Myxoma - benign
Stable angina

30. What are the sx of cardiac myxoma?
Aortic regurg
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Chest pain <20 min brought on by exertion or emotional stress
LA dilation

31. What is the tx for aortic stenosis?
Squat in response to cyanotic spell
Restrictive cardiomyopathy
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Valve replacement AFTER the onset of complications

32. What are complications of dilated cardiomyopathy?
Indomethacin - decreases PGE
Squatting - increased systemic resistence decreases LV emptying
4-7 days macrophage infiltration
Mitral and tricuspid regurg - arrhythmia

33. How does subendocardial MI/ischemia present on EKG?
Hypertophy of RV atrophy of LV
ASD - R-->L
ST- segment depression
Ostium secundum (90%)

34. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Mitral regurgitation due to vegetations
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Bicuspid aortic valve

35. What coronary arterysupplies the lateral wall of the LV?
Inability to fill ventricles
PDA
Circumflex
Mitral regurg

36. Low voltage EKG w/diminished QRS amplitude.
Hemosiderin laden macrophages
Infectious endocarditis - arrythmias - severe mitral regurg no
45%
Restrictive cardiomyopathy

37. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Cardiogenic shock - CHF - arrhythmia
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Ehlers - Danlow and Marfan syndrome
Aschoff bodies

38. What is the effect of mitral regurg on the heart?
AD mutation in sarcomere proteins
Type I
Volume overload and LHF
Pericarditits

39. What does chronic ischemic heart disease progress to?
CHF
Asymptomatic
Loss of fx
PDA

40. What is cardiogenic shock?
Loss of fx
Inability to maintain systemic pressure w/lack of O2 to vital organs
Months out fibrosis
Autoimmune pericarditis 6-8 wks post MI

41. What congenital heart defect does indomethacin tx?
R-->L
Mitral and tricuspid regurg - arrhythmia
Pts w/previously damaged valves
PDA

42. What congenital heart defect presents later in life with lower extremity cyanosis?
S aureus
PDA
Pts w/previously damaged valves
Bicuspid aortic valve

43. Which angina is relieved by Ca channel blockers?
2-3%
Right to left
Prinzmetal
LAD

44. Is injury due angina reversible or irreversible?
Spontaneous
Reversible
Mitral insufficiency
Hypertrophic cardiomyopathy

45. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reperfusion injury
R-->L

46. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
Increased blood in right heart delays closure of P valve
Stable angina
Type I

47. What is the foundation of a scar?
Pericarditits
Granulation tissue
Red border granulation tissue
PDA

48. What causes acute endocarditis?
Kawasaki disease
Large vegetations of S aureus
Systolic dysfx leading to biventricular CHF
Regurg vs stenosis

49. What is the characteristic murmur of aortic stenosis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Systolic ejection click followed by crescendo - decrescendo murmur
Boot shaped heart
Sudden cardiac death

50. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Janeway lesions
>60 years - bicuspid aortic valve
RHF

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