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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is the murmur of mitral regurg?
Congestive heart failure
Acute inflammation
Right -->left
Holosystolic blowing murmur

2. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Mitral regurg
Systemic venous congestion
MI

3. How long after pharyngitis does acute rheumatic fever occur?
RHF
2-3 weeks
Stretched muscle loses contractility
Subendocardial

4. What cardiac disease is associated with tuberous sclerosis?
Nitroglycerin
Months out fibrosis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Rhabdomyoma

5. Are most congenital heart defects spontaneous or inherited?
LHF
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Positive blood cultures anemia of chronic disease
Spontaneous

6. What is the foundation of a scar?
Adult coarctation of the aorta
ASD - R-->L
Tender lesions on fingers or toes.
Granulation tissue

7. What is the most common type of ASD? What %?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Stable angina
Aneurysm - mural thrombus - Dressler syndrome
Ostium secundum (90%)

8. What is a common complication of cardiac metastasis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Chronic ischemic heart disease
NG or Ca channel blocker
Pericardial effusion due to pericardial involvement

9. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Ventricle
Aneurysm - mural thrombus - Dressler syndrome
>60 years - bicuspid aortic valve
ASD - R-->L

10. Which congenital heart defect is associated with maternal diabetes?
Stable angina
Transposition of the great vessels
Within the first day
Valve replacement AFTER the onset of complications

11. What are the sx/complications of myocarditis?
Limits thrombosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Dark discoloration coagulative necrosis

12. How does aortic regurg affect the heart chambers?
S aureus
LV dilation and eccentric hypertrophy
Opening snap followed by diastolic rumble
Prophylactic abx during dental procedures

13. What are other (not atherosclerotic) causes of MI?
Plump fibroblasts - collagen - blood vessels
Coronary artery vasospasm - emboli - vasculitis
Surgical closure small defects may close spontaneously
Dilated

14. What makes the MV prolapse murmur louder? Why?
Loss of LV fx
Squatting - increased systemic resistence decreases LV emptying
Ischemic heart disease
ST- segment elevation

15. What is the characteristic murmurr of mitral stenosis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LV dilation and eccentric hypertrophy
Opening snap followed by diastolic rumble
Tetralogy of fallot

16. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
SLE
Tetralogy of fallot
Opening snap followed by diastolic rumble

17. What causes notching of the ribs in adult coarctation of the aorta?
Atherosclerosis of coronary arteries
Type I
Intercostal arteries enlarged due to collateral circulation
Pump failure

18. What is the leading cause of death in the US?
Reversible
Ischemic heart disease
Ventricle
Sterile vegetations on surface and undersurface on mitral valve

19. Which vasculitis can cause MI?
Dark discoloration coagulative necrosis
Kawasaki disease
Bounding pulse
Nonspecific - eg fever and elevated ESR

20. What type of shunt does ASD cause?
Left -->right
Valve scarring that arises as a consequence of rheumatic fever
Aortic regurg
Hypertrophic cardiomyopathy

21. What are the causes of LHF?
Red border granulation tissue
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
1-3 days
Tender lesions on fingers or toes.

22. What structures are susceptible to rupture post MI?
Papillary muscle - free wall - IV septum
Volume overload and LHF
Ostium primum
Tetralogy of fallot

23. What is the definition of ischemia?
Erythematous nontender lesions on palms and soles.
First 4 hours
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
Decrease in blood flow to an organ

24. What areas of the heart does the LAD supply?
Nonspecific - eg fever and elevated ESR
Anterior wall of LV and anterior septum
Transesophageal echo
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

25. What effect does dilated cardiomyopathy have on the heart?
Systemic venous congestion
Systolic dysfx leading to biventricular CHF
Loss of fx
Endocardial fibroelastosis

26. What increases the volume of mitral regurg murmur?
Atria and RV
>60 years - bicuspid aortic valve
Squatting - expiration
Louder - increased systemic resistence decreases LV emptying

27. What are the major criteria of the Jones criteria?
Subendocardial
Streptococcus bovis/
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
ST- segment depression

28. What is the 1day-1wk -1mo mneumonic for MI?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Tuberous sclerosis
Infantile coarctation of the aorta PDA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

29. Is scar tissue or myocardium stronger?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Myocardium
Hypertrophic cardiomyopathy
Infectious

30. What does rupture of a papillary muscle cause?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Dressler syndrome
Mitral insufficiency
Preductal - post aortic arch

31. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Large vegetations of S aureus
Red border granulation tissue
Coxsackie A or B

32. What is Dressler syndrome? When does it occur?
Nitroglycerin
Autoimmune pericarditis 6-8 wks post MI
Rhabdomyoma
4-24 hours

33. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Shunt - PGE to maintain PDA until surgical repair can be performed
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

34. What are the laboratory findings of bacterial endocarditis?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Coronary artery vasospasm - emboli - vasculitis
Positive blood cultures anemia of chronic disease
Dilation of all four chambers of the heart

35. How do you tx prinzmetal angina?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Bacterial endocarditis
Infectious
NG or Ca channel blocker

36. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Regurg vs stenosis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

37. What are the complications of mitral valve prolapse? Are they common?
Congested central veins
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Infectious endocarditis - arrythmias - severe mitral regurg no
Decrease in blood flow to an organ

38. How does asprin/heparin tx MI?
Limits thrombosis
Increased blood in right heart delays closure of P valve
4-7 days
Louder - increased systemic resistence decreases LV emptying

39. What type of shunt does transposition of the great vessels cause?
4-24 hours
Hypertrophic cardiomyopathy
R-->L
Anitschow cell

40. What murmur ccan be heard in PDA?
Libman - Sacks endocarditis
Autoimmune pericarditis 6-8 wks post MI
Holosystolic machine like murmur
Opening snap followed by diastolic rumble

41. In what pt population does S aureus commonly cause valvular disease?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
IV drug users
Valve replacement
Libman - Sacks endocarditis

42. What are the sx of hypertrophic cardiomyopathy?
Bicuspid aortic valve
Shunt - PGE to maintain PDA until surgical repair can be performed
Subendocardial
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

43. What is migratory polyarthritis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Regurg vs stenosis
Congestive heart failure

44. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Positive blood cultures anemia of chronic disease
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

45. What is the characteristic finding on CXR in tetralogy of fallot?
Left -->right
Decrease preload -->lowers myocardial stress
RCA
Boot shaped heart

46. What side of the heart do carcinoid tumors affect? Why?
L->R
Right side - serotonin and other secretory products detoxified in the lung
Valve scarring that arises as a consequence of rheumatic fever
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

47. With what condition are rhabdomyomas associated?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Myocarditis
ST- segment depression
Tuberous sclerosis

48. What is the rate of congenital heart defects?
Louder - increased systemic resistence decreases LV emptying
Chest pain <20 min brought on by exertion or emotional stress
Volume overload and LHF
1%

49. What does Libman - Sacks endocarditis cause?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Mitral regurg
PDA
Subendocardial

50. What causes acute endocarditis?
Preductal - post aortic arch
Large vegetations of S aureus
Aortic regurg
Rhabdomyoma

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