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Cardiac

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Answer 50 questions in 15 minutes.
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1. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
VSD
Ostium secundum (90%)
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

2. What heart sound manifest with an ASD?
Split S2 on auscultation
Bicuspid aortic valve
PDA
Preductal - post aortic arch

3. What type of shunt dose PDA cause?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Prinzmetal
Left -->right
Aortic stenosis

4. How long after pharyngitis does acute rheumatic fever occur?
Intercostal arteries enlarged due to collateral circulation
Systolic ejection click followed by crescendo - decrescendo murmur
2-3 weeks
Contraction band necrosis - reperfusion injury

5. What are Janeway lesions?
Granulation tissue
Erythematous nontender lesions on palms and soles.
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Transposition of the great vessels

6. What is the etiology of S viridans endocarditis?
LHF
RHF
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
SLE

7. What type of valvular vegetations does S aureus cause?
2-4 hours - 24 hours - 7-10 days
Large - destructive vegetations
Left -->right
Small - nondestructive vegetations (subacute endocarditis)

8. Lower extremity cyanosis later in life - holostystolic machine like murmur.
ASD - R-->L
Squatting - increased systemic resistence decreases LV emptying
LAD
PDA

9. What is the JOneS mneumonic?
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
Decrease preload -->lowers myocardial stress
RCA
Acute inflammation

10. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Mitral regurg
Regurg vs stenosis

11. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Aortic regurg
1-3 days
Aortic stenosis

12. What is the most common cause of infectious endocarditis?
Ventricle
Volume overload and LHF
Prinzmetal angina
Streptococcus viridans

13. How does restrictive cardiomyopathy cause LHF?

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14. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Tuberous sclerosis
4-7 days macrophage infiltration
Valve replacement

15. What cardiac enzyme is useful for detecting reinfarction?
LV dilation and eccentric hypertrophy
Thickening of chrodae tendinae and cusps - mitral stenosis
CK- MB
Volume overload and LHF

16. What is the most common form of cardiomyopathy?
Left -->right
Myxoma - benign
Dilated
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

17. What is the murmur of mitral regurg?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Holosystolic blowing murmur
Blood vessels coming in from normal tissue
Fibrosis and dystrophic calcification

18. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Libman - Sacks endocarditis
Months out fibrosis
Rupture of free wall - IV septum - or papillary muscle
Nitroglycerin

19. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
PDA
Pts w/previously damaged valves
Squatting - expiration

20. What increases the risk for chronic rheumatic heart disease?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Decreased forward perfusion pulmonary congestion
Prinzmetal

21. What is the characteristic finding on CXR in tetralogy of fallot?
Systolic dysfx leading to biventricular CHF
Bounding pulse
Hypertrophic cardiomyopathy
Boot shaped heart

22. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Heart can't fill
Regurg vs stenosis
Ostium primum

23. With what disease is Libman - Sacks endocarditis associated?
SLE
Preductal - post aortic arch
Valve replacement AFTER the onset of complications
Prinzmetal stable and unstable

24. What is the tx for dilated cardiomyopathy?
Maternal diabetes
Squatting - increased systemic resistence decreases LV emptying
Heart transplant
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

25. What does rupture of the LV free wall cause?
Decrease in blood flow to an organ
Cardiac tamponade
Cardiogenic shock - CHF - arrhythmia
ST- segment depression

26. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Coexisting mitral stenosis and fusion of commisures exist
Mitral mitral+aortic
Prophylactic abx during dental procedures

27. Vegetations on surface and undersurface of mitral valve.
PDA
Tricuspid
Libman - Sacks endocarditis
Subendocardial

28. What congenital heart defect often is present with infantile coarctation of the aorta?
LAD
PDA
Dilated
Pump failure

29. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
Gelatinous - abundant ground substance
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Months out fibrosis

30. What bug causes acute rheumatic fever?
VSD
Group A beta - hemolytic streptococci
Mitral insufficiency
Endocardial fibroelastosis

31. What iis the tx for aortic regurg?
2-3 weeks
Decrease in blood flow to an organ
Valve replacement once LV dysfx develops
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

32. What are Osler nodes?
Mitral mitral+aortic
Trisomy 21
Tender lesions on fingers or toes.
Dilation of all four chambers of the heart

33. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Subendocardial
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
PDA
4-7 days macrophage infiltration

34. At what point in development do congenital heart defects arise?
Rhadbomyoma - benign
3-8 wks
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Reperfusion injury

35. What gross and microscopic changes occur 1-3 days after an MI?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Yellow pallor neutrophils
First 4 hours

36. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Transposition of the great vessels
Bacterial endocarditis
Valve replacement
Stable and unstable prinzmetal

37. What is molecular mimicry?
When a bacterial protein resembles a protein in human tissue
Rhabdomyoma
PDA
Papillary muscle - free wall - IV septum

38. Is scar tissue or myocardium stronger?
Heart transplant
Type I
Myocardium
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

39. Dense layer of elastic and fibrotic tissue in the endocardium.
Endocardial fibroelastosis
Boot shaped heart
PDA
Prinzmetal stable and unstable

40. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Contraction band necrosis - reperfusion injury
Pulsating nail bed
Increased hydrostatic pressure

41. What congenital heart defect presents later in life with lower extremity cyanosis?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Spontaneous
Wear and tear
PDA

42. Erythematous nontender lesions on palms and soles.
Systolic dysfx leading to biventricular CHF
Janeway lesions
Sterile vegetations on mitral valve along lines of closure
Slow HR - decreasing O2 demand and risk for arrhythmia

43. What are the cancers that most commonly metastasize to the heart?
Breast and lung carcinoma - melanoma - lymphoma
Prinzmetal angina - cocaine
Regurg vs stenosis
Janeway lesions

44. With what developmental disorder is VSD associated?
Osler nodes (ouch - ouch Osler)
Hypertophy of RV atrophy of LV
Fetal alcohol syndrome
Coronary artery vasospasm - emboli - vasculitis

45. What causes microangiopathic hemolytic anemia in aortic stenosis?
Valve scarring that arises as a consequence of rheumatic fever
Louder - increased systemic resistence decreases LV emptying
RBC damaged while crossing the calcified valve causing schistocytes
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

46. Which chambers of the heart are generally spared in an MI?
CK- MB
RCA
Ventricle
Atria and RV

47. What causes angina and syncope in aortic stenosis?

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48. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
>60 years - bicuspid aortic valve
Breast and lung carcinoma - melanoma - lymphoma
Metastasis

49. What is the 1day-1wk -1mo mneumonic for MI?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Papillary muscle - free wall - IV septum
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Prinzmetal

50. What is dilated cardiomyopathy?
Decrease preload -->lowers myocardial stress
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
S viridans
Dilation of all four chambers of the heart

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