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Cardiac

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Answer 50 questions in 15 minutes.
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1. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Infectious endocarditis
Rhabdomyoma
Limits thrombosis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

2. What effect does aortic stenosis have on the chambers of the heart?
When a bacterial protein resembles a protein in human tissue
Autoimmune pericarditis 6-8 wks post MI
Concentric LV hypertophy
Myxoid degeneration

3. What is an Anitschow cell?
4-7 days
Reactive histiocyte with caterpillar nucleus
Split S2 on auscultation
CK- MB

4. What vavular defect results from acute rheumatic fever?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Bacterial endocarditis
Mitral regurgitation due to vegetations
SLE

5. What maintains patency of the PDA?
Myocarditis in acute rheumatic heart fever
Degree of pulmonary artery stenosis
PGE
Positive blood cultures anemia of chronic disease

6. What is the most common congenital heart defect?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Libman - Sacks endocarditis
VSD
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

7. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Troponin I
20 min
Osler nodes (ouch - ouch Osler)
Nitroglycerin

8. What is the 1day-1wk -1mo mneumonic for MI?
RCA
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Streptococcus viridans
Intercostal arteries enlarged due to collateral circulation

9. With what virus is PDA associated?
CK- MB
IV drug users
VSD
Congenital rubella

10. What gross and microscopic changes occur 4-24 hours after an MI?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Louder - increased systemic resistence decreases LV emptying
Dark discoloration coagulative necrosis
PDA

11. How does contraction band necrosis occur?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Hypertophy of RV atrophy of LV
Systolic ejection click followed by crescendo - decrescendo murmur
Aschoff bodies

12. What complications occur 4-7 days post MI?
Aneurysm - mural thrombus - Dressler syndrome
2-3%
Rupture of free wall - IV septum - or papillary muscle
Congestive heart failure

13. With what disease is Libman - Sacks endocarditis associated?
SLE
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Squatting - increased systemic resistence decreases LV emptying
NG or Ca channel blocker

14. How does reperfusion injury occur?
First 4 hours
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Doxorubicin - cocaine
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

15. What is an important complication of ASD?
Paradoxical emboli
Increased blood in right heart delays closure of P valve
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Coexisting mitral stenosis and fusion of commisures exist

16. What side of the heart do carcinoid tumors affect? Why?
Mitral regurg
Right side - serotonin and other secretory products detoxified in the lung
Atria and RV
LHF

17. What coronary artery supplies the mitral valve papillary muscles?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Blood vessels coming in from normal tissue
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
RCA

18. What makes the MV prolapse murmur louder? Why?
Membrane damage
Squatting - increased systemic resistence decreases LV emptying
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Decrease in blood flow to an organ

19. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Wear and tear
Inability to maintain systemic pressure w/lack of O2 to vital organs
Open blocked vessels

20. What are the laboratory findings of bacterial endocarditis?
Mitral insufficiency
Positive blood cultures anemia of chronic disease
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Mitral regurg

21. What is the foundation of a scar?
Pericarditits
4-6 hours - 24 hours - 72 hours
Granulation tissue
Holosystolic blowing murmur

22. What is diastolic dysfx?
Decreases LV dilation by decreasing volume
S aureus
Bicuspid aortic valve
Inability to fill ventricles

23. Where is the coarctation in infantile coarctation of the aorta?
Ventricle
Preductal - post aortic arch
Myocarditis
2-3%

24. What type of shunt does transposition of the great vessels cause?
4-7 days
R-->L
Sudden cardiac death
Atherosclerosis of coronary arteries

25. How do beta blockers tx MI?
Ostium primum
Myofiber hypertrophy with disarray
Concentric LV hypertophy
Slow HR - decreasing O2 demand and risk for arrhythmia

26. What are the clinical features of RHF due to?
Coexisting mitral stenosis and fusion of commisures exist
Loss of LV fx
Systemic venous congestion
Libman - Sacks endocarditis

27. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Pts w/previously damaged valves
Holosystolic blowing murmur
Right -->left

28. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Plump fibroblasts - collagen - blood vessels
Open blocked vessels
Shunt

29. What are the clinical features of RHF?
Concentric LV hypertophy
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Positive blood cultures anemia of chronic disease
Eisenmenger syndrome

30. What effect does transposition of the great vessels have on the ventricles?
Left -->right
Aneurysm - mural thrombus - Dressler syndrome
Hypertophy of RV atrophy of LV
Minimizes ischemia

31. What is Dressler syndrome? When does it occur?
S aureus
Friction rub and chest pain
Autoimmune pericarditis 6-8 wks post MI
Shunt - PGE to maintain PDA until surgical repair can be performed

32. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Transposition of the great vessels
PDA
Large vegetations of S aureus
Pump failure

33. What gross and microscopic changes occur 4-7 days after an MI?
Nitroglycerin
Decreases LV dilation by decreasing volume
Dense layer of elastic and fibrotic tissue in the endocardium - children
Yellow pallor macrophages

34. What is chronic rheumatic heart disease?
LHF
R-->L
Valve scarring that arises as a consequence of rheumatic fever
Yellow pallor macrophages

35. What is systolic dysfx?
Ventricular arrhythmia
1-3 days out
Bicuspid aortic valve
Ventricles cannot pump

36. What are the four defects in tetralogy of fallot?
Prophylactic abx during dental procedures
Aortic stenosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

37. What is the most common type of endocarditis?
Gelatinous - abundant ground substance
Infectious
Aortic stenosis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

38. What is the murmur of mitral regurg?
Nonspecific - eg fever and elevated ESR
Reactive histiocyte with caterpillar nucleus
Holosystolic blowing murmur
White scar fibrosis

39. What are the sx/complications of myocarditis?
Within the first day
>60 years - bicuspid aortic valve
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

40. What is the most common cause of myocarditis?
Preductal - post aortic arch
Coxsackie A or B
ASD - R-->L
Dressler syndrome

41. What does granulation tissue contain?
Holosystolic blowing murmur
Plump fibroblasts - collagen - blood vessels
Ehlers - Danlow and Marfan syndrome
Intercostal arteries enlarged due to collateral circulation

42. What characterizes acute rheumatic fever endocarditiis?
LA dilation
Small vegetations along the line of closure
>70%
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

43. What is the etiology of S viridans endocarditis?
Spontaneous
RBC damaged while crossing the calcified valve causing schistocytes
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
AD mutation in sarcomere proteins

44. What does rupture of the IV septum cause?
Shunt
PDA
1-3 days
Open blocked vessels

45. What % stenosis causes stable angina?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
CK- MB
Stable angina
>70%

46. What is cardiogenic shock?
Decreased forward perfusion pulmonary congestion
Squatting - increased systemic resistence decreases LV emptying
Inability to maintain systemic pressure w/lack of O2 to vital organs
Mid - systolic click followed by regurgitation murmur

47. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Posterior wall of LV - posterior septum - papillary muscles
RCA
Ostium primum
Turner syndrome

48. What type of ischemia does stable angina cause?
4-24 hours
Sudden cardiac death
Subendocardial
Degree of pulmonary artery stenosis

49. What is the most common valve infected by S aureus?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Stable angina
Tricuspid
Papillary muscle - free wall - IV septum

50. What causes the dependent pitting edema in RHF?
Transposition of the great vessels
Increased hydrostatic pressure
Aschoff bodies
S epidermidis

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