Cardiac Flashcards
What causes Printzmetal Angina? What drug is used to Dx Prinzmetal’s Angina?
coronary artery vasospasm
Ergonovine
Would Printzmetal Angina cause ST elevation or ST depression?
ST elevation
Which protein is the gold standard for MI?
Troponin I
How long does it take for Troponin I levels to rise?
2-4 hours
How long does it take for Troponin I to peak?
24 hours
Which protein is the transient marker for MI?
CK-MB
How long is the myocardium dark following M.I.?
4-24 hours
What is the microscopic change one day post-MI?
coagulative necrosis
What is the microscopic change one week post-MI?
invasion of neutrophils and then macrophages
What vessel feeds the papillary muscle?
RCA
What is the complication of neutrophils invading the myocardium post-MI?
fibrinous pericarditis
How does fibrinous pericarditis present?
friction rub
What is the complication of macrophages invading the myocardium post-MI?
wall rupture
What type of tissue invades one month post-MI?
granulation tissue
What is the gross change months after an MI?
white scar
What is the complication of a white scar in the myocardium?
Aneurysm
What mediates Dressler syndrome? How many weeks post-MI does it take for this to occur?
autoimmune reaction to PERICARDIAL membrane
6-8 weeks
How is Dressler Syndrome treated?
colchicine
What are VSDs associated with?
fetal alcohol
What is Eisenmenger Syndrome?
VSD–> L to R –> Pulm. HTN–> R to L
What type of speciific heart defect is associated with Downs Syndrome?
Ostium Primum ASD
Why does an ASD produce a split S2?
more blood in left heart delays closure
What is the important and potentially fatal complication of an ostium primum?
paradoxical emboli
What is the most common cause of a PDA?
congenital rubella
Does a PDA result in a right-to-left or a left-to-right shunt?
left to right
What is the treatment of a PDA? Why?
indomethacin
decreases PGE synthesis
What are the four characteristics of Tetralogy of Fallot?
Persistent PDA
RVH
Over-riding aorta
VSD
Does tetralogy of fallot cause a right-to-left or a left-to-right?
right-to-left
What is Transposition of the Great Arteries associated with?
maternal diabetes
What maintains a PDA?
PGE
What is a Truncus Arteriosus?
single vessel arising from both ventricles
Tricuspid atresia results in the development of what structure?
ASD
Where does an infantile Aortic Coarctation often present?
distal to aortic arch
proximal to PDA
What disease is Coarctation of the Aorta associated with?
Turner Syndrome
How does adult Coarctation of the Aorta present?
strong UE pulses and low LE pulses
What is the finding of Coarctation of the Aorta on Imaging? What causes this?
notched ribs
development of collateral circulation
What valvular issue does Adult Coarctation of the Aorta present with?
bicuspid aortic valve
What group of Strep cause rheumatic fever?
Group A
What is the hemolysis pattern of Strep that causes Rheumatic Fever ?
β-hemolytic
How long after an infection can Rheumatic Fever present?
2-3 weeks
What is the constituent of Strep that causes Rheumatic Fever molecular mimmicry?
M-protein
What are the two titers that may be present if a patient has been previously diagnosed with Group A β-hemolytic Strep?
anti-ASO
anti-DNase B
What criteria are used to Dx Group B β-hemolytic Strep infection?
Jones Criteria
What is the J of the JONES criteria?
joints (Migratory polyartiritis)
What is the O of the JONES criteria? What specific condition?
O = heart shape = pancarditis
What is the N of the JONES criteria?
N = (subcutaneous) Nodules
What is the E of the JONES criteria?
Erythema Marginatum
What is the S of the JONES criteria?
Syndenham Chorea
What is Migratory Polyarteritis?
swelling/pain in one joint that moves to involve another joint
What two valves are involved during Rheumatic Fever? Which more often?
aortic and mitral
Mitral = More often
What type of abnormality takes place at the mitral valve early during Rheumatic Fever?
mitral regurgitation
What is the most common cause of death in the acute phase of Rheumatic Fever?
myocarditis
What is the histological finding of Myocarditis during Rheumatic Fever?
Aschoff Bodies
What three cells compose the Aschoff Bodies during Rheumatic Fever?
Reactive Histiocytes
Giant cells
fibrinoid material
What is Erythema Marginatum?
annular rash with erythematous border
What happens to the mitral valve anatomy during chronic rheumatic fever?
thickening of chordae tendinae
What happens to the aortic valve during chronic rheumatic fever?
fusion of commissures (bicuspid aortic valve)
Ejection Click is a pathological finding of what cardiac abnormality?
Aortic Stenosis
What are the three major complications of Aortic Stenosis?
- LVH
- Angina/Syncope upon exercise
- Micropathic Hemolytic Anemia
What causes Aortic Regurgitation?
aortic root dilation
What is the cause of Mitral Valve Prolapse ?
myxoid degeneration
What are the two potential causes of Myxoid Degeneration?
ED or Marfan
What is heard on auscultation during Mitral Valve Prolapse?
mid-systolic click
Does a Mitral Valve Prolapse become louder or softer during squatting?
softer
What is heard on auscultation during Mitral Valve Prolapse?
holosystolic click
Does a Mitral Valve Regurgitation become louder or softer during squatting? Why?
louder
squatting causes increased systemic pressure that cause LV to pump more blood through mitral valve
What is heard during auscultation during mitral valve stenosis?
opening snap
What are the three complications of Mitral Valve Stenosis?
pulmonary congestion
pulmonary HTN
atrial fibrillation
What bacteria is the most common cause of endocarditis/?
Strep. viridans
Strep. viridans can infect with type of valve? Why?
previously damaged valve
bacteria attach to exposed collagen
What is the most common cause of endocarditis in IV drug users?
S. aureus
What valve is most commonly infected by S. aureus?
Tricuspid
What does S. aureus do to heart valves?
destroy
What species of bacteria most often infects prosthetic heart valves?
S. epidermidis
What bug strongly hints at Colorectal Carcinoma?
Strep. bovis
What group of bacteria is responsible for endocarditis with a negative blood cultures?
HACEK
What is H of HACEK?
Haemophilus
What is A of HACEK?
Actinobacillus
What is C of HACEK?
Cardiobacterium
What is E of HACEK?
Eikenella
What is K of HACEK?
Kingella
What two locations do Janeway lesions manifest? What disease are they indicative of?
palms and soles
endocarditis
What two locations do Osler nodes lesions manifest? What disease are they indicative of?
fingers and toes
Endocarditis
Where do splinter hemorrhages manifest?
nail-bed
Where do Roth Spots manifest? What disease are they indicative of?
Retina
endocarditis
What disease can endocarditis precipitate the formation of?
anemia of chronic disease
What type of echo is used for endocarditis?
transesophageal echo
What two diseases are sterile vegetations indicative of?
hyper-coaguable state
Adenocarcinoma
What valve is most commonly infected by sterile vegetations? What is the result?
mitral
mitral regurgitation
What endocarditis disease is produce during SLE? Which valve? What does this result in?
Libman-Sachs endocarditis
mitral
regurgitation
Does a dilated cardiomyopathy result in systolic or diastolic function?
sytolic
What two valves are most often affected during dilated cardiomyopathy? What does this lead to?
mitral and tricuspid
regurgitation
What two viruses can cause a dilative cardiomyopathy?
Coxsackie A and B
What type of immune cell invades the heart during a coxsackie virus infection? What layer?
Lymphocytes
myocardium
What drug can cause a dilative cardiomyopathy?
Doxorubicin
What specific disease can hemochromatosis cause in the heart?
dilative cardiomyopathy
A mutation in genes for what protein can cause a hypertrophic cardiomyopathy? What is the mode of inheritance?
sarcomere
autosomal dominant
What is the mode of inheritance for the most common genetic form of hypertrophic cardiomyopathy?
autosomdal dominant
Would a hypertrophic cardiomyopathy lead to a systolic or diastolic dysfunction?
diastolic
What type of stenosis can a patient with hypertrophic cardiomyopathy present with? Why?
aortic stenosis
ventricular septum hypertrophy
What are the four causes of a restrictive cardiomyopathy?
amyloidosis
sarcoidosis
endocardial fibroelastosis
Loeffler Syndrome
What are the three findings of Loeffler Syndrome?
endoMYOcardial fibrosis
Eosinophilic infiltrate
eosinophilia
What is the classic finding of restrictive cardiomyopathy?
low-amplitude EKG
What is a myxoma? What is the specific location as to where a myxoma often arises?
benign pedunculated mass
usually in left atria
What type of tumor is a myxoma?
mesenchymal
What valve does a myxoma often occlude?
mitral
What is a rhabdomyoma?
benign hamartoma of cardiac muscle
What patient population does a myxoma arise?
adult
What patient population does a rhabdomyoma arise?
children
What other disease is a rhabdomyoma associated with?
tuberous sclerosis
Where in the heart does a rhabdomyoma often arise?
ventricle
Which four cancer can metastisize to the heart?
breast, lung, lymphoma, melanoma
What layer of the heart do metastatic tumors like to lodge? What can this lead to?
pericardium
pericardial effusion
Does Temporal Arteritis more commonly effect males or females? Over what age?
females
50
What causes Unstable Angina?
rupture of a coronary artery with incomplete occlusion
When does unstable angina occur?
at rest
Is prinzmetal angina a reversible or irreversible injury?
reversible
What does Prinzmetal Angina do on the EKG?
ST elevation
What are the two treatments of Prinzmetal Angina?
GTN or CCBs
Does GTN relieve the symptoms of myocardial infarction?
no
What parts of the heart are often spared during Myocardial Infarction?
RV and both atria
How long is Troponin I detectable?
7-10 days
Reperfusion of irreversibly damaged myocytes leads to influx of what ion? Causing?
calcium
contraction band necrosis
What is the microscopic change of the myocardium months after injury?
fibrosis
What is the key complication of the macrophage phase of post-MI immune response?
rupture
What must occur for pericarditis to occur post-MI?
transmural infarction
How long post-MI does Dressler Syndrome arise?
6-8 weeks
What type of collagen would be present in a healed MI?
type one
What is the most common cause of right-sided HF?
left-sided HF
What are the three manifestations of right-sided HF?
JVD
nutmeg liver
peripheral edema
What are the two findings of Eisenmenger syndrome on physical exam and labs?
clubbing of fingers
polycythemia
Why does S2 split during an ASD?
delayed closure of pulmonic valve due to increased blood volume
Explain the process of why a person with Tetralogy of Fallot squat?
increase pressure on left heart to shunt blood to right heart and improve blood flow to lungs
What drug is used to treat TGA? Why?
misoprostol
maintain PDA
What is truncus arteriosus ?
single vessel arising from ventricles
What are the two forms of Coarctation of the Aorta?
infantile and adult
Infantile Coarctation of the Aorta is associated with what other finding?
PDA
Where does Adult Coarctation of Aorta occur?
distal to aortic arch
How long will each joint be affected during Migratory Polyarthritis?
2-3 days
Of the JONES criteria, which is the only symptom that will not resolve with time?
valvular issue
What specific cell type is found during myocarditis of rheumatic fever? What type of cell is this?
Anitschkow
reactive histiocyte
What process causes the friction of Acute Rheumatic Fever?
pericarditis
Repeated exposure to Group A β-hemolytic Strep. can cause what long term heart problem?
mitral stenosis
What type of aortic valve has a higher liklihood of developing aortic stenosis?
bicuspid aortic valve
What will be heard on auscultation during Aortic Regurgitation ?
early, blowing diastolic murmur
What are three common presenting symptoms for a patient with aortic regurgitation?
wide pulse pressure
pulsating nail bed
bobbing head
What would be heard during auscultation for mitral valve regurgitation?
holosystolic ‘blowing’ murmur
Would mitral valve regurgitation become louder or softer during expiration? Why?
louder
more blood enters LA and LV to be pumped
Below what vessel do the vaso vasorum cease to exist? What can this lead to?
renal arteries
AAA
Would a right sided murmur become louder or softer upon inspiration?
louder
What is Kussmaul’s sign?
rise in JVD upon inspiration
Which β-blocker can exacerbate Prinzmetal Angina?
Propranalol
What are Janeway Lesions/Osler Nodes/Splinter Hemorrhages composed of?
Septic Embloi
Do Janeway lesions hurt?
no
Do Osler nodes hurt?
yes
Other than a fever and murmur, what disease can all forms of endocarditis produce?
Anemia of Chronic Disease
What process occurs during Libman-Sacks Endocrditis?
mitral regurgitation
What is the major form of endocarditis that can produce vegetations on the surface and underside of the mitral valve?
Libman Sacks Endocarditis
What is the mode of inheritance for a genetic mutation that could lead to dilated cardiomyopathy?
autosomal dominant
Other than doxorubicin, what drug is known to cause a dilative cardiomyopathy?
alcohol
What heart pathology can pregnancy cause?
dilated cardiomyopathy
Myofiber Disarray is indicative of what disease?
hypertrophic cardiomyopathy
Endocardial Fibroelastosis primarily effects what age group?
children
What is the most common primary cardiac tumor in adults?
Myxoma
What is the most common presentation for a myxoma?
syncope
What vessel supplies the papillary muscles of the LV?
right coronary artery
How long does it take CK-MB to rise after an infarction?
4-6 hours
How long does it takes CK-MB to peak after an infarction?
24 hours
How long does it takes CK-MB to return to normal levels after an infarction?
72 hours
Does a Mitral Valve Regurgitation become louder or softer during inspiration? Why?
louder
more blood enters left atria
Which angina show STE? Which angina shows STDs?
STDs = stable or unstable
STEs = prinzmetal
What part of the body is cyanotic in a kid with a PDA?
lower extremities
What presents with a bounding pulse, aortic stenosis or aortic regurgitation?
regurgitation
Does aortic regurgitation result in eccentric or concentric hypertrophy?
eccentric
Does aortic stenosis result in eccentric or concentric hypertrophy?
concentric
Is stable angina a reversible or irreversible injury?
reversible
Would Stable Angina cause ST elevation or ST depression?
depression
Would Unstable Angina cause ST elevation or ST depression?
depression
What two drugs are used to treat Prinzmetal Angina?
nitro and CCBs
What time frame of chest pain differentiate angina from M.I.?
twenty minutes
What is removed from the cell during coagulative necrosis?
nuclei
For how long following ischemia will no changes be seen in microscopy or gross changes?
four hours
What color is the heart on gross examination when neutrophils are present?
yellow
What specific days for neutrophil infiltration post-MI?
1-3
What specific days for macrophage infiltration post-MI?
4-7
What is the most common type of ASD?
ostium secundum
Is PDA symptomatic at birth?
no
During what kind of heart inflammation do Anitschkow cells arise?
Myocarditis
Is mitral regurgitation caused by acute or chronic rheumatic fever?
acute
Is mitral stenosis caused by acute or chronic rheumatic fever?
chronic
Does S. viridans destroy valves?
no
Does S. aureus destroy valves?
yes
What type of cardiomyopathy could pregnancy produce?
dilated
What is the most common tumor of the heart?
metastasis
