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Cardiac

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Answer 50 questions in 15 minutes.
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1. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Heart transplant
First 4 hours
Transesophageal echo

2. What is the cause of the red border around granulation tissue?
Concentric LV hypertophy
Contraction band necrosis
Myxoma - benign
Blood vessels coming in from normal tissue

3. What does rupture of a papillary muscle cause?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
CHF
Mitral insufficiency
Mitral regurg

4. What are the four defects in tetralogy of fallot?
LA
Large vegetations of S aureus
Intercostal arteries enlarged due to collateral circulation
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

5. What are the clinical features of RHF due to?
Systemic venous congestion
Boot shaped heart
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Doxorubicin - cocaine

6. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Ehlers - Danlow and Marfan syndrome
1%
RHF
AD mutation in sarcomere proteins

7. What is the foundation of a scar?
Turner syndrome
Granulation tissue
Loss of LV fx
Autoimmune pericarditis 6-8 wks post MI

8. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Myxoid degeneration
Prinzmetal angina - cocaine
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

9. What is the main cause of MV regurg? What are other causes?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Pts w/previously damaged valves
Cardiac tamponade

10. What are the Jones criteria?
PDA
ASD - R-->L
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

11. Lower extremity cyanosis in infants? In adults?
Anitschow cell
Tetralogy of fallot
Bicuspid aortic valve
Infantile coarctation of the aorta PDA

12. What is the effect of mitral regurg on the heart?
LAD
Papillary muscle - free wall - IV septum
Volume overload and LHF
Mitral stenosis

13. What are the cancers that most commonly metastasize to the heart?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Breast and lung carcinoma - melanoma - lymphoma
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

14. What causes a mid - systolic click followed by a regurgitation murmur?
Posterior wall of LV - posterior septum - papillary muscles
Mitral valve prolapse
Limits thrombosis
RCA

15. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Slow HR - decreasing O2 demand and risk for arrhythmia
Prophylactic abx during dental procedures
4-7 days macrophage infiltration
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

16. How does dilated cardiomyopathy cause LHF?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
>70%
Stretched muscle loses contractility
Plump fibroblasts - collagen - blood vessels

17. What conditions can cause nonbacterial thrombotic endocarditis?
Chest pain <20 min brought on by exertion or emotional stress
Hypercoagulable state or underlying adenocarcinoma
1-3 days out
ST- segment elevation

18. What causes an early - blowing diastolic murmur?
Mitral regurg
Aortic regurg
Pts w/previously damaged valves
Mitral mitral+aortic

19. What is the murmur of mitral valve prolapse?
2-3%
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Mid - systolic click followed by regurgitation murmur
Papillary muscle - free wall - IV septum

20. What causes prinzmetal angina?
Coronary artery vasospasm
Systolic dysfx leading to biventricular CHF
ASD - R-->L
Turner syndrome

21. What coronary artery supplies the mitral valve papillary muscles?
Boot shaped heart
CHF
RCA
Mitral mitral+aortic

22. In which pts does S viridans cause endocarditits?
Ehlers - Danlow and Marfan syndrome
NG or Ca channel blocker
Bacterial endocarditis
Pts w/previously damaged valves

23. With what congenital heart defect is ADULT coarctation of the aorta associated?
Breast and lung carcinoma - melanoma - lymphoma
Bicuspid aortic valve
Right -->left
S viridans

24. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Months out fibrosis
Myxoma - benign
Fibrinous pericarditis
RHF

25. What is systolic dysfx?
Ventricles cannot pump
Months out fibrosis
Endocarditis of prosthetic valves
Degree of pulmonary artery stenosis

26. What are the sx of PDA at birth?
Autoimmune pericarditis 6-8 wks post MI
Asymptomatic
S epidermidis
Louder - increased systemic resistence decreases LV emptying

27. What causes mitral valve prolapse?
Aortic regurg
Myxoid degeneration
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Fibrinous pericarditis

28. Holosystolic blowing murmur that increases w/expiration?
Chest pain <20 min brought on by exertion or emotional stress
Bacterial endocarditis
Mitral regurg
Decreased forward perfusion pulmonary congestion

29. How does fibrinolysis/angioplasty tx MI?
AD mutation in sarcomere proteins
Open blocked vessels
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
VSD

30. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Right -->left
Aschoff bodies
Ventricle

31. What is molecular mimicry?
Decreases LV dilation by decreasing volume
Stable angina
Sudden cardiac death
When a bacterial protein resembles a protein in human tissue

32. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Aortic stenosis
Myocarditis
>70%

33. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Split S2 on auscultation
Infantile coarctation of the aorta

34. How do you tx prinzmetal angina?
Coronary artery vasospasm
Fetal alcohol syndrome
NG or Ca channel blocker
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

35. What is the characteristic murmur of aortic stenosis?
S aureus
ST- segment elevation
Systolic ejection click followed by crescendo - decrescendo murmur
Myocardium

36. What is the basic principle of CHF?
Hypertrophic cardiomyopathy
Red border granulation tissue
Prinzmetal
Pump failure

37. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Right side - serotonin and other secretory products detoxified in the lung
Holosystolic blowing murmur
Ostium secundum (90%)

38. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Prophylactic abx during dental procedures
Tender lesions on fingers or toes.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

39. How does restrictive cardiomyopathy present?
Congestive heart failure
Loeffler syndrome
Contraction band necrosis - reperfusion injury
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

40. How does reperfusion injury occur?
Endocarditis of prosthetic valves
R-->L
SLE
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

41. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Concentric LV hypertophy
Sudden cardiac death
Ventricles cannot pump
Paradoxical emboli

42. What makes the MV prolapse murmur louder? Why?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Squatting - increased systemic resistence decreases LV emptying
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Squatting - expiration

43. What genetic conditions predispose a pt to mitral valve prolapse?
Ventricle
Limits thrombosis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Ehlers - Danlow and Marfan syndrome

44. Which coronary artery supplies the anterior wall and anterior septum?
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
Split S2 on auscultation
Tender lesions on fingers or toes.
LAD

45. What are the tx for MI?
LA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
2-3 weeks
Pericarditits

46. What valves are involved in rhuematic endocarditis?
Ostium secundum (90%)
Mitral mitral+aortic
ST- segment depression
Small - nondestructive vegetations (subacute endocarditis)

47. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
S aureus
LAD
Increased hydrostatic pressure

48. What is the most common type of endocarditis?
Maternal diabetes
Volume overload and LHF
Infectious
Stable angina

49. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Aortic regurg
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Reperfusion injury
Prophylactic abx during dental procedures

50. With what condition are rhabdomyomas associated?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Infectious
Tuberous sclerosis
RBC damaged while crossing the calcified valve causing schistocytes

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