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Cardiac

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Answer 50 questions in 15 minutes.
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1. What gross and microscopic changes occur 1-3 days after an MI?
Prinzmetal angina - cocaine
Hemosiderin laden macrophages
Ventricular arrhythmia
Yellow pallor neutrophils

2. What valves are involved in rhuematic endocarditis?
Endocardial fibroelastosis (rare)
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Mitral mitral+aortic
4-7 days

3. What causes wear and tear aortic stenosis?
IV drug users
2-3%
RCA
Fibrosis and dystrophic calcification

4. What is the leading cause of death in the US?
Ostium secundum (90%)
Ischemic heart disease
Breast and lung carcinoma - melanoma - lymphoma
Rhadbomyoma - benign

5. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
45%
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

6. What does nonbacterial thrombotic endocarditis cause?
Ventricles cannot pump
Chronic rheumatic heart disease
Yellow pallor neutrophils
Mitral regurg

7. When does the heart have a yellow pallor post MI?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Acute inflammation
PDA
Day 1-7

8. Which congenital heart defect is associated with maternal diabetes?
Cyanosis - RV hypertrophy - polycythemia - clubbing
PDA
Acute inflammation
Transposition of the great vessels

9. What two things happen when a blocked vessel is opened after an MI?
Sudden cardiac death
S aureus
Contraction band necrosis - reperfusion injury
Aortic regurg

10. What gross and microscopic changes occur 1-3 weeks after an MI?
Yellow pallor macrophages
3-8 wks
Red border granulation tissue
Loeffler syndrome

11. What tests show prior group A beta - hemolytic strep infection?
Wear and tear
Elevated ASO anti - DNase B titers
Plump fibroblasts - collagen - blood vessels
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

12. What is the foundation of a scar?
Open blocked vessels
Infantile coarctation of the aorta
Granulation tissue
LAD

13. What are the four defects in tetralogy of fallot?
Ventricles cannot pump
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
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

14. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Mitral mitral+aortic
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
LA

15. What effect does aortic stenosis have on the chambers of the heart?
Decrease preload -->lowers myocardial stress
Concentric LV hypertophy
Maternal diabetes
Holosystolic machine like murmur

16. When is an MI pt at greatest risk for cardiogenic shock?
Granulation tissue
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
First 4 hours
4-24 hours

17. What is diastolic dysfx?
Fetal alcohol syndrome
Heart transplant
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Inability to fill ventricles

18. Is injury due angina reversible or irreversible?
RHF
RCA
Chronic rheumatic heart disease
Reversible

19. L- to - R shunt switching to R- to - L shunt.
Increased hydrostatic pressure
Eisenmenger syndrome
Endocarditis of prosthetic valves
Streptococcus viridans

20. What maintains patency of the PDA?
Bacterial endocarditis
Coexisting mitral stenosis and fusion of commisures exist
Rhabdomyoma
PGE

21. What increases the volume of mitral regurg murmur?
Squatting - expiration
Hypertrophic cardiomyopathy
4-7 days macrophage infiltration
SLE

22. What imaging test is useful for detecting lesions on valves?
RBC damaged while crossing the calcified valve causing schistocytes
Maternal diabetes
Transesophageal echo
Prinzmetal angina - cocaine

23. What are the complications of mitral stenosis?
Open blocked vessels
Backward LHF pulm htn and RHF - afib and associated mural thombis
Trisomy 21
Endocardial fibroelastosis (rare)

24. Which artery is most often occluded in an MI?
Systolic ejection click followed by crescendo - decrescendo murmur
Nonspecific - eg fever and elevated ESR
LAD
Atria and RV

25. Pericarditis 6-8 wks post MI.
Ischemic heart disease
Nitroglycerin
Holosystolic blowing murmur
Dressler syndrome

26. What are the sx of aortic regurg?
Left -->right
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Ventricle
First 4 hours

27. What is Loeffler syndrome?
Myocarditis
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Reperfusion injury
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

28. How does subendocardial MI/ischemia present on EKG?
45%
Large - destructive vegetations
ST- segment depression
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

29. Infects predamaged valves after transient bacteremia?
Tender lesions on fingers or toes.
S viridans
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
PDA

30. What are the complications of aortic stenosis?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Months out fibrosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Tender lesions on fingers or toes.

31. What are the clinical features of RHF?
Thickening of chrodae tendinae and cusps - mitral stenosis
Hypertrophic cardiomyopathy
Maternal diabetes
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

32. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Hemosiderin laden macrophages
Adult coarctation of the aorta

33. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
3-8 wks
Janeway lesions
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

34. What are Osler nodes?
Tender lesions on fingers or toes.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Ventricular arrhythmia
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

35. What is the tx for mitral valve prolapse?
Valve replacement
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Endocardial fibroelastosis
S viridans

36. What is the rate of congenital heart defects?
1%
Infectious endocarditis - arrythmias - severe mitral regurg no
L->R
Infantile coarctation of the aorta

37. What type of valvular vegetations does S aureus cause?
Plump fibroblasts - collagen - blood vessels
Large - destructive vegetations
Sudden cardiac death
Chest pain <20 min brought on by exertion or emotional stress

38. What does rupture of the LV free wall cause?
Minimizes ischemia
Stable angina
Cardiac tamponade
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

39. What causes the split S2 in ASD?
Cardiogenic shock - CHF - arrhythmia
Squatting - increased systemic resistence decreases LV emptying
Increased blood in right heart delays closure of P valve
Left -->right

40. Which angina(s) show ST elevation on EKG? ST depression?
Positive blood cultures anemia of chronic disease
Prinzmetal stable and unstable
PGE
Backward LHF pulm htn and RHF - afib and associated mural thombis

41. What is the gross and microscopic appearance of cardiac myxomas?
Valve replacement once LV dysfx develops
Rupture of free wall - IV septum - or papillary muscle
Reactive histiocyte with caterpillar nucleus
Gelatinous - abundant ground substance

42. What are the Jones criteria?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
SLE
Ventricles cannot pump

43. How does aortic regurg affect the heart chambers?
Squat in response to cyanotic spell
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
LV dilation and eccentric hypertrophy
Pump failure

44. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Months out fibrosis
Blood vessels coming in from normal tissue
Mitral insufficiency

45. Dilated cardiomyopathy is a late complication of what illness?
Pts w/previously damaged valves
Myocarditis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Atria and RV

46. What gross and microscopic changes occur 4-24 hours after an MI?
Tuberous sclerosis
Adult coarctation of the aorta
Dark discoloration coagulative necrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

47. What causes a mid - systolic click followed by a regurgitation murmur?
Contraction band necrosis - reperfusion injury
Shunt
Atherosclerosis of coronary arteries
Mitral valve prolapse

48. What characterizes acute rheumatic fever endocarditiis?
Chronic ischemic heart disease
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Small vegetations along the line of closure

49. What generally causes ischemic heart disease?
Streptococcus viridans
2-3 weeks
Atherosclerosis of coronary arteries
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

50. When do troponin levels rise - peak - and return to normal?
Mitral regurgitation due to vegetations
2-4 hours - 24 hours - 7-10 days
Blood vessels coming in from normal tissue
Gelatinous - abundant ground substance

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