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Cardiac

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Answer 50 questions in 15 minutes.
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1. What is the cause of restrictive cardiomyopathy in children?
Friction rub and chest pain
Endocardial fibroelastosis (rare)
2-3 weeks
4-24 hours

2. What type of shunt dose PDA cause?
Aortic regurg
Hemosiderin laden macrophages
Left -->right
Rhadbomyoma - benign

3. What valves are most commonly involved in chronic rheumatic heart disease?
Bounding pulse
Infectious endocarditis - arrythmias - severe mitral regurg no
Mitral mitral+aortic
Pericardial effusion due to pericardial involvement

4. Is scar tissue or myocardium stronger?
Rhabdomyoma
Myocardium
Systemic venous congestion
Anterior wall of LV and anterior septum

5. How does MI cause LHF?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Shunt
Loss of LV fx
Streptococcus viridans

6. What are heart failure cells?
Split S2 on auscultation
Hemosiderin laden macrophages
Dilation of all four chambers of the heart
Subendocardial

7. What are the sx of hypertrophic cardiomyopathy?
Right side - serotonin and other secretory products detoxified in the lung
L->R
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
PDA

8. What side of the heart do carcinoid tumors affect? Why?
Large vegetations of S aureus
Posterior wall of LV - posterior septum - papillary muscles
Right side - serotonin and other secretory products detoxified in the lung
Intercostal arteries enlarged due to collateral circulation

9. With what disease is infantile coarctation of the aorta associated?
Atria and RV
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Squat in response to cyanotic spell
Turner syndrome

10. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
VSD
Shunt - PGE to maintain PDA until surgical repair can be performed
4-7 days macrophage infiltration
Left -->right

11. What is the effect of mitral regurg on the heart?
White scar fibrosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Coxsackie A or B
Volume overload and LHF

12. What causes unstable angina?
PDA
Right to left
Aortic regurg
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

13. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Ventricles cannot pump
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
20 min

14. What causes an early - blowing diastolic murmur?
Mitral regurg
LAD
Aortic regurg
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

15. What is an Anitschow cell?
Endocardial fibroelastosis (rare)
Mitral regurg
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Reactive histiocyte with caterpillar nucleus

16. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Turner syndrome
Aschoff bodies
Stable angina

17. When do neutrophils infiltrate the myocardium post MI?
ACE inhibitor
ASD - R-->L
Reperfusion injury
1-3 days

18. What is the tx for VSD?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Systemic venous congestion
Surgical closure small defects may close spontaneously
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

19. How does ischemia cause LHF?
Tetralogy of fallot
Loss of fx
Inability to maintain systemic pressure w/lack of O2 to vital organs
1-3 days out

20. What is the gold standard blood marker for MI?
Troponin I
Aortic regurg
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Bounding pulse

21. What characterizes acute rheumatic fever endocarditiis?
SLE
Boot shaped heart
Pancarditis
Small vegetations along the line of closure

22. What is a Quincke pulse?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pulsating nail bed
Rhabdomyoma
Aschoff bodies

23. With what disease is Libman - Sacks endocarditis associated?
Prinzmetal stable and unstable
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
SLE
Mitral stenosis

24. What heart sound manifest with an ASD?
Split S2 on auscultation
Hypertrophic cardiomyopathy
Decrease in blood flow to an organ
ASD - R-->L

25. What causes mitral valve prolapse?
Loeffler syndrome
Endocardial fibroelastosis (rare)
Myxoid degeneration
NG or Ca channel blocker

26. What is the characteristic murmurr of mitral stenosis?
Infantile coarctation of the aorta PDA
LV dilation and eccentric hypertrophy
Opening snap followed by diastolic rumble
Right side - serotonin and other secretory products detoxified in the lung

27. Tx for PDA?
Squatting - increased systemic resistence decreases LV emptying
Slow HR - decreasing O2 demand and risk for arrhythmia
Indomethacin - decreases PGE
Pump failure

28. What is the most common tumor of the heart?
Osler nodes (ouch - ouch Osler)
Autoimmune pericarditis 6-8 wks post MI
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Metastasis

29. What gross and microscopic changes occur 1-3 weeks after an MI?
Intercostal arteries enlarged due to collateral circulation
Inability to fill ventricles
Red border granulation tissue
4-6 hours - 24 hours - 72 hours

30. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Fibrinous pericarditis
Hemosiderin laden macrophages
Reactive histiocyte with caterpillar nucleus
Stable angina

31. What is typically the mechanims of sudden cardiac death?
First 4 hours
Pericarditits
Ventricular arrhythmia
45%

32. What is eythema marginatum? What parts of the body does it commonly involve?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
4-24 hours
Annular - non pruritic rash w/erythematous borders trunks and limbs

33. How do ACE inhibitors tx MI?
Nonspecific - eg fever and elevated ESR
Ehlers - Danlow and Marfan syndrome
Decreases LV dilation by decreasing volume
Infectious endocarditis - arrythmias - severe mitral regurg no

34. Opening snap followed by diastolic rumble.
NG or Ca channel blocker
2-3 weeks
Myocardium
Mitral stenosis

35. What gross and microscopic changes occur months after an MI?
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
Hypertrophic cardiomyopathy
White scar fibrosis
MI

36. What are the sx/complications of myocarditis?
PDA
CHF
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

37. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
Dilated
Elevated ASO anti - DNase B titers
Mitral regurg

38. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Myocardium
Stable angina
CHF

39. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
RCA
45%
LAD

40. What is the most common congenital heart defect?
VSD
Prinzmetal stable and unstable
RCA
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

41. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Small vegetations along the line of closure
Dilation of all four chambers of the heart
Months out fibrosis
Pericardial effusion due to pericardial involvement

42. What is the 1day-1wk -1mo mneumonic for MI?
Decrease preload -->lowers myocardial stress
SLE
Yellow pallor macrophages
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

43. What are the sx of right - to - left shunt?
Dressler syndrome
Ventricular arrhythmia
Cyanosis - RV hypertrophy - polycythemia - clubbing
Nitroglycerin

44. What effect does chronic rheumatic heart disease have the mitral valve?
Aneurysm - mural thrombus - Dressler syndrome
Loss of fx
Dark discoloration coagulative necrosis
Thickening of chrodae tendinae and cusps - mitral stenosis

45. What type of vegetations form in nonbacterial thrombotic endocarditis?
Aortic regurg
Sterile vegetations on mitral valve along lines of closure
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Regurg vs stenosis

46. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Hemosiderin laden macrophages
Thickening of chrodae tendinae and cusps - mitral stenosis
PGE

47. What two things cause coronary artery vasospasm?
Reactive histiocyte with caterpillar nucleus
Prinzmetal angina - cocaine
ST- segment depression
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

48. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Slow HR - decreasing O2 demand and risk for arrhythmia
Mitral stenosis
Myocarditis

49. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Anterior wall of LV and anterior septum
RBC damaged while crossing the calcified valve causing schistocytes
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

50. What type of ischemia does stable angina cause?
Subendocardial
Split S2 on auscultation
Valve scarring that arises as a consequence of rheumatic fever
Decreases LV dilation by decreasing volume

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