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Cardiac

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Answer 50 questions in 15 minutes.
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1. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Pericarditits
Prophylactic abx during dental procedures
Nitroglycerin
Pulsating nail bed

2. What does rupture of a papillary muscle cause?
Mitral insufficiency
Positive blood cultures anemia of chronic disease
LAD
Mitral regurg

3. What is the tx for dilated cardiomyopathy?
Bounding pulse
Low voltage EKG w/diminished QRS amplitude
Squatting - expiration
Heart transplant

4. How do ACE inhibitors tx MI?
Pericardial effusion due to pericardial involvement
Tuberous sclerosis
Coexisting mitral stenosis and fusion of commisures exist
Decreases LV dilation by decreasing volume

5. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
PDA
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Contraction band necrosis

6. What two things happen when a blocked vessel is opened after an MI?
Anitschow cell
45%
Degree of pulmonary artery stenosis
Contraction band necrosis - reperfusion injury

7. What are the major criteria of the Jones criteria?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Rhabdomyoma
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Valve replacement AFTER the onset of complications

8. What causes prinzmetal angina?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Maternal diabetes
Coronary artery vasospasm
Loss of LV fx

9. What is the leading cause of death in the US?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
PDA
Ischemic heart disease
Subendocardial

10. What type of collagen is involved in fibrosis?
Type I
Stretched muscle loses contractility
Sterile vegetations on surface and undersurface on mitral valve
Metastasis

11. What characterizes acute rheumatic fever endocarditiis?
3-8 wks
Within the first day
Mitral regurgitation due to vegetations
Small vegetations along the line of closure

12. What is diastolic dysfx?
20 min
4-24 hours
Myxoid degeneration
Inability to fill ventricles

13. What type of shunt does ASD cause?
Left -->right
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
4-6 hours - 24 hours - 72 hours
Congestive heart failure

14. What is the most common form of cardiomyopathy?
Mitral insufficiency
1-3 days out
Preductal - post aortic arch
Dilated

15. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Reactive histiocyte with caterpillar nucleus
Autoimmune pericarditis 6-8 wks post MI
Ostium secundum (90%)

16. Which vasculitis can cause MI?
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Kawasaki disease
RHF

17. What is systolic dysfx?
IV drug users
Tuberous sclerosis
Ventricles cannot pump
Aschoff bodies

18. What gross and microscopic changes occur 4-24 hours after an MI?
Ventricles cannot pump
Months out fibrosis
Dark discoloration coagulative necrosis
Chronic rheumatic heart disease

19. What increases the volume of mitral regurg murmur?
Pulsating nail bed
Squatting - expiration
Reversible
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

20. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
S aureus
Anitschow cell
Preductal - post aortic arch
Eisenmenger syndrome

21. What is the most common tumor of the heart?
PDA
Volume overload and LHF
Metastasis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

22. With what disease is Libman - Sacks endocarditis associated?
Gelatinous - abundant ground substance
Months out fibrosis
SLE
Tender lesions on fingers or toes.

23. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Infectious endocarditis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Sudden cardiac death
Hypertrophic cardiomyopathy

24. What is migratory polyarthritis?
Rhabdomyoma
ST- segment depression
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Circumflex

25. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Right -->left
>70%
Backward LHF pulm htn and RHF - afib and associated mural thombis

26. Are most congenital heart defects spontaneous or inherited?
LV dilation and eccentric hypertrophy
S aureus
Pts w/previously damaged valves
Spontaneous

27. What increases the risk for chronic rheumatic heart disease?
Myocarditis
Plump fibroblasts - collagen - blood vessels
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Coexisting mitral stenosis and fusion of commisures exist

28. What is the most common type of endocarditis?
Cardiac tamponade
IV drug users
Infectious
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

29. What is the tx for VSD?
Coexisting mitral stenosis and fusion of commisures exist
Squatting - expiration
Elevated ASO anti - DNase B titers
Surgical closure small defects may close spontaneously

30. What type of shunt does a VSD cause?
Acute inflammation
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
L->R
Friction rub and chest pain

31. What is a Quincke pulse?
Mitral mitral+aortic
Pts w/previously damaged valves
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Pulsating nail bed

32. What artery is the 2nd most often occluded in an MI?
Coxsackie A or B
RCA
Infectious endocarditis - arrythmias - severe mitral regurg no
20 min

33. What causes the dependent pitting edema in RHF?
Right -->left
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Loeffler syndrome
Increased hydrostatic pressure

34. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Dilated
Atria and RV
Coexisting mitral stenosis and fusion of commisures exist

35. What heart sound manifest with an ASD?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
PDA
Split S2 on auscultation
Fibrosis and dystrophic calcification

36. How does MI cause LHF?
LA dilation
Fibrinous pericarditis
Yellow pallor neutrophils
Loss of LV fx

37. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Streptococcus viridans
Endocardial fibroelastosis (rare)
Myxoma - benign

38. What is the main cause of MV regurg? What are other causes?
Erythematous nontender lesions on palms and soles.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
L->R
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

39. What gross and microscopic changes occur 4-7 days after an MI?
RCA
Yellow pallor macrophages
When a bacterial protein resembles a protein in human tissue
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

40. What causes endocarditis of prosthetic valves?
ST- segment elevation
Red border granulation tissue
S epidermidis
20 min

41. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Pericardial effusion due to pericardial involvement
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

42. Which artery is most often occluded in an MI?
Ostium primum
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Nitroglycerin
LAD

43. What does rupture of the LV free wall cause?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
20 min
Dark discoloration coagulative necrosis
Cardiac tamponade

44. Turner syndrome is associated with which congenital heart defect?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Infantile coarctation of the aorta
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Tetralogy of fallot

45. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
Backward LHF pulm htn and RHF - afib and associated mural thombis
Stretched muscle loses contractility
Concentric LV hypertophy

46. What congenital heart defect does indomethacin tx?
Left -->right
PDA
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
Infantile coarctation of the aorta PDA

47. How does transmural MI/ischemia present on EKG?
Endocardial fibroelastosis (rare)
LAD
ST- segment elevation
Atria and RV

48. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
PDA
Months out fibrosis
Cardiogenic shock - CHF - arrhythmia
Aneurysm - mural thrombus - Dressler syndrome

49. What is the only Jones criteria that doesn't resolve with time?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
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
Trisomy 21
Pancarditis

50. What type of shunt does transposition of the great vessels cause?
Increased blood in right heart delays closure of P valve
Right side - serotonin and other secretory products detoxified in the lung
R-->L
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

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