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Cardiac

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Answer 50 questions in 15 minutes.
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1. What drug relieves stable angina?
Shunt - PGE to maintain PDA until surgical repair can be performed
Nitroglycerin
Reperfusion injury
Mitral insufficiency

2. What is the basic principle of CHF?
LA
Months out fibrosis
Pump failure
Day 1-7

3. Low voltage EKG w/diminished QRS amplitude.
Squatting - increased systemic resistence decreases LV emptying
Paradoxical emboli
S viridans
Restrictive cardiomyopathy

4. What is the most common cause of myocarditis?
Aortic stenosis
Coxsackie A or B
R-->L
Tender lesions on fingers or toes.

5. When does the heart have a yellow pallor post MI?
Valve replacement AFTER the onset of complications
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Cardiogenic shock - CHF - arrhythmia
Day 1-7

6. How long after pharyngitis does acute rheumatic fever occur?
Contraction band necrosis - reperfusion injury
Inability to fill ventricles
2-3 weeks
Minimizes ischemia

7. What is a common complication of cardiac metastasis?
Pts w/previously damaged valves
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral insufficiency
Pericardial effusion due to pericardial involvement

8. What are the clinical features of RHF due to?
Spontaneous
Months out fibrosis
Systemic venous congestion
Loeffler syndrome

9. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Asymptomatic
Coexisting mitral stenosis and fusion of commisures exist
Congestive heart failure
Infantile coarctation of the aorta PDA

10. What are the sx of PDA at birth?
Breast and lung carcinoma - melanoma - lymphoma
Sterile vegetations on mitral valve along lines of closure
Asymptomatic
Fetal alcohol syndrome

11. When does the heart have dark discoloration post MI?
Hemosiderin laden macrophages
Volume overload and LHF
4-24 hours
Streptococcus bovis/

12. With what virus is PDA associated?
Congenital rubella
Loeffler syndrome
Wear and tear
Type I

13. What are the sx of right - to - left shunt?
Reperfusion injury
Cyanosis - RV hypertrophy - polycythemia - clubbing
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
Loss of LV fx

14. Holosystolic blowing murmur that increases w/expiration?
Dilated
Autoimmune pericarditis 6-8 wks post MI
Subendocardial
Mitral regurg

15. EKG for stable angina?
S epidermidis
Transesophageal echo
NG or Ca channel blocker
ST- segment depression

16. What is the foundation of a scar?
Circumflex
Granulation tissue
Cardiac tamponade
Myocardium

17. What causes an early - blowing diastolic murmur?
Hypertrophic cardiomyopathy
1-3 days out
Aortic regurg
Reperfusion injury

18. Tx for PDA?
Plump fibroblasts - collagen - blood vessels
Libman - Sacks endocarditis
RCA
Indomethacin - decreases PGE

19. When do troponin levels rise - peak - and return to normal?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
2-4 hours - 24 hours - 7-10 days
S viridans
Streptococcus viridans

20. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
S epidermidis
Stretched muscle loses contractility
Migratory polyarthritis

21. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Troponin I
Mitral regurg
Ostium secundum (90%)

22. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Membrane damage
Loss of LV fx
ST- segment depression

23. What are the minor critera of the Jones criteria?
Nonspecific - eg fever and elevated ESR
Right -->left
Prophylactic abx during dental procedures
RHF

24. What are Osler nodes?
Reversible
Nitroglycerin
Tender lesions on fingers or toes.
Day 1-7

25. How do you tx prinzmetal angina?
Rhadbomyoma - benign
NG or Ca channel blocker
Nitroglycerin
ST- segment elevation

26. What type of shunt does ASD cause?
When a bacterial protein resembles a protein in human tissue
Loeffler syndrome
Left -->right
Nonspecific - eg fever and elevated ESR

27. What is the rate of mitral valve prolapse in the US?
2-3%
Positive blood cultures anemia of chronic disease
CHF
S aureus

28. What is the etiology of S viridans endocarditis?
Chest pain <20 min brought on by exertion or emotional stress
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Months out fibrosis
Valve replacement

29. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Right -->left
Aschoff bodies
Large vegetations of S aureus
Breast and lung carcinoma - melanoma - lymphoma

30. Which congenital heart defect is associated with maternal diabetes?
Tuberous sclerosis
Transposition of the great vessels
Infectious endocarditis
Myocarditis

31. What are the sx/complications of myocarditis?
Chronic ischemic heart disease
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Squatting - expiration

32. How does hypertension cause LHF?

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33. What are the sx of hypertrophic cardiomyopathy?
Myofiber hypertrophy with disarray
Subendocardial
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Reactive histiocyte with caterpillar nucleus

34. What type of tumor is a rhabdomyoma?
Tuberous sclerosis
Harmartoma
LA dilation
Decrease preload -->lowers myocardial stress

35. What imaging test is useful for detecting lesions on valves?
Months out fibrosis
Blood vessels coming in from normal tissue
Transesophageal echo
Nitroglycerin

36. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Myxoid degeneration
Months out fibrosis
Hypertrophic cardiomyopathy

37. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Myocarditis in acute rheumatic heart fever
Type I
Loeffler syndrome
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

38. How does restrictive cardiomyopathy present?
Congestive heart failure
Annular - non pruritic rash w/erythematous borders trunks and limbs
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Acute inflammation

39. Are most congenital heart defects spontaneous or inherited?
Tuberous sclerosis
Aortic regurg
Dressler syndrome
Spontaneous

40. What type of ischemia does stable angina cause?
Pulsating nail bed
Subendocardial
Prophylactic abx during dental procedures
Thickening of chrodae tendinae and cusps - mitral stenosis

41. What vavular defect results from acute rheumatic fever?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Mitral regurgitation due to vegetations
Degree of pulmonary artery stenosis
45%

42. What complication occurs 1-3 days post MI?
Hypertrophic cardiomyopathy
Tuberous sclerosis
Hypercoagulable state or underlying adenocarcinoma
Fibrinous pericarditis

43. What causes endocarditis of prosthetic valves?
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
S epidermidis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Stable angina

44. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Fetal alcohol syndrome
ST- segment depression

45. What are the sx of aortic regurg?
4-24 hours
When a bacterial protein resembles a protein in human tissue
Congenital rubella
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

46. Poor myocardial fx due to chronic ischemic damage?
Degree of pulmonary artery stenosis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Wear and tear
Chronic ischemic heart disease

47. What structures are susceptible to rupture post MI?
Myxoma - benign
Increased blood in right heart delays closure of P valve
Papillary muscle - free wall - IV septum
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

48. What genetic conditions predispose a pt to mitral valve prolapse?
Ehlers - Danlow and Marfan syndrome
When a bacterial protein resembles a protein in human tissue
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Pericardial effusion due to pericardial involvement

49. What is the most common cause of RHF? What are others?
NG or Ca channel blocker
Bacterial endocarditis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Preductal - post aortic arch

50. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
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
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Stable angina

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