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Cardiac

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What is the most common type of ASD? What %?
Large vegetations of S aureus
4-24 hours
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Ostium secundum (90%)

2. Friction rub and chest pain.
Pericarditits
Squatting - increased systemic resistence decreases LV emptying
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
R-->L

3. What are the causes of restrictive cardiomyopathy in adults?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Loeffler syndrome
Ehlers - Danlow and Marfan syndrome
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

4. What two things cause coronary artery vasospasm?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Type I
Prinzmetal angina - cocaine
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

5. Is injury due angina reversible or irreversible?
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
Wear and tear
Reversible
Regurg vs stenosis

6. What artery is the 2nd most often occluded in an MI?
Fibrinous pericarditis
RCA
Large - destructive vegetations
Erythematous nontender lesions on palms and soles.

7. What iis the tx for aortic regurg?
Sudden cardiac death
Valve replacement once LV dysfx develops
Prinzmetal angina
Myocardium

8. What valves are most commonly involved in chronic rheumatic heart disease?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Mitral mitral+aortic
Dark discoloration coagulative necrosis
Infantile coarctation of the aorta

9. How does transmural MI/ischemia present on EKG?
Congenital rubella
Chronic rheumatic heart disease
R-->L
ST- segment elevation

10. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
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
Trisomy 21
Coexisting mitral stenosis and fusion of commisures exist
Migratory polyarthritis

11. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Breast and lung carcinoma - melanoma - lymphoma
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Coexisting mitral stenosis and fusion of commisures exist

12. What are the major criteria of the Jones criteria?
Ischemic heart disease
RCA
NG or Ca channel blocker
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

13. What is the etiology of S viridans endocarditis?
Congested central veins
RCA
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Posterior wall of LV - posterior septum - papillary muscles

14. What conditions can cause nonbacterial thrombotic endocarditis?
Reperfusion injury
Hypercoagulable state or underlying adenocarcinoma
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Dense layer of elastic and fibrotic tissue in the endocardium - children

15. What complication occurs 1-3 days post MI?
Small - nondestructive vegetations (subacute endocarditis)
Fibrinous pericarditis
MI
Type I

16. What is the effect of mitral regurg on the heart?
Decrease in blood flow to an organ
Contraction band necrosis
Volume overload and LHF
Chronic rheumatic heart disease

17. What compensatory mechanism do tetralogy of fallot pts learn?
Hemosiderin laden macrophages
Squat in response to cyanotic spell
20 min
Tender lesions on fingers or toes.

18. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Pericarditits
Valve replacement AFTER the onset of complications
Inability to fill ventricles

19. What does chronic ischemic heart disease progress to?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
CHF
Increased hydrostatic pressure
Coxsackie A or B

20. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Prinzmetal angina - cocaine
Low voltage EKG w/diminished QRS amplitude
Months out fibrosis
Ventricles cannot pump

21. What are the laboratory findings of bacterial endocarditis?
Red border granulation tissue
Atherosclerosis of coronary arteries
Valve replacement once LV dysfx develops
Positive blood cultures anemia of chronic disease

22. How does squating decrease hypoxemia in tetralogy of fallot?
Bicuspid aortic valve
>60 years - bicuspid aortic valve
Mitral regurg
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

23. What vavular defect results from acute rheumatic fever?
Large - destructive vegetations
Heart transplant
Surgical closure small defects may close spontaneously
Mitral regurgitation due to vegetations

24. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
CHF
Aortic regurg
Small - nondestructive vegetations (subacute endocarditis)

25. When do troponin levels rise - peak - and return to normal?
Tender lesions on fingers or toes.
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
L->R
2-4 hours - 24 hours - 7-10 days

26. What causes the dependent pitting edema in RHF?
Prinzmetal stable and unstable
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
Increased hydrostatic pressure
Left -->right

27. What is the tx for aortic stenosis?
PDA
Valve replacement
Large - destructive vegetations
Valve replacement AFTER the onset of complications

28. What is the main cause of MV regurg? What are other causes?
First 4 hours
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Eisenmenger syndrome
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

29. With what disease is transposition of the great vessels associated?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Pts w/previously damaged valves
Maternal diabetes
Trisomy 21

30. What are the complications of aortic stenosis?
Endocardial fibroelastosis (rare)
Metastasis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
2-3 weeks

31. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
Osler nodes (ouch - ouch Osler)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Reperfusion injury

32. Which angina(s) show ST elevation on EKG? ST depression?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Autoimmune pericarditis 6-8 wks post MI
Bicuspid aortic valve
Prinzmetal stable and unstable

33. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
R-->L
Myocarditis
Stable angina
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

34. How does reperfusion injury occur?
PGE
45%
Mitral mitral+aortic
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

35. Which vasculitis can cause MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Breast and lung carcinoma - melanoma - lymphoma
Kawasaki disease
Fetal alcohol syndrome

36. What is the most common cause of RHF? What are others?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
4-7 days
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Adult coarctation of the aorta

37. What are the two effects of ATII?
Boot shaped heart
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
>70%
Cardiogenic shock - CHF - arrhythmia

38. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
4-7 days macrophage infiltration
Contraction band necrosis - reperfusion injury
Atria and RV

39. With what endocarditis is S epidermidis associated?
Myocarditis
RCA
Mitral mitral+aortic
Endocarditis of prosthetic valves

40. What effect does chronic rheumatic heart disease have the mitral valve?
Stable and unstable prinzmetal
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Thickening of chrodae tendinae and cusps - mitral stenosis
Prinzmetal

41. What bug causes acute rheumatic fever?
2-3 weeks
Positive blood cultures anemia of chronic disease
Group A beta - hemolytic streptococci
Decrease preload -->lowers myocardial stress

42. What is molecular mimicry?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Mid - systolic click followed by regurgitation murmur
When a bacterial protein resembles a protein in human tissue
Inability to fill ventricles

43. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Months out fibrosis
ASD - R-->L
Janeway lesions
Dilation of all four chambers of the heart

44. What drugs can cause dilated cardiomyopathy?
Squatting - increased systemic resistence decreases LV emptying
Aortic regurg
Coexisting mitral stenosis and fusion of commisures exist
Doxorubicin - cocaine

45. What coronary artery supplies the mitral valve papillary muscles?
S epidermidis
RCA
Prinzmetal stable and unstable
Aneurysm - mural thrombus - Dressler syndrome

46. What is the most common cause of aortic stenosis?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Wear and tear
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Membrane damage

47. How do nitrates tx MI?
Mitral regurg
Endocardial fibroelastosis
Heart transplant
Decrease preload -->lowers myocardial stress

48. What are heart failure cells?
Hemosiderin laden macrophages
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Valve replacement AFTER the onset of complications
PDA

49. What is the tx for VSD?
Harmartoma
Surgical closure small defects may close spontaneously
Cardiogenic shock - CHF - arrhythmia
Slow HR - decreasing O2 demand and risk for arrhythmia

50. In which pts does S viridans cause endocarditits?
VSD
Tetralogy of fallot
Bacterial endocarditis
Pts w/previously damaged valves

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