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Cardiac

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Answer 50 questions in 15 minutes.
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1. What are Osler nodes?
R-->L
Tender lesions on fingers or toes.
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Regurg vs stenosis

2. Myofiber hypertrophy with disarray.
Systemic venous congestion
Holosystolic machine like murmur
Tender lesions on fingers or toes.
Hypertrophic cardiomyopathy

3. What causes the nutmeg color in nutmeg liver?
Congested central veins
1-3 days
Large vegetations of S aureus
Rhadbomyoma - benign

4. How does adult coarctation of the aorta present?
Infectious
R-->L
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

5. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
Increased hydrostatic pressure
Holosystolic blowing murmur
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

6. What is the gross and microscopic appearance of cardiac myxomas?
Aortic regurg
Osler nodes (ouch - ouch Osler)
Valve replacement
Gelatinous - abundant ground substance

7. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Troponin I
Papillary muscle - free wall - IV septum
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

8. How does stable angina present?
Fibrosis and dystrophic calcification
Chest pain <20 min brought on by exertion or emotional stress
Tetralogy of fallot
1-3 days

9. With what disease is transposition of the great vessels associated?
Volume overload and LHF
Squat in response to cyanotic spell
Maternal diabetes
1-3 days out

10. How does contraction band necrosis occur?
Systolic dysfx leading to biventricular CHF
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Tuberous sclerosis

11. How do you tx prinzmetal angina?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Blood vessels coming in from normal tissue
Congenital rubella
NG or Ca channel blocker

12. How do you prevent S viridans endocarditis?
Increased hydrostatic pressure
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Prophylactic abx during dental procedures
Type I

13. Which congenital heart defect is associated with maternal diabetes?
White scar fibrosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
4-7 days macrophage infiltration
Transposition of the great vessels

14. What does granulation tissue contain?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Plump fibroblasts - collagen - blood vessels
Shunt - PGE to maintain PDA until surgical repair can be performed
Wear and tear

15. What causes unstable angina?
Erythematous nontender lesions on palms and soles.
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Large vegetations of S aureus
When a bacterial protein resembles a protein in human tissue

16. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Ostium secundum (90%)
PGE
Ostium primum

17. What causes wear and tear aortic stenosis?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Inability to maintain systemic pressure w/lack of O2 to vital organs
Fibrosis and dystrophic calcification
MI

18. Which coronary artery supplies the posterior wall of the LV and posterior septum?
RCA
LA dilation
Infantile coarctation of the aorta
Ostium primum

19. What causes mitral valve prolapse?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Group A beta - hemolytic streptococci
Myxoid degeneration
Rupture of free wall - IV septum - or papillary muscle

20. What is the characteristic finding on CXR in tetralogy of fallot?
Small vegetations along the line of closure
Doxorubicin - cocaine
Regurg vs stenosis
Boot shaped heart

21. What always follows necrosis?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Acute inflammation
Cyanosis - RV hypertrophy - polycythemia - clubbing
S epidermidis

22. What is the murmur of mitral regurg?
Aneurysm - mural thrombus - Dressler syndrome
Holosystolic blowing murmur
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Sterile vegetations on surface and undersurface on mitral valve

23. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
LA
Valve replacement
Congested central veins

24. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Louder - increased systemic resistence decreases LV emptying
PDA
>60 years - bicuspid aortic valve

25. Which vasculitis can cause MI?
Hypercoagulable state or underlying adenocarcinoma
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Congenital rubella
Kawasaki disease

26. What is the most common cause of endocarditis in IV drug users?
Pericarditits
S aureus
R-->L
VSD

27. What congenital heart defect does indomethacin tx?
Thickening of chrodae tendinae and cusps - mitral stenosis
Colon cancer
PDA
4-7 days

28. How does O2 tx MI?
R-->L
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Coexisting mitral stenosis and fusion of commisures exist
Minimizes ischemia

29. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Minimizes ischemia
Prinzmetal
Rhadbomyoma - benign
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

30. What is endocardial fibroelastosis? In what population is it found?
Concentric LV hypertophy
Atria and RV
Dense layer of elastic and fibrotic tissue in the endocardium - children
Stable and unstable prinzmetal

31. What endocarditis is commonly found in patients with colon cancer?
NG or Ca channel blocker
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Streptococcus bovis/
Systolic dysfx leading to biventricular CHF

32. Is injury due angina reversible or irreversible?
Dark discoloration coagulative necrosis
Reversible
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Trisomy 21

33. How does ischemia cause LHF?
ST- segment depression
Loss of fx
Red border granulation tissue
Endocardial fibroelastosis (rare)

34. With what developmental disorder is VSD associated?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Fetal alcohol syndrome
Mitral insufficiency
Coxsackie A or B

35. What causes endocarditis of prosthetic valves?
Membrane damage
PDA
2-3%
S epidermidis

36. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Spontaneous
Bacterial endocarditis
Shunt - PGE to maintain PDA until surgical repair can be performed
Left -->right

37. What causes heart failure cells?
Small vegetations along the line of closure
Squatting - expiration
PDA
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

38. How does fibrinolysis/angioplasty tx MI?
Troponin I
Open blocked vessels
Paradoxical emboli
Metastasis

39. With what condition are rhabdomyomas associated?
When a bacterial protein resembles a protein in human tissue
Tuberous sclerosis
Plump fibroblasts - collagen - blood vessels
Aortic regurg

40. With what endocarditis is S epidermidis associated?
1-3 days out
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Endocarditis of prosthetic valves
Yellow pallor neutrophils

41. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
3-8 wks
Congenital rubella
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

42. What causes the split S2 in ASD?
Friction rub and chest pain
Increased blood in right heart delays closure of P valve
PDA
Posterior wall of LV - posterior septum - papillary muscles

43. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Chronic ischemic heart disease
Tuberous sclerosis
Mid - systolic click followed by regurgitation murmur
Nonbacterial thrombotic endocarditis (marantic endocarditis)

44. Tx for PDA?
Indomethacin - decreases PGE
Left -->right
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral and tricuspid regurg - arrhythmia

45. What are the clinical features of RHF?
Hemosiderin laden macrophages
Tricuspid
Streptococcus bovis/
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

46. What are the sx of hypertrophic cardiomyopathy?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Restrictive cardiomyopathy
Decreases LV dilation by decreasing volume

47. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Autoimmune pericarditis 6-8 wks post MI
LA dilation
Coexisting mitral stenosis and fusion of commisures exist

48. What are the sx of aortic regurg?
Pts w/previously damaged valves
Opening snap followed by diastolic rumble
ACE inhibitor
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

49. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Right to left
PDA
Pericarditits

50. What does rupture of the IV septum cause?
ST- segment depression
Shunt
Hypertrophic cardiomyopathy
RCA

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