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Cardiac

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Answer 50 questions in 15 minutes.
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1. Which chambers of the heart are generally spared in an MI?
Coronary artery vasospasm - emboli - vasculitis
Atria and RV
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Doxorubicin - cocaine

2. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Limits thrombosis
Fetal alcohol syndrome
Papillary muscle - free wall - IV septum

3. What are the complications of mitral valve prolapse? Are they common?
RHF
Infectious endocarditis - arrythmias - severe mitral regurg no
ST- segment elevation
CK- MB

4. What characterizes acute rheumatic fever endocarditiis?
Mitral valve prolapse
Squatting - expiration
Loss of fx
Small vegetations along the line of closure

5. What type of collagen is involved in fibrosis?
4-7 days macrophage infiltration
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Autoimmune pericarditis 6-8 wks post MI
Type I

6. What is Loeffler syndrome?
Chest pain <20 min brought on by exertion or emotional stress
LAD
1%
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

7. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Coxsackie A or B
VSD
Migratory polyarthritis

8. What are the HACEK organisms? With what condition are they associated?
S aureus
1-3 days out
Opening snap followed by diastolic rumble
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

9. What congenital heart defect does indomethacin tx?
Anterior wall of LV and anterior septum
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)
PGE

10. Which congenital heart defect is associated with congenital rubella?
Valve replacement once LV dysfx develops
PDA
4-7 days
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

11. What heart sound manifest with an ASD?
Tricuspid
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Split S2 on auscultation
2-3 weeks

12. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Prinzmetal stable and unstable
Ventricles cannot pump

13. What causes an early - blowing diastolic murmur?
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
Aortic regurg
Boot shaped heart
Ostium primum

14. With what endocarditis is S epidermidis associated?
Mitral regurg
RCA
Endocarditis of prosthetic valves
Mitral insufficiency

15. With what virus is PDA associated?
Shunt - PGE to maintain PDA until surgical repair can be performed
Decreased forward perfusion pulmonary congestion
Holosystolic machine like murmur
Congenital rubella

16. What is the gross and microscopic appearance of cardiac myxomas?
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
Gelatinous - abundant ground substance
RCA
Squat in response to cyanotic spell

17. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Aneurysm - mural thrombus - Dressler syndrome
L->R
Fibrosis and dystrophic calcification

18. What are the Jones criteria?
White scar fibrosis
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Mitral stenosis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

19. When do neutrophils infiltrate the myocardium post MI?
Coronary artery vasospasm
20 min
1-3 days
Plump fibroblasts - collagen - blood vessels

20. What increases the risk for chronic rheumatic heart disease?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Squat in response to cyanotic spell
Infectious endocarditis - arrythmias - severe mitral regurg no

21. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Aneurysm - mural thrombus - Dressler syndrome
Ventricles cannot pump
Stretched muscle loses contractility
PDA

22. What is the definition of ischemia?
Decreases LV dilation by decreasing volume
Decrease in blood flow to an organ
Rupture of free wall - IV septum - or papillary muscle
Nonbacterial thrombotic endocarditis (marantic endocarditis)

23. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Libman - Sacks endocarditis
Sudden cardiac death
Within the first day
Subendocardial

24. What is the most common cause of dilated cardiomyopathy? What are other causes?
Wear and tear
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myocarditis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

25. How does aortic regurg affect the heart chambers?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
LV dilation and eccentric hypertrophy
Red border granulation tissue
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

26. What does nonbacterial thrombotic endocarditis cause?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Doxorubicin - cocaine
Erythematous nontender lesions on palms and soles.
Mitral regurg

27. Lower extremity cyanosis in infants? In adults?
Harmartoma
2-3%
Janeway lesions
Infantile coarctation of the aorta PDA

28. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Sudden cardiac death
Minimizes ischemia
VSD

29. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Ehlers - Danlow and Marfan syndrome
Mitral and tricuspid regurg - arrhythmia
Limits thrombosis

30. What is eythema marginatum? What parts of the body does it commonly involve?
R-->L
>60 years - bicuspid aortic valve
Dressler syndrome
Annular - non pruritic rash w/erythematous borders trunks and limbs

31. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Increased blood in right heart delays closure of P valve
Rupture of free wall - IV septum - or papillary muscle
1-3 days out

32. How long after pharyngitis does acute rheumatic fever occur?
Chronic ischemic heart disease
4-7 days macrophage infiltration
Preductal - post aortic arch
2-3 weeks

33. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Regurg vs stenosis
PDA
Decrease preload -->lowers myocardial stress

34. Which artery is most often occluded in an MI?
Decreased forward perfusion pulmonary congestion
Mitral and tricuspid regurg - arrhythmia
LAD
Coxsackie A or B

35. How does contraction band necrosis occur?
Small - nondestructive vegetations (subacute endocarditis)
Regurg vs stenosis
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Friction rub and chest pain

36. What causes heart failure cells?
Pts w/previously damaged valves
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
SLE

37. What coronary arterysupplies the lateral wall of the LV?
Prinzmetal angina - cocaine
Circumflex
Transesophageal echo
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

38. How do you tx prinzmetal angina?
NG or Ca channel blocker
MI
When a bacterial protein resembles a protein in human tissue
Infectious

39. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Infantile coarctation of the aorta PDA
R-->L
LHF
Ventricle

40. What cardiac disease is associated with tuberous sclerosis?
Rhabdomyoma
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Aortic regurg
Hypercoagulable state or underlying adenocarcinoma

41. In what pt population does S aureus commonly cause valvular disease?
Libman - Sacks endocarditis
Rhadbomyoma - benign
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
IV drug users

42. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Prinzmetal
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Myocarditis in acute rheumatic heart fever
Bacterial endocarditis

43. What is the most common cause of aortic stenosis?
Ostium primum
PDA
Infantile coarctation of the aorta
Wear and tear

44. What always follows necrosis?
Dilation of all four chambers of the heart
Erythematous nontender lesions on palms and soles.
4-7 days
Acute inflammation

45. What conditions can cause nonbacterial thrombotic endocarditis?
Friction rub and chest pain
Hypercoagulable state or underlying adenocarcinoma
Mitral and tricuspid regurg - arrhythmia
Squat in response to cyanotic spell

46. What causes endocarditis of prosthetic valves?
Friction rub and chest pain
Loss of fx
S epidermidis
PDA

47. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Systolic ejection click followed by crescendo - decrescendo murmur
2-3%
Group A beta - hemolytic streptococci

48. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Backward LHF pulm htn and RHF - afib and associated mural thombis
Volume overload and LHF
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Reperfusion injury

49. Are most congenital heart defects spontaneous or inherited?
Tuberous sclerosis
4-24 hours
Coexisting mitral stenosis and fusion of commisures exist
Spontaneous

50. Dilated cardiomyopathy is a late complication of what illness?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Prophylactic abx during dental procedures
Myocarditis
Chronic ischemic heart disease

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