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Cardiac

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Answer 50 questions in 15 minutes.
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1. What effect does transposition of the great vessels have on the ventricles?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Tender lesions on fingers or toes.
Tetralogy of fallot
Hypertophy of RV atrophy of LV

2. What type of collagen is involved in fibrosis?
Hypertrophic cardiomyopathy
Loss of fx
Type I
Ostium secundum (90%)

3. Is injury due angina reversible or irreversible?
Myxoid degeneration
Adult coarctation of the aorta
Reversible
Inability to fill ventricles

4. What is the classic EKG finding of restrictive cardiomyopathy?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Migratory polyarthritis
Low voltage EKG w/diminished QRS amplitude
Dense layer of elastic and fibrotic tissue in the endocardium - children

5. What are the forward and backward sx of LHF?
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
Right side - serotonin and other secretory products detoxified in the lung
RCA
Sterile vegetations on mitral valve along lines of closure

6. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Infantile coarctation of the aorta
Migratory polyarthritis
Acute inflammation

7. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Reactive histiocyte with caterpillar nucleus
Prinzmetal angina
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Boot shaped heart

8. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Reperfusion injury
Reactive histiocyte with caterpillar nucleus
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

9. What is the 1day-1wk -1mo mneumonic for MI?
Infantile coarctation of the aorta PDA
Systolic dysfx leading to biventricular CHF
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

10. Where is the coarctation in infantile coarctation of the aorta?
Sudden cardiac death
Wear and tear
Bounding pulse
Preductal - post aortic arch

11. When is an MI patent at highest risk for fibrionous pericarditis?
Myxoid degeneration
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
1-3 days out
Decreases LV dilation by decreasing volume

12. Which angina(s) show ST elevation on EKG? ST depression?
Opening snap followed by diastolic rumble
Maternal diabetes
Turner syndrome
Prinzmetal stable and unstable

13. What effect does chronic rheumatic heart disease have the mitral valve?
Pancarditis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Thickening of chrodae tendinae and cusps - mitral stenosis

14. What is the most common form of cardiomyopathy?
PDA
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Inability to maintain systemic pressure w/lack of O2 to vital organs
Dilated

15. What is the murmur of mitral valve prolapse?
Acute inflammation
Mid - systolic click followed by regurgitation murmur
Large vegetations of S aureus
Myxoma - benign

16. With what disease is Libman - Sacks endocarditis associated?
Hypercoagulable state or underlying adenocarcinoma
Mitral regurg
Friction rub and chest pain
SLE

17. What is a complication of chronic rheumatic heart disease?
ST- segment depression
Slow HR - decreasing O2 demand and risk for arrhythmia
Libman - Sacks endocarditis
Infectious endocarditis

18. What type of vegetations does Strep viridans cause?
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
Small - nondestructive vegetations (subacute endocarditis)
Aschoff bodies
Volume overload and LHF

19. Large vegetations on tricuspid valve?
MI
Nitroglycerin
PDA
S aureus

20. What is the tx for dilated cardiomyopathy?
Hypertrophic cardiomyopathy
Heart transplant
Split S2 on auscultation
PDA

21. How does O2 tx MI?
Fibrosis and dystrophic calcification
Stable and unstable prinzmetal
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Minimizes ischemia

22. What artery is the 2nd most often occluded in an MI?
Ischemic heart disease
Backward LHF pulm htn and RHF - afib and associated mural thombis
RCA
Fibrosis and dystrophic calcification

23. What are heart failure cells?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Hemosiderin laden macrophages
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral regurg

24. At what point in development do congenital heart defects arise?
Rupture of free wall - IV septum - or papillary muscle
3-8 wks
Tender lesions on fingers or toes.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

25. What is the most common cause of mitral stenosis?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
CK- MB
Chronic rheumatic heart disease
Harmartoma

26. In transposition of the great vessels - What is required for survival? How is this achieved?
1-3 days out
Shunt - PGE to maintain PDA until surgical repair can be performed
ST- segment depression
4-7 days

27. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Loeffler syndrome
Infectious endocarditis - arrythmias - severe mitral regurg no
Open blocked vessels

28. What gross and microscopic changes occur months after an MI?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
White scar fibrosis
Cardiac tamponade
Eisenmenger syndrome

29. What cardiac disease is associated with tuberous sclerosis?
Friction rub and chest pain
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Rhabdomyoma
Congestive heart failure

30. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Contraction band necrosis
CK- MB
Infantile coarctation of the aorta

31. What is the most common cause of endocarditis in IV drug users?
S aureus
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Ventricles cannot pump
R-->L

32. Sudden death in a young athlete.
Left -->right
Prinzmetal angina - cocaine
PDA
Hypertrophic cardiomyopathy

33. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Stable and unstable prinzmetal
Acute inflammation
Endocardial fibroelastosis
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation

34. What makes the MV prolapse murmur louder? Why?
Trisomy 21
Mitral valve prolapse
RCA
Squatting - increased systemic resistence decreases LV emptying

35. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Fibrinous pericarditis
Heart can't fill

36. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Migratory polyarthritis
Breast and lung carcinoma - melanoma - lymphoma
Sterile vegetations on surface and undersurface on mitral valve
20 min

37. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
S epidermidis
Shunt - PGE to maintain PDA until surgical repair can be performed
4-7 days macrophage infiltration
Decreases LV dilation by decreasing volume

38. What is an Anitschow cell?
Dilated
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Reactive histiocyte with caterpillar nucleus
Within the first day

39. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Mitral valve prolapse
Split S2 on auscultation
Reversible

40. How does fibrinolysis/angioplasty tx MI?
Heart can't fill
Congenital rubella
Decreases LV dilation by decreasing volume
Open blocked vessels

41. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Systemic venous congestion
Mid - systolic click followed by regurgitation murmur
Myocarditis

42. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
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
Infectious endocarditis
Sudden cardiac death
Cardiac tamponade

43. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Mitral mitral+aortic
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

44. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

45. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
2-3 weeks
Left -->right
Ischemic heart disease

46. How does Eisenmeger syndrome occur?
Decrease preload -->lowers myocardial stress
Loeffler syndrome
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
S aureus

47. Which congenital heart defect is associated with congenital rubella?
S aureus
Minimizes ischemia
PDA
Yellow pallor neutrophils

48. What complication occurs 1-3 days post MI?
Asymptomatic
Friction rub and chest pain
Fibrinous pericarditis
Congestive heart failure

49. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Colon cancer
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Myofiber hypertrophy with disarray

50. Lower extremity cyanosis in infants? In adults?
PDA
Dilation of all four chambers of the heart
Infantile coarctation of the aorta PDA
Aortic regurg

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