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Cardiac

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

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2. What murmur ccan be heard in PDA?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Transesophageal echo
Holosystolic machine like murmur
Rhabdomyoma

3. What bug causes acute rheumatic fever?
Breast and lung carcinoma - melanoma - lymphoma
Group A beta - hemolytic streptococci
Myofiber hypertrophy with disarray
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

4. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Stable angina
LHF
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Posterior wall of LV - posterior septum - papillary muscles

5. What disesase has Aschoff bodies?
Group A beta - hemolytic streptococci
Reversible
Myocarditis in acute rheumatic heart fever
Mitral mitral+aortic

6. What heart sound manifest with an ASD?
Yellow pallor neutrophils
20 min
Valve replacement AFTER the onset of complications
Split S2 on auscultation

7. What is cardiogenic shock?
Slow HR - decreasing O2 demand and risk for arrhythmia
Janeway lesions
Inability to maintain systemic pressure w/lack of O2 to vital organs
Dense layer of elastic and fibrotic tissue in the endocardium - children

8. What areas of the heart does the RCA supply?
Coexisting mitral stenosis and fusion of commisures exist
Posterior wall of LV - posterior septum - papillary muscles
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Contraction band necrosis - reperfusion injury

9. What causes heart failure cells?
Group A beta - hemolytic streptococci
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Systolic dysfx leading to biventricular CHF
Hypertophy of RV atrophy of LV

10. What endocarditis is commonly found in patients with colon cancer?
Loss of fx
Systolic ejection click followed by crescendo - decrescendo murmur
Valve scarring that arises as a consequence of rheumatic fever
Streptococcus bovis/

11. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Rhadbomyoma - benign
Tender lesions on fingers or toes.
Months out fibrosis

12. What causes mitral valve prolapse?
Myxoid degeneration
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
1-3 days
2-4 hours - 24 hours - 7-10 days

13. Which coronary artery supplies the anterior wall and anterior septum?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Myofiber hypertrophy with disarray
Fibrinous pericarditis
LAD

14. What type of ASD is associated w/Down syndrome?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ostium primum
Prinzmetal
Blood vessels coming in from normal tissue

15. What compensatory mechanism do tetralogy of fallot pts learn?
Migratory polyarthritis
Squat in response to cyanotic spell
Reperfusion injury
Streptococcus viridans

16. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
1-3 days out
Congenital rubella
2-3%

17. What two things cause coronary artery vasospasm?
Valve replacement once LV dysfx develops
Prinzmetal angina - cocaine
Dilation of all four chambers of the heart
Increased hydrostatic pressure

18. What is an Anitschow cell?
Prophylactic abx during dental procedures
Reactive histiocyte with caterpillar nucleus
Mitral regurg
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

19. What is the most common congenital heart defect?
Elevated ASO anti - DNase B titers
Reperfusion injury
Myofiber hypertrophy with disarray
VSD

20. Sudden death in a young athlete.
Left -->right
Hypertrophic cardiomyopathy
Shunt
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

21. What are complications of dilated cardiomyopathy?
Erythematous nontender lesions on palms and soles.
IV drug users
Mitral and tricuspid regurg - arrhythmia
Thickening of chrodae tendinae and cusps - mitral stenosis

22. How does asprin/heparin tx MI?
Limits thrombosis
Myocarditis
Tetralogy of fallot
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

23. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Small vegetations along the line of closure
MI
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

24. In which pts does S viridans cause endocarditits?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Endocarditis of prosthetic valves
Pts w/previously damaged valves
Membrane damage

25. What is the murmur of mitral regurg?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Holosystolic blowing murmur
Systemic venous congestion
Pump failure

26. Pericarditis 6-8 wks post MI.
Concentric LV hypertophy
Dressler syndrome
Infectious endocarditis
RCA

27. What are Janeway lesions?
Contraction band necrosis - reperfusion injury
Erythematous nontender lesions on palms and soles.
Systolic dysfx leading to biventricular CHF
Valve scarring that arises as a consequence of rheumatic fever

28. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Chronic rheumatic heart disease
Right side - serotonin and other secretory products detoxified in the lung
IV drug users

29. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Ischemic heart disease
Infantile coarctation of the aorta PDA
Chronic rheumatic heart disease
Sudden cardiac death

30. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Congested central veins
Regurg vs stenosis
VSD
4-6 hours - 24 hours - 72 hours

31. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
3-8 wks
Streptococcus bovis/
Bacterial endocarditis

32. How does reperfusion injury occur?
Spontaneous
Libman - Sacks endocarditis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

33. What generally causes ischemic heart disease?
Mitral regurg
Atherosclerosis of coronary arteries
Transposition of the great vessels
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

34. What is the most common cause of myocarditis?
Minimizes ischemia
Coxsackie A or B
Slow HR - decreasing O2 demand and risk for arrhythmia
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

35. Where is the coarctation in infantile coarctation of the aorta?
4-24 hours
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Preductal - post aortic arch
Dilation of all four chambers of the heart

36. What are the sx of PDA at birth?
Myxoid degeneration
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
Small vegetations along the line of closure
Asymptomatic

37. Erythematous nontender lesions on palms and soles.
Congestive heart failure
>70%
Janeway lesions
PDA

38. Infects predamaged valves after transient bacteremia?
Type I
Mitral and tricuspid regurg - arrhythmia
S viridans
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

39. Friction rub and chest pain.
Pericarditits
2-4 hours - 24 hours - 7-10 days
PDA
Months out fibrosis

40. Myofiber hypertrophy with disarray.
Contraction band necrosis - reperfusion injury
Hypertrophic cardiomyopathy
Intercostal arteries enlarged due to collateral circulation
Hypertophy of RV atrophy of LV

41. What artery is the 2nd most often occluded in an MI?
>70%
RCA
NG or Ca channel blocker
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

42. What is an important complication of ASD?
Subendocardial
Paradoxical emboli
Bounding pulse
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

43. What coronary arterysupplies the lateral wall of the LV?
Inability to fill ventricles
S aureus
Circumflex
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

44. What is the cause of the red border around granulation tissue?
Metastasis
Shunt
RCA
Blood vessels coming in from normal tissue

45. What type of shunt dose PDA cause?
Doxorubicin - cocaine
Months out fibrosis
Maternal diabetes
Left -->right

46. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Squatting - expiration
Reversible
4-7 days

47. What is the most comon cause of aortic regurg? What are the other causes?
Sudden cardiac death
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
NG or Ca channel blocker
Mitral mitral+aortic

48. What are other (not atherosclerotic) causes of MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Coronary artery vasospasm - emboli - vasculitis
Prinzmetal stable and unstable

49. Tx for PDA?
Indomethacin - decreases PGE
Anitschow cell
Papillary muscle - free wall - IV septum
Blood vessels coming in from normal tissue

50. What is the most common type of ASD? What %?
Eisenmenger syndrome
Infectious endocarditis
Ostium secundum (90%)
Cyanosis - RV hypertrophy - polycythemia - clubbing

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