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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is the tx for dilated cardiomyopathy?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Small vegetations along the line of closure
Aschoff bodies
Heart transplant

2. What type of endocarditis is associated with SLE?
Within the first day
RHF
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Libman - Sacks endocarditis

3. What congenital heart defect presents later in life with lower extremity cyanosis?
Pts w/previously damaged valves
PDA
VSD
Chronic rheumatic heart disease

4. Sudden death in a young athlete.
Infantile coarctation of the aorta PDA
Hypertrophic cardiomyopathy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Endocardial fibroelastosis (rare)

5. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
LHF
Mid - systolic click followed by regurgitation murmur
Small - nondestructive vegetations (subacute endocarditis)

6. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Streptococcus viridans
Minimizes ischemia
Nonbacterial thrombotic endocarditis (marantic endocarditis)

7. What are the major criteria of the Jones criteria?
Acute inflammation
Dilated
Myocarditis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

8. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Bacterial endocarditis
Anitschow cell
Systolic dysfx leading to biventricular CHF
Ischemic heart disease

9. What are other (not atherosclerotic) causes of MI?
Split S2 on auscultation
Harmartoma
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Coronary artery vasospasm - emboli - vasculitis

10. What two things happen when a blocked vessel is opened after an MI?
Contraction band necrosis - reperfusion injury
Opening snap followed by diastolic rumble
Asymptomatic
Mitral mitral+aortic

11. What are the causes of restrictive cardiomyopathy in adults?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Reperfusion injury
Breast and lung carcinoma - melanoma - lymphoma
Posterior wall of LV - posterior septum - papillary muscles

12. How do beta blockers tx MI?
4-7 days macrophage infiltration
Elevated ASO anti - DNase B titers
Right -->left
Slow HR - decreasing O2 demand and risk for arrhythmia

13. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Cardiogenic shock - CHF - arrhythmia
Hypertrophic cardiomyopathy
Loeffler syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia

14. What does rupture of a papillary muscle cause?
Circumflex
Mitral regurg
Bacterial endocarditis
Mitral insufficiency

15. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Low voltage EKG w/diminished QRS amplitude
Congestive heart failure
Myxoma - benign

16. What is the most common cause of RHF? What are others?
Prinzmetal angina
Months out fibrosis
Inability to maintain systemic pressure w/lack of O2 to vital organs
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

17. What type of collagen is involved in fibrosis?
Dilation of all four chambers of the heart
Atria and RV
Type I
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

18. What type of ischemia does stable angina cause?
Dark discoloration coagulative necrosis
Subendocardial
Mitral regurg
Reversible

19. What are the minor critera of the Jones criteria?
Squatting - increased systemic resistence decreases LV emptying
Inability to maintain systemic pressure w/lack of O2 to vital organs
Nonspecific - eg fever and elevated ESR
Prophylactic abx during dental procedures

20. Which congenital heart defect is associated with congenital rubella?
Sudden cardiac death
2-4 hours - 24 hours - 7-10 days
Libman - Sacks endocarditis
PDA

21. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Squatting - increased systemic resistence decreases LV emptying
ACE inhibitor
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Mitral stenosis

22. What is the rate of mitral valve prolapse in the US?
Aortic stenosis
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
Atria and RV
2-3%

23. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Troponin I
20 min
1%
Rupture of free wall - IV septum - or papillary muscle

24. Why are cardiac enzymes elevated after an MI?
Open blocked vessels
Myocarditis
Membrane damage
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

25. What is the leading cause of death in the US?
Ischemic heart disease
Inability to fill ventricles
Cardiac tamponade
Myofiber hypertrophy with disarray

26. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
PDA
Increased blood in right heart delays closure of P valve
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
RHF

27. What are complications of dilated cardiomyopathy?
Turner syndrome
R-->L
Mitral and tricuspid regurg - arrhythmia
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

28. How does squating decrease hypoxemia in tetralogy of fallot?
Preductal - post aortic arch
ST- segment depression
Ventricles cannot pump
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

29. What is the basic principle of CHF?
Mitral mitral+aortic
Pump failure
Coronary artery vasospasm
Right -->left

30. What heart sound manifest with an ASD?
Split S2 on auscultation
Anitschow cell
Ischemic heart disease
Congested central veins

31. What is the definition of ischemia?
Decrease in blood flow to an organ
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Congestive heart failure
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

32. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Day 1-7
LAD
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

33. What causes angina and syncope in aortic stenosis?

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34. What is a water - hammer pulse?
Mitral insufficiency
LA
S epidermidis
Bounding pulse

35. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Erythematous nontender lesions on palms and soles.
RCA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Stable and unstable prinzmetal

36. What is a common complication of cardiac metastasis?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Pericardial effusion due to pericardial involvement
4-7 days
Infectious endocarditis

37. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
Type I
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Valve replacement AFTER the onset of complications

38. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Nitroglycerin
Circumflex
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal angina

39. Holosystolic blowing murmur that increases w/expiration?
Mitral regurg
4-24 hours
Infantile coarctation of the aorta
Nitroglycerin

40. What causes microangiopathic hemolytic anemia in aortic stenosis?
Pericarditits
Rupture of free wall - IV septum - or papillary muscle
RBC damaged while crossing the calcified valve causing schistocytes
Prophylactic abx during dental procedures

41. How does adult coarctation of the aorta present?
Months out fibrosis
Pericarditits
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RCA

42. What bug causes acute rheumatic fever?
Tricuspid
Group A beta - hemolytic streptococci
IV drug users
Prophylactic abx during dental procedures

43. What is diastolic dysfx?
IV drug users
Inability to fill ventricles
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Endocardial fibroelastosis (rare)

44. What causes wear and tear aortic stenosis?
Decreases LV dilation by decreasing volume
Acute inflammation
Fibrosis and dystrophic calcification
Decrease in blood flow to an organ

45. What is molecular mimicry?
Myofiber hypertrophy with disarray
Congenital rubella
When a bacterial protein resembles a protein in human tissue
Pulsating nail bed

46. What gross and microscopic changes occur 1-3 weeks after an MI?
Ostium secundum (90%)
Red border granulation tissue
Coronary artery vasospasm
Opening snap followed by diastolic rumble

47. What is the classic EKG finding of restrictive cardiomyopathy?
Tender lesions on fingers or toes.
When a bacterial protein resembles a protein in human tissue
Low voltage EKG w/diminished QRS amplitude
Squatting - expiration

48. What does chronic ischemic heart disease progress to?
CHF
Nonspecific - eg fever and elevated ESR
Large - destructive vegetations
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

49. How do you tx prinzmetal angina?
NG or Ca channel blocker
Coronary artery vasospasm
SLE
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

50. What vavular defect results from acute rheumatic fever?
Infantile coarctation of the aorta PDA
Paradoxical emboli
Mitral regurgitation due to vegetations
Osler nodes (ouch - ouch Osler)

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