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Cardiac

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Answer 50 questions in 15 minutes.
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1. Pericarditis 6-8 wks post MI.
Migratory polyarthritis
Red border granulation tissue
Streptococcus viridans
Dressler syndrome

2. What does rupture of the LV free wall cause?
Hypertophy of RV atrophy of LV
Cardiac tamponade
RHF
VSD

3. What side of the heart do carcinoid tumors affect? Why?
Hypertrophic cardiomyopathy
Minimizes ischemia
Right side - serotonin and other secretory products detoxified in the lung
Myocardium

4. What is the most common congenital heart defect?
Stretched muscle loses contractility
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
VSD
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

5. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
Annular - non pruritic rash w/erythematous borders trunks and limbs
Mitral stenosis
Type I

6. Erythematous nontender lesions on palms and soles.
Osler nodes (ouch - ouch Osler)
Janeway lesions
Hypertophy of RV atrophy of LV
L->R

7. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Dilated
Right -->left
ASD - R-->L

8. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
MI
Mitral regurg
Yellow pallor macrophages

9. What drugs can cause dilated cardiomyopathy?
RCA
Doxorubicin - cocaine
Spontaneous
Mid - systolic click followed by regurgitation murmur

10. What areas of the heart does the LAD supply?
Elevated ASO anti - DNase B titers
Endocarditis of prosthetic valves
Myofiber hypertrophy with disarray
Anterior wall of LV and anterior septum

11. Which congenital heart defect is associated with maternal diabetes?
4-7 days
Turner syndrome
Transposition of the great vessels
Increased hydrostatic pressure

12. What is the most common cause of infectious endocarditis?
Acute inflammation
Streptococcus viridans
Yellow pallor macrophages
Prinzmetal angina - cocaine

13. What are the minor critera of the Jones criteria?
Sterile vegetations on surface and undersurface on mitral valve
Coronary artery vasospasm
Cyanosis - RV hypertrophy - polycythemia - clubbing
Nonspecific - eg fever and elevated ESR

14. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Tender lesions on fingers or toes.
Degree of pulmonary artery stenosis
RCA
Day 1-7

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

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16. What complication occurs 1-3 days post MI?
When a bacterial protein resembles a protein in human tissue
Degree of pulmonary artery stenosis
Fibrinous pericarditis
Harmartoma

17. What is the most common cause of myocarditis?
Ostium primum
Chronic rheumatic heart disease
Coxsackie A or B
Stable and unstable prinzmetal

18. How does aortic regurg affect the heart chambers?
Within the first day
Myocarditis
LV dilation and eccentric hypertrophy
Inability to fill ventricles

19. What are the sx of right - to - left shunt?
Cyanosis - RV hypertrophy - polycythemia - clubbing
ST- segment elevation
Rupture of free wall - IV septum - or papillary muscle
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

20. What generally causes ischemic heart disease?
Tricuspid
Surgical closure small defects may close spontaneously
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Atherosclerosis of coronary arteries

21. Friction rub and chest pain.
4-7 days
LAD
Months out fibrosis
Pericarditits

22. What structures are susceptible to rupture post MI?
Loss of LV fx
Papillary muscle - free wall - IV septum
Inability to maintain systemic pressure w/lack of O2 to vital organs
Dilation of all four chambers of the heart

23. What type of shunt does a VSD cause?
Osler nodes (ouch - ouch Osler)
ST- segment depression
L->R
Valve replacement once LV dysfx develops

24. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Decrease in blood flow to an organ
Stretched muscle loses contractility
Friction rub and chest pain

25. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Sterile vegetations on mitral valve along lines of closure
PDA
Decrease in blood flow to an organ
Mitral regurgitation due to vegetations

26. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Migratory polyarthritis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Contraction band necrosis
Chest pain <20 min brought on by exertion or emotional stress

27. What are the tx for MI?
Reversible
Large - destructive vegetations
LAD
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

28. What is an important complication of ASD?
Thickening of chrodae tendinae and cusps - mitral stenosis
Mitral regurgitation due to vegetations
IV drug users
Paradoxical emboli

29. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
NG or Ca channel blocker
Asymptomatic
Coxsackie A or B

30. What are the clinical features of RHF?
Streptococcus viridans
Left -->right
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
CK- MB

31. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Rhabdomyoma
Right to left
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

32. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Shunt - PGE to maintain PDA until surgical repair can be performed
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Autoimmune pericarditis 6-8 wks post MI
Reactive histiocyte with caterpillar nucleus

33. What is the definition of ischemia?
Ehlers - Danlow and Marfan syndrome
Hypercoagulable state or underlying adenocarcinoma
Decrease in blood flow to an organ
Infectious

34. When do neutrophils infiltrate the myocardium post MI?
Myocardium
Ventricles cannot pump
1-3 days
Mitral mitral+aortic

35. What is endocardial fibroelastosis? In what population is it found?
Reperfusion injury
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Transesophageal echo
Dense layer of elastic and fibrotic tissue in the endocardium - children

36. When would arrhythmia occur after MI?
Decreases LV dilation by decreasing volume
Decreased forward perfusion pulmonary congestion
Inability to fill ventricles
Within the first day

37. What is chronic rheumatic heart disease?
Tuberous sclerosis
Within the first day
Aortic stenosis
Valve scarring that arises as a consequence of rheumatic fever

38. When does the heart have dark discoloration post MI?
Loss of LV fx
LV dilation and eccentric hypertrophy
4-24 hours
Mitral valve prolapse

39. What are the clinical features of RHF due to?
Systemic venous congestion
LA
Squatting - increased systemic resistence decreases LV emptying
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

40. What is a complication of chronic rheumatic heart disease?
Hypertophy of RV atrophy of LV
Within the first day
R-->L
Infectious endocarditis

41. What is the characteristic murmurr of mitral stenosis?
Spontaneous
Opening snap followed by diastolic rumble
Open blocked vessels
Backward LHF pulm htn and RHF - afib and associated mural thombis

42. What valves are most commonly involved in chronic rheumatic heart disease?
Large vegetations of S aureus
Mitral mitral+aortic
Anitschow cell
Fetal alcohol syndrome

43. What type of shunt results in cyanosis at birth?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
PDA
Right to left
Restrictive cardiomyopathy

44. What causes heart failure cells?
Ventricle
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Rhabdomyoma
Stable and unstable prinzmetal

45. What is the gold standard blood marker for MI?
Prinzmetal angina
Troponin I
Annular - non pruritic rash w/erythematous borders trunks and limbs
RBC damaged while crossing the calcified valve causing schistocytes

46. How does contraction band necrosis occur?
Atherosclerosis of coronary arteries
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
S aureus
Large vegetations of S aureus

47. In which pts does S viridans cause endocarditits?
Small vegetations along the line of closure
Cardiac tamponade
Pts w/previously damaged valves
Bounding pulse

48. What is the most common cause of aortic stenosis?
Transposition of the great vessels
Wear and tear
Squatting - increased systemic resistence decreases LV emptying
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

49. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Months out fibrosis
Anterior wall of LV and anterior septum
Hypercoagulable state or underlying adenocarcinoma

50. Systolic ejection click followed by crescendo - decrescendo murmur.
Maternal diabetes
Aortic stenosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Colon cancer

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