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Cardiac

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Answer 50 questions in 15 minutes.
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1. When is an MI patent at highest risk for fibrionous pericarditis?
Right -->left
1-3 days out
LAD
Streptococcus viridans

2. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Turner syndrome
Open blocked vessels
Cyanosis - RV hypertrophy - polycythemia - clubbing

3. Systolic ejection click followed by crescendo - decrescendo murmur.
Erythematous nontender lesions on palms and soles.
RCA
Paradoxical emboli
Aortic stenosis

4. What is the most common cause of death during the acute phase of rheumatic fever?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Erythematous nontender lesions on palms and soles.
Fibrosis and dystrophic calcification
Myocarditis

5. What gross and microscopic changes occur 4-24 hours after an MI?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decrease preload -->lowers myocardial stress
Dark discoloration coagulative necrosis
Tuberous sclerosis

6. What does nonbacterial thrombotic endocarditis cause?
Asymptomatic
Ventricle
Mitral regurg
Myocarditis in acute rheumatic heart fever

7. What are the clinical features of RHF?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
Prinzmetal angina - cocaine
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

8. When would arrhythmia occur after MI?
Infantile coarctation of the aorta
4-7 days
Holosystolic blowing murmur
Within the first day

9. Which coronary artery supplies the anterior wall and anterior septum?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Streptococcus bovis/
Aortic stenosis
LAD

10. What type of ASD is associated w/Down syndrome?
CK- MB
RHF
Ostium primum
Myocarditis

11. What is diastolic dysfx?
Pancarditis
Troponin I
Breast and lung carcinoma - melanoma - lymphoma
Inability to fill ventricles

12. Large vegetations on tricuspid valve?
Minimizes ischemia
S aureus
Dressler syndrome
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

13. What type of vegetations are associated with Libman - Sacks endocarditis?
Tuberous sclerosis
Sterile vegetations on surface and undersurface on mitral valve
ACE inhibitor
Infantile coarctation of the aorta

14. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
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
Dressler syndrome
PDA

15. How does MI cause LHF?
Holosystolic blowing murmur
Nonspecific - eg fever and elevated ESR
Loss of LV fx
Chest pain <20 min brought on by exertion or emotional stress

16. What tests show prior group A beta - hemolytic strep infection?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Annular - non pruritic rash w/erythematous borders trunks and limbs
Right to left
Elevated ASO anti - DNase B titers

17. What coronary artery supplies the mitral valve papillary muscles?
RCA
Stable angina
Preductal - post aortic arch
Membrane damage

18. When does the heart have a yellow pallor post MI?
SLE
Mitral insufficiency
Day 1-7
Stable and unstable prinzmetal

19. How does fibrinolysis/angioplasty tx MI?
AD mutation in sarcomere proteins
Open blocked vessels
Osler nodes (ouch - ouch Osler)
Harmartoma

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

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21. What is a common complication of cardiac metastasis?
Louder - increased systemic resistence decreases LV emptying
Stable angina
Ostium secundum (90%)
Pericardial effusion due to pericardial involvement

22. What are Janeway lesions?
Ventricles cannot pump
Valve replacement
Myxoma - benign
Erythematous nontender lesions on palms and soles.

23. What bug causes acute rheumatic fever?
Spontaneous
Indomethacin - decreases PGE
Group A beta - hemolytic streptococci
Ischemic heart disease

24. What complications occur 4-7 days post MI?
Aschoff bodies
Papillary muscle - free wall - IV septum
Rupture of free wall - IV septum - or papillary muscle
Positive blood cultures anemia of chronic disease

25. What is the cause of the red border around granulation tissue?
NG or Ca channel blocker
2-4 hours - 24 hours - 7-10 days
Blood vessels coming in from normal tissue
Dark discoloration coagulative necrosis

26. Which angina is relieved by Ca channel blockers?
Coexisting mitral stenosis and fusion of commisures exist
Prinzmetal
Nitroglycerin
MI

27. What does a biopsy of hypertrophic cardiomyopathy look like?
ASD - R-->L
4-7 days macrophage infiltration
Large vegetations of S aureus
Myofiber hypertrophy with disarray

28. What conditions can cause nonbacterial thrombotic endocarditis?
Mitral and tricuspid regurg - arrhythmia
Hypercoagulable state or underlying adenocarcinoma
Turner syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

29. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Increased hydrostatic pressure
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Sterile vegetations on mitral valve along lines of closure

30. What drugs can cause dilated cardiomyopathy?
Large vegetations of S aureus
Doxorubicin - cocaine
Chest pain <20 min brought on by exertion or emotional stress
Granulation tissue

31. What causes a mid - systolic click followed by a regurgitation murmur?
Erythematous nontender lesions on palms and soles.
Low voltage EKG w/diminished QRS amplitude
Increased blood in right heart delays closure of P valve
Mitral valve prolapse

32. Why are cardiac enzymes elevated after an MI?
Months out fibrosis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Membrane damage

33. What is the most common congenital heart defect?
VSD
Infectious
20 min
Hemosiderin laden macrophages

34. Which congenital heart defect is associated with maternal diabetes?
LA
Transposition of the great vessels
Spontaneous
AD mutation in sarcomere proteins

35. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Holosystolic machine like murmur
Valve scarring that arises as a consequence of rheumatic fever
Regurg vs stenosis
Mitral mitral+aortic

36. What is the only Jones criteria that doesn't resolve with time?
Pump failure
Pancarditis
PDA
SLE

37. What does rupture of the LV free wall cause?
Cardiac tamponade
PDA
Mitral and tricuspid regurg - arrhythmia
1-3 days

38. With what congenital heart defect is ADULT coarctation of the aorta associated?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
ST- segment elevation
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Bicuspid aortic valve

39. When do neutrophils infiltrate the myocardium post MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
ACE inhibitor
1-3 days
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

40. What causes the dependent pitting edema in RHF?
Large - destructive vegetations
Increased hydrostatic pressure
Group A beta - hemolytic streptococci
Reversible

41. What is the most common cause of infectious endocarditis?
Harmartoma
Streptococcus viridans
LAD
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

42. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Heart can't fill
MI
Endocarditis of prosthetic valves

43. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
>60 years - bicuspid aortic valve
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
ASD - R-->L

44. What causes heart failure cells?
Elevated ASO anti - DNase B titers
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Squatting - increased systemic resistence decreases LV emptying
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

45. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
20 min
Congested central veins
Increased hydrostatic pressure

46. What areas of the heart does the LAD supply?
LAD
Spontaneous
Mitral mitral+aortic
Anterior wall of LV and anterior septum

47. Ostium primum ASD is associated with what congenital disorder?
Prinzmetal
Trisomy 21
Coronary artery vasospasm - emboli - vasculitis
Yellow pallor macrophages

48. What is a complication of chronic rheumatic heart disease?
ST- segment depression
Aortic stenosis
Infectious endocarditis
Hypertrophic cardiomyopathy

49. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Left -->right
Limits thrombosis
Tuberous sclerosis

50. What is the main cause of MV regurg? What are other causes?
Aschoff bodies
Large - destructive vegetations
Plump fibroblasts - collagen - blood vessels
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

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