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Cardiac

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Answer 50 questions in 15 minutes.
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1. What type of collagen is involved in fibrosis?
ST- segment elevation
NG or Ca channel blocker
Type I
Myxoid degeneration

2. What type of tumor is a rhabdomyoma?
Yellow pallor neutrophils
Harmartoma
PDA
RCA

3. What tests show prior group A beta - hemolytic strep infection?
Holosystolic blowing murmur
Tender lesions on fingers or toes.
Elevated ASO anti - DNase B titers
Boot shaped heart

4. Pericarditis 6-8 wks post MI.
Aortic regurg
Dressler syndrome
Regurg vs stenosis
Acute inflammation

5. How does restrictive cardiomyopathy cause LHF?

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6. What causes a mid - systolic click followed by a regurgitation murmur?
Prinzmetal stable and unstable
Mitral valve prolapse
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

7. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Right to left
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
PDA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

8. What gross and microscopic changes occur 1-3 weeks after an MI?
Transesophageal echo
Red border granulation tissue
Anterior wall of LV and anterior septum
Ventricles cannot pump

9. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Tricuspid
Coexisting mitral stenosis and fusion of commisures exist
Indomethacin - decreases PGE
Congenital rubella

10. Which artery is most often occluded in an MI?
Loeffler syndrome
Spontaneous
Infantile coarctation of the aorta PDA
LAD

11. What bug causes acute rheumatic fever?
Acute inflammation
Mitral regurg
Left -->right
Group A beta - hemolytic streptococci

12. What endocarditis is commonly found in patients with colon cancer?
Valve scarring that arises as a consequence of rheumatic fever
Streptococcus bovis/
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

13. How does Eisenmeger syndrome occur?
Volume overload and LHF
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
Rupture of free wall - IV septum - or papillary muscle
When a bacterial protein resembles a protein in human tissue

14. What increases the risk for chronic rheumatic heart disease?
PDA
Ehlers - Danlow and Marfan syndrome
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Heart can't fill

15. What are the sx of cardiac myxoma?
Adult coarctation of the aorta
Hypercoagulable state or underlying adenocarcinoma
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Pancarditis

16. What is the murmur of mitral regurg?
Hemosiderin laden macrophages
Aneurysm - mural thrombus - Dressler syndrome
Day 1-7
Holosystolic blowing murmur

17. What is the most common cause of RHF? What are others?
Papillary muscle - free wall - IV septum
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Prophylactic abx during dental procedures
Limits thrombosis

18. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Boot shaped heart
Small - nondestructive vegetations (subacute endocarditis)
Spontaneous
Stable angina

19. How does fibrinolysis/angioplasty tx MI?
Months out fibrosis
Open blocked vessels
Mitral mitral+aortic
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

20. How does asprin/heparin tx MI?
Limits thrombosis
Valve replacement once LV dysfx develops
Cardiogenic shock - CHF - arrhythmia
Loeffler syndrome

21. Is scar tissue or myocardium stronger?
Myocardium
Wear and tear
Rhadbomyoma - benign
Mitral valve prolapse

22. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Dark discoloration coagulative necrosis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Valve scarring that arises as a consequence of rheumatic fever

23. What is a water - hammer pulse?
Positive blood cultures anemia of chronic disease
Bounding pulse
Systolic dysfx leading to biventricular CHF
Inability to maintain systemic pressure w/lack of O2 to vital organs

24. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Surgical closure small defects may close spontaneously
RCA
Heart can't fill
Rhadbomyoma - benign

25. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Surgical closure small defects may close spontaneously
Yellow pallor neutrophils
MI
Months out fibrosis

26. What are the sx of PDA at birth?
Valve scarring that arises as a consequence of rheumatic fever
Valve replacement once LV dysfx develops
Asymptomatic
Prinzmetal angina

27. What causes notching of the ribs in adult coarctation of the aorta?
Fetal alcohol syndrome
Day 1-7
Intercostal arteries enlarged due to collateral circulation
Months out fibrosis

28. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Heart transplant
Valve scarring that arises as a consequence of rheumatic fever
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

29. Erythematous nontender lesions on palms and soles.
PDA
Autoimmune pericarditis 6-8 wks post MI
Janeway lesions
PDA

30. What is the most common cause of mitral stenosis?
Pulsating nail bed
S aureus
Rhabdomyoma
Chronic rheumatic heart disease

31. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Limits thrombosis
Mitral stenosis
RHF

32. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Squatting - expiration
Inability to maintain systemic pressure w/lack of O2 to vital organs
>60 years - bicuspid aortic valve
Mitral valve prolapse

33. What is the tx for LHF?
ACE inhibitor
Concentric LV hypertophy
Heart transplant
Stable angina

34. What type of valvular vegetations does S aureus cause?
Concentric LV hypertophy
Ostium secundum (90%)
Shunt
Large - destructive vegetations

35. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Contraction band necrosis - reperfusion injury
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Breast and lung carcinoma - melanoma - lymphoma

36. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Dilation of all four chambers of the heart
Positive blood cultures anemia of chronic disease
Prophylactic abx during dental procedures

37. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Mitral regurgitation due to vegetations
ST- segment depression
Thickening of chrodae tendinae and cusps - mitral stenosis

38. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Anterior wall of LV and anterior septum
Myxoma - benign
Elevated ASO anti - DNase B titers

39. What causes acute endocarditis?
Large vegetations of S aureus
Congestive heart failure
Infantile coarctation of the aorta
Ehlers - Danlow and Marfan syndrome

40. What are the minor critera of the Jones criteria?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Sterile vegetations on mitral valve along lines of closure
>70%
Nonspecific - eg fever and elevated ESR

41. Are most congenital heart defects spontaneous or inherited?
Heart transplant
Spontaneous
Streptococcus bovis/
Loeffler syndrome

42. What type of shunt does a VSD cause?
L->R
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Right side - serotonin and other secretory products detoxified in the lung
Pump failure

43. How does aortic regurg affect the heart chambers?
RHF
Coronary artery vasospasm
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
LV dilation and eccentric hypertrophy

44. Low voltage EKG w/diminished QRS amplitude.
LA dilation
Restrictive cardiomyopathy
>70%
Reperfusion injury

45. How does subendocardial MI/ischemia present on EKG?
Streptococcus bovis/
Mitral and tricuspid regurg - arrhythmia
PDA
ST- segment depression

46. What is eythema marginatum? What parts of the body does it commonly involve?
Boot shaped heart
Libman - Sacks endocarditis
Coronary artery vasospasm - emboli - vasculitis
Annular - non pruritic rash w/erythematous borders trunks and limbs

47. How does hypertension cause LHF?

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48. How do nitrates tx MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Valve replacement
Mitral insufficiency
Decrease preload -->lowers myocardial stress

49. What are other (not atherosclerotic) causes of MI?
Ischemic heart disease
AD mutation in sarcomere proteins
Circumflex
Coronary artery vasospasm - emboli - vasculitis

50. What is the murmur of mitral valve prolapse?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mid - systolic click followed by regurgitation murmur
Endocarditis of prosthetic valves
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

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