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Cardiac

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Answer 50 questions in 15 minutes.
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1. Which chambers of the heart are generally spared in an MI?
CHF
Systemic venous congestion
Coxsackie A or B
Atria and RV

2. With what disease is infantile coarctation of the aorta associated?
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
Within the first day
Turner syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

3. What is a Quincke pulse?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Pulsating nail bed
Ventricles cannot pump
Large - destructive vegetations

4. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Nitroglycerin
Surgical closure small defects may close spontaneously
RCA

5. What complications occur 4-7 days post MI?
Contraction band necrosis - reperfusion injury
Transposition of the great vessels
Thickening of chrodae tendinae and cusps - mitral stenosis
Rupture of free wall - IV septum - or papillary muscle

6. Lower extremity cyanosis in infants? In adults?
Preductal - post aortic arch
Stable angina
Kawasaki disease
Infantile coarctation of the aorta PDA

7. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Prinzmetal stable and unstable
Tender lesions on fingers or toes.
Ventricular arrhythmia
ASD - R-->L

8. How do you tx prinzmetal angina?
NG or Ca channel blocker
Low voltage EKG w/diminished QRS amplitude
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Anterior wall of LV and anterior septum

9. How does ischemia cause LHF?
Infectious endocarditis - arrythmias - severe mitral regurg no
Loss of fx
2-3%
Mitral regurgitation due to vegetations

10. Large vegetations on tricuspid valve?
Mid - systolic click followed by regurgitation murmur
S aureus
Yellow pallor neutrophils
Contraction band necrosis

11. What are the complications of mitral valve prolapse? Are they common?
Friction rub and chest pain
1-3 days
Left -->right
Infectious endocarditis - arrythmias - severe mitral regurg no

12. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Autoimmune pericarditis 6-8 wks post MI
PDA
Stable and unstable prinzmetal

13. What is an important complication of ASD?
Paradoxical emboli
RHF
Mitral regurg
Boot shaped heart

14. EKG for stable angina?
ST- segment depression
PDA
Chronic rheumatic heart disease
Asymptomatic

15. How does squating decrease hypoxemia in tetralogy of fallot?
1-3 days out
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Mitral valve prolapse
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

16. What is the basic principle of CHF?
Endocardial fibroelastosis
Red border granulation tissue
Aschoff bodies
Pump failure

17. What is the etiology of S viridans endocarditis?
Coxsackie A or B
LAD
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

18. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Squatting - expiration
RCA
Small vegetations along the line of closure

19. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Aschoff bodies
Louder - increased systemic resistence decreases LV emptying
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

20. What type of valvular vegetations does S aureus cause?
PDA
Valve replacement AFTER the onset of complications
Large - destructive vegetations
Tetralogy of fallot

21. What type of ischemia does stable angina cause?
Subendocardial
Mitral regurg
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Membrane damage

22. What cardiac enzyme is useful for detecting reinfarction?
Coronary artery vasospasm - emboli - vasculitis
Regurg vs stenosis
CK- MB
Acute inflammation

23. What are the minor critera of the Jones criteria?
Ventricle
Breast and lung carcinoma - melanoma - lymphoma
Anterior wall of LV and anterior septum
Nonspecific - eg fever and elevated ESR

24. What type of shunt does transposition of the great vessels cause?
LAD
R-->L
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
ST- segment elevation

25. How does restrictive cardiomyopathy cause LHF?

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26. What type of shunt does a VSD cause?
L->R
Mitral mitral+aortic
Tetralogy of fallot
Systemic venous congestion

27. What valves are most commonly involved in chronic rheumatic heart disease?
Infectious endocarditis
Mitral mitral+aortic
ST- segment depression
Coxsackie A or B

28. What areas of the heart does the RCA supply?
Libman - Sacks endocarditis
Thickening of chrodae tendinae and cusps - mitral stenosis
Posterior wall of LV - posterior septum - papillary muscles
Degree of pulmonary artery stenosis

29. Tender lesions on fingers or toes.
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Spontaneous
Contraction band necrosis - reperfusion injury
Osler nodes (ouch - ouch Osler)

30. What is the rate of congenital heart defects?
Reperfusion injury
1%
Infantile coarctation of the aorta PDA
Streptococcus viridans

31. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
ST- segment depression
Decrease preload -->lowers myocardial stress
Backward LHF pulm htn and RHF - afib and associated mural thombis

32. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Maternal diabetes
>60 years - bicuspid aortic valve
4-7 days macrophage infiltration
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

33. L- to - R shunt switching to R- to - L shunt.
Elevated ASO anti - DNase B titers
Small vegetations along the line of closure
Eisenmenger syndrome
Friction rub and chest pain

34. What conditions can cause nonbacterial thrombotic endocarditis?
Squatting - expiration
RHF
Hypercoagulable state or underlying adenocarcinoma
Trisomy 21

35. What artery is the 2nd most often occluded in an MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Rhabdomyoma
RCA

36. What causes microangiopathic hemolytic anemia in aortic stenosis?
2-3%
RBC damaged while crossing the calcified valve causing schistocytes
Granulation tissue
Sudden cardiac death

37. With what congenital heart defect is ADULT coarctation of the aorta associated?
S viridans
Right to left
Bicuspid aortic valve
ST- segment depression

38. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ostium secundum (90%)
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

39. Ostium primum ASD is associated with what congenital disorder?
Transposition of the great vessels
>60 years - bicuspid aortic valve
Systolic ejection click followed by crescendo - decrescendo murmur
Trisomy 21

40. What type of vegetations form in nonbacterial thrombotic endocarditis?
RBC damaged while crossing the calcified valve causing schistocytes
Sterile vegetations on mitral valve along lines of closure
Fetal alcohol syndrome
Loss of fx

41. What is the most common cause of aortic stenosis?
Wear and tear
Regurg vs stenosis
Mitral stenosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

42. What coronary artery supplies the mitral valve papillary muscles?
2-4 hours - 24 hours - 7-10 days
RCA
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Sterile vegetations on surface and undersurface on mitral valve

43. What is Dressler syndrome? When does it occur?
Within the first day
Prophylactic abx during dental procedures
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Autoimmune pericarditis 6-8 wks post MI

44. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
3-8 wks
LHF
Myocarditis
Hypertrophic cardiomyopathy

45. What does rupture of the LV free wall cause?
Cardiac tamponade
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Kawasaki disease
Acute inflammation

46. What are heart failure cells?
1-3 days
Squat in response to cyanotic spell
Hemosiderin laden macrophages
Small vegetations along the line of closure

47. What compensatory mechanism do tetralogy of fallot pts learn?
45%
RBC damaged while crossing the calcified valve causing schistocytes
Dressler syndrome
Squat in response to cyanotic spell

48. Which artery is most often occluded in an MI?
ST- segment depression
Subendocardial
LAD
Large vegetations of S aureus

49. What causes mitral valve prolapse?
Myxoid degeneration
Heart can't fill
Day 1-7
Red border granulation tissue

50. What is typically the mechanims of sudden cardiac death?
Doxorubicin - cocaine
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Ventricular arrhythmia
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

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