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Cardiac

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Answer 50 questions in 15 minutes.
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1. Why are cardiac enzymes elevated after an MI?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Right side - serotonin and other secretory products detoxified in the lung
Pericarditits
Membrane damage

2. What complications occur 4-7 days post MI?
Stable and unstable prinzmetal
Adult coarctation of the aorta
S viridans
Rupture of free wall - IV septum - or papillary muscle

3. What causes acute endocarditis?
Squatting - expiration
Spontaneous
RCA
Large vegetations of S aureus

4. Is scar tissue or myocardium stronger?
Kawasaki disease
Myocardium
Decreased forward perfusion pulmonary congestion
Prinzmetal angina - cocaine

5. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Anitschow cell
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Endocarditis of prosthetic valves

6. What is the tx for VSD?
NG or Ca channel blocker
Surgical closure small defects may close spontaneously
Atria and RV
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

7. What artery is the 2nd most often occluded in an MI?
RCA
Right to left
Day 1-7
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

8. What is migratory polyarthritis?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
S aureus
Myocardium
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

9. What causes an early - blowing diastolic murmur?
Aortic regurg
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
PDA
Aneurysm - mural thrombus - Dressler syndrome

10. What maintains patency of the PDA?
PGE
PDA
Mid - systolic click followed by regurgitation murmur
Valve replacement AFTER the onset of complications

11. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Intercostal arteries enlarged due to collateral circulation
PDA
Preductal - post aortic arch

12. What is a water - hammer pulse?
Infantile coarctation of the aorta
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Bounding pulse
Cardiac tamponade

13. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ventricle
4-6 hours - 24 hours - 72 hours
Contraction band necrosis

14. What effect does chronic rheumatic heart disease have the mitral valve?
Hypertrophic cardiomyopathy
Mitral valve prolapse
Thickening of chrodae tendinae and cusps - mitral stenosis
Minimizes ischemia

15. With what virus is PDA associated?
Congenital rubella
L->R
Ehlers - Danlow and Marfan syndrome
Stable and unstable prinzmetal

16. What are the sx of right - to - left shunt?
Prinzmetal
Holosystolic machine like murmur
Cyanosis - RV hypertrophy - polycythemia - clubbing
PDA

17. What drug relieves stable angina?
S aureus
45%
Nitroglycerin
Tetralogy of fallot

18. What is a complication of chronic rheumatic heart disease?
Congenital rubella
ACE inhibitor
Infectious endocarditis
Right side - serotonin and other secretory products detoxified in the lung

19. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Gelatinous - abundant ground substance
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

20. What is the most common type of endocarditis?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Infectious
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
45%

21. With what condition are rhabdomyomas associated?
Rupture of free wall - IV septum - or papillary muscle
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Bacterial endocarditis
Tuberous sclerosis

22. Which angina is relieved by Ca channel blockers?
Decrease preload -->lowers myocardial stress
Prinzmetal
Congested central veins
Thickening of chrodae tendinae and cusps - mitral stenosis

23. What is the tx for LHF?
Bounding pulse
ACE inhibitor
PGE
RBC damaged while crossing the calcified valve causing schistocytes

24. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Elevated ASO anti - DNase B titers
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)

25. What side of the heart do carcinoid tumors affect? Why?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Positive blood cultures anemia of chronic disease
Right side - serotonin and other secretory products detoxified in the lung
Spontaneous

26. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
Migratory polyarthritis
Infantile coarctation of the aorta
Janeway lesions

27. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Increased hydrostatic pressure
Rhadbomyoma - benign
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

28. What always follows necrosis?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Erythematous nontender lesions on palms and soles.
RHF
Acute inflammation

29. What generally causes ischemic heart disease?
Large - destructive vegetations
Holosystolic machine like murmur
Atherosclerosis of coronary arteries
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

30. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Breast and lung carcinoma - melanoma - lymphoma
Osler nodes (ouch - ouch Osler)
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

31. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
2-4 hours - 24 hours - 7-10 days
Preductal - post aortic arch
Myofiber hypertrophy with disarray

32. What are the four defects in tetralogy of fallot?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Tender lesions on fingers or toes.
Coexisting mitral stenosis and fusion of commisures exist
Infectious endocarditis - arrythmias - severe mitral regurg no

33. When do troponin levels rise - peak - and return to normal?
When a bacterial protein resembles a protein in human tissue
Months out fibrosis
Heart can't fill
2-4 hours - 24 hours - 7-10 days

34. What is a Quincke pulse?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Pulsating nail bed
Valve replacement
Stable angina

35. What structures are susceptible to rupture post MI?
Papillary muscle - free wall - IV septum
Stretched muscle loses contractility
Squatting - increased systemic resistence decreases LV emptying
First 4 hours

36. What type of ASD is associated w/Down syndrome?
Coronary artery vasospasm - emboli - vasculitis
Paradoxical emboli
Inability to fill ventricles
Ostium primum

37. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Mitral and tricuspid regurg - arrhythmia
Libman - Sacks endocarditis
2-3 weeks

38. What valves are most commonly involved in chronic rheumatic heart disease?
Rupture of free wall - IV septum - or papillary muscle
Mitral mitral+aortic
Regurg vs stenosis
Decrease in blood flow to an organ

39. What increases the volume of mitral regurg murmur?
ST- segment elevation
Reactive histiocyte with caterpillar nucleus
Maternal diabetes
Squatting - expiration

40. Erythematous nontender lesions on palms and soles.
4-24 hours
Stable and unstable prinzmetal
Janeway lesions
Months out fibrosis

41. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
LV dilation and eccentric hypertrophy
Valve scarring that arises as a consequence of rheumatic fever
ST- segment elevation

42. What complication occurs 1-3 days post MI?
2-3%
Months out fibrosis
ST- segment depression
Fibrinous pericarditis

43. What is Dressler syndrome? When does it occur?
Ventricular arrhythmia
Dilation of all four chambers of the heart
Autoimmune pericarditis 6-8 wks post MI
Day 1-7

44. What type of ischemia does stable angina cause?
Libman - Sacks endocarditis
Subendocardial
ST- segment depression
Myofiber hypertrophy with disarray

45. What causes mitral valve prolapse?
Myxoid degeneration
Months out fibrosis
L->R
Troponin I

46. What iis the tx for aortic regurg?
Libman - Sacks endocarditis
Valve replacement once LV dysfx develops
Myofiber hypertrophy with disarray
Opening snap followed by diastolic rumble

47. What is dilated cardiomyopathy?
Dark discoloration coagulative necrosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Dilation of all four chambers of the heart
VSD

48. Which artery is most often occluded in an MI?
Open blocked vessels
VSD
LAD
Dark discoloration coagulative necrosis

49. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Preductal - post aortic arch
Gelatinous - abundant ground substance
First 4 hours

50. What is the leading cause of death in the US?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Ischemic heart disease
Bounding pulse
Subendocardial

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