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Cardiac

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Answer 50 questions in 15 minutes.
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1. Myofiber hypertrophy with disarray.
Aortic regurg
Hypertrophic cardiomyopathy
Ventricular arrhythmia
Mitral mitral+aortic

2. What is the murmur of mitral regurg?
Positive blood cultures anemia of chronic disease
Mid - systolic click followed by regurgitation murmur
Transesophageal echo
Holosystolic blowing murmur

3. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Split S2 on auscultation
Months out fibrosis
Myocarditis

4. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reperfusion injury
Louder - increased systemic resistence decreases LV emptying

5. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Kawasaki disease
Volume overload and LHF
Autoimmune pericarditis 6-8 wks post MI

6. What is an Aschoff body?
45%
Endocardial fibroelastosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

7. What are the clinical features of RHF due to?
Increased blood in right heart delays closure of P valve
S aureus
Systemic venous congestion
20 min

8. Large vegetations on tricuspid valve?
4-7 days macrophage infiltration
4-6 hours - 24 hours - 72 hours
S aureus
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

9. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Small vegetations along the line of closure
Mitral insufficiency
Congested central veins
20 min

10. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Right to left
Coxsackie A or B
Anitschow cell

11. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
Decrease preload -->lowers myocardial stress
Systolic dysfx leading to biventricular CHF
Inability to fill ventricles

12. What is the cause of restrictive cardiomyopathy in children?
VSD
Coronary artery vasospasm - emboli - vasculitis
Endocardial fibroelastosis (rare)
Heart transplant

13. What gross and microscopic changes occur 4-24 hours after an MI?
Ventricles cannot pump
3-8 wks
Dark discoloration coagulative necrosis
Harmartoma

14. What is the most common cause of death during the acute phase of rheumatic fever?
Hypercoagulable state or underlying adenocarcinoma
ST- segment depression
Spontaneous
Myocarditis

15. What causes heart failure cells?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Myocarditis in acute rheumatic heart fever

16. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
Myxoid degeneration
MI
Subendocardial

17. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
LHF
Janeway lesions
Mitral mitral+aortic

18. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Indomethacin - decreases PGE
Cardiac tamponade
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

19. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Posterior wall of LV - posterior septum - papillary muscles
Aortic stenosis
Prophylactic abx during dental procedures

20. What is the most common type of ASD? What %?
4-7 days
Ostium secundum (90%)
L->R
>60 years - bicuspid aortic valve

21. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
AD mutation in sarcomere proteins
Mitral regurg
Red border granulation tissue

22. What coronary arterysupplies the lateral wall of the LV?
Right to left
Maternal diabetes
Circumflex
LV dilation and eccentric hypertrophy

23. What is the tx for VSD?
Shunt - PGE to maintain PDA until surgical repair can be performed
ACE inhibitor
Surgical closure small defects may close spontaneously
Yellow pallor macrophages

24. What causes a mid - systolic click followed by a regurgitation murmur?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Infantile coarctation of the aorta PDA
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Mitral valve prolapse

25. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
RCA
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

26. What is the tx for LHF?
Ventricles cannot pump
Prinzmetal stable and unstable
ACE inhibitor
Nitroglycerin

27. What % stenosis causes stable angina?
3-8 wks
>70%
Loss of fx
Degree of pulmonary artery stenosis

28. Lower extremity cyanosis in infants? In adults?
2-4 hours - 24 hours - 7-10 days
Aneurysm - mural thrombus - Dressler syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Infantile coarctation of the aorta PDA

29. In what pt population does S aureus commonly cause valvular disease?
Reperfusion injury
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
IV drug users
Right to left

30. What are the major criteria of the Jones criteria?
Squatting - increased systemic resistence decreases LV emptying
Contraction band necrosis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
RCA

31. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Type I
Myxoma - benign
Concentric LV hypertophy
Circumflex

32. What iis the tx for aortic regurg?
Valve replacement once LV dysfx develops
Nitroglycerin
Small vegetations along the line of closure
Regurg vs stenosis

33. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Myocardium
S viridans
Chronic ischemic heart disease
Degree of pulmonary artery stenosis

34. What cardiac disease is associated with tuberous sclerosis?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Regurg vs stenosis
Bounding pulse
Rhabdomyoma

35. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
Myofiber hypertrophy with disarray
4-7 days
Right side - serotonin and other secretory products detoxified in the lung

36. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rhabdomyoma
Plump fibroblasts - collagen - blood vessels
ASD - R-->L

37. Friction rub and chest pain.
Pericarditits
Indomethacin - decreases PGE
Autoimmune pericarditis 6-8 wks post MI
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

38. What are the cancers that most commonly metastasize to the heart?
Reversible
Breast and lung carcinoma - melanoma - lymphoma
ST- segment depression
Shunt - PGE to maintain PDA until surgical repair can be performed

39. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Cyanosis - RV hypertrophy - polycythemia - clubbing
Heart can't fill
Contraction band necrosis
Pulsating nail bed

40. How does stable angina present?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Chest pain <20 min brought on by exertion or emotional stress

41. What is molecular mimicry?
Dense layer of elastic and fibrotic tissue in the endocardium - children
LAD
Surgical closure small defects may close spontaneously
When a bacterial protein resembles a protein in human tissue

42. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Libman - Sacks endocarditis
Dressler syndrome
Myocarditis in acute rheumatic heart fever

43. What is the gross and microscopic appearance of cardiac myxomas?
Atria and RV
1-3 days
Gelatinous - abundant ground substance
NG or Ca channel blocker

44. What conditions can cause nonbacterial thrombotic endocarditis?
Blood vessels coming in from normal tissue
LA
Mitral regurg
Hypercoagulable state or underlying adenocarcinoma

45. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
S aureus
Transposition of the great vessels
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

46. What effect does dilated cardiomyopathy have on the heart?
Decreases LV dilation by decreasing volume
Yellow pallor macrophages
RCA
Systolic dysfx leading to biventricular CHF

47. What are the clinical features of LHF due to?
VSD
Mitral regurg
Within the first day
Decreased forward perfusion pulmonary congestion

48. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Osler nodes (ouch - ouch Osler)
Membrane damage
PDA

49. What causes acute endocarditis?
Troponin I
Large vegetations of S aureus
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
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

50. What is an Anitschow cell?
RCA
Stretched muscle loses contractility
Reactive histiocyte with caterpillar nucleus
Aortic stenosis

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