Rest of Cardio PATHOMA

Question 1

What pathology has the greatest association with VSD?

Answer 1

FETAL ALCOHOL SYNDROME

Question 2

What pathology has the greatest association with a FORAMEN PRIMUM ASD?

Answer 2

DOWN SYNDROME

Question 3

Describe the pathophysiology of a paradoxical embolus that arises with ASD.

What is the most common etiology of a paradoxical embolus?

Answer 3

Paradoxical embolus (DVT) that arises in the RIGHT SIDE but crosses over and ends up in the LEFT SIDE because of the ASD -> Can lodge in the brain

PATENT FORAMEN OVALE is the most common etiology of paradoxical embolus

Question 4

Which infection is most commonly associated with a PATENT DUCTUS ARTERIOSUS?

Answer 4

CONGENITAL RUBELLA

Question 5

What pathology is associated with TRANSPOSITION OF GREAT VESSELS?

Answer 5

MATERNAL DIABETES

Question 6

AORTICOPULMONARY SEPTUM SIMPLY DOES NOT FORM (always has VSD)

Answer 6

PERSISTENT TRUCUS ARTERIOSUS

Question 7

FAILURE OF AORTICOPULMONARY SEPTUM TO SPIRAL 180, associated with MATERNAL DIABETES

Answer 7

TRANSPOSITON OF GREAT ARTERIES

Question 8

MACHINE LIKE MURMUR, loudest at S2, CONGENITAL RUBELLA, DUCTUS ARTERIOSUS does NOT close

Answer 8

PATENT DUCTUS ARTERIOSUS

Question 9

PERSISTENCE OF FORAMEN OVALE, Fixed Split S2

Answer 9

ASD SECONDUM

Question 10

NCC Migratory defect, failure of septum primum to fuse with endocardial cushions, Association with DOWN SYNDROME

Answer 10

ASD PRIMUM

Question 11

Describe how TRICUSPID ATRESIA results in EARLY CYANOSIS. Which septal defect is it associated with?

Answer 11

TRICUSPID ATRESIA: Atretic tricuspid valve + Hypoplastic RV
ASD**
RA->LA shunt = CYANOSIS

Question 12

Which congenital heart defect is associated with INFANTILE AORTA COARCTATION? What is the classic location of an AORTA COARCTATION? How does this clinically manifest?

Answer 12

PDA** Infantile coarctation (narrowing) of aorta located **Distal to aortic arch, Proximal to PDA = classic location
Clinically manifests as LE CYANOSIS at birth

De-oxygenated blood -> RA -> RV -> PDA -> Down to Lower extremities = LE cyanosis
Brain and UE supplied by the 3 branches of the aorta before the PDA (brachiocephalic trunk, subclavian artery, common carotid)

Question 13

Which congenital heart defect is greatly associated with TURNER SYNDROME?

Answer 13

INFANTILE AORTA COARCTATION distal to the aortic arches and proximal to the PDA

Question 14

Is ADULT AORTA COARCTATION associated with a PDA?

Answer 14

NO

Question 15

What is the classic location of an ADULT AORTA COARCTATION?

KEY FINDING: Would pt have HTN or hypotension in UE? What about in LE?

Answer 15

Distal to the aortic arch

• Coarctation distal to aortic arch -> INCREASED Blood volume to the aorta arch -> HTN in UE
• DECREASED blood volume distal to aorta arch due to coarctation -> HYPOTENSION in LE

Question 16

Which heart defect is ADULT AORTA COARCTATION most associated with?

Answer 16

BICUSPID AORTIC VALVE

Question 17

What is the classic X-ray finding of AORTA COARCTATION? Why does this occur?

Answer 17

NOTCHING OF RIBS: Due to dvlm of collateral circulation across the intercostal arteries

Coarctation distal to the aortic arch -> INCREASED VOLUME at the aorta arch -> Dvlm of collaterals to try to bypass the narrowing - one of the collaterals = intercostal arteries at rib surface -> Compress surface of bone -> Engorgement of arteries creates NOTCHING

Question 18

2 CARDIAC SX ASSOCIATIONS WITH SYPHILIS

Answer 18

1. Aortitis -> resulting in AORTIC REGURGITATION

2. Thoracic aortic ANEURYSM

Question 19

ASCHOFF BODIES is a hallmark finding of what?

What is the ASCHOFF BODY made of?

Answer 19

RHEUMATIC FEVER MYOCARDITIS - FATAL

ASCHOFF BODY = FIBRINOID (Collagen) + GIANT CELLS + ANITSCHKOW cells (Reactive histiocytes with slender, wavy nuclei)

Question 20

Which valve is most commonly involved with RHEUMATIC FEVER (Group A strep)? If another valve is also involved in addition to the first, what is also involved?

Answer 20

MITRAL VALVE - most commonly involved

AORTIC VALVE if another is involved

Question 21

FISH MOUTH APPEARANCE OF AORTIC VALVE resulting in AORTIC STENOSIS is a complication of what pathology?

Answer 21

FISH MOUTH - Due to fusion of commissures of aortic valve, resulting in AORTIC STENOSIS = Complication of CHRONIC RHEUMATIC HEART DISEASE

Question 22

Which valvular defect increases the risk of and hastens the onset of AORTIC STENOSIS?

Answer 22

BICUSPID AORTIC VALVE

Question 23

How does one distinguish AORTIC STENOSIS resulting from age-related CALCIFICATIONS and as a result of CHRONIC RHEUMATIC FEVER DISEASE?

Answer 23

CALCIFICATIONS:

1) AS can exist by itself.
2) NO fusion of commissures, just calcifications from wear/tear

CHRONIC RHEUMATIC FEVER DISEASE:

1) AS does not exist by itself. ALWAYS have MITRAL STENOSIS BEFORE and IN CONJUNCTION with AS
2) AS results from a FUSION OF COMMISSURES (Fish mouth appearance)

Question 24

Which hematological disorder can arise as a complication of AORTIC STENOSIS?

Answer 24

MICROANGIOPATHIC HEMOLYTIC ANEMIA - RBCs get damaged while crossing through calcified valve -> SCHISTOCYTES

Question 25

What is the most common cause of AORTIC REGURGITATION? What are three less common etiologies of AR?

Answer 25

ISOLATED AORTIC ROOT DILATION = most common cause

1. Aortic root dilation - Syphilitic aneurysm of the thoracic aorta (Pulls on the aortic root)
2. Aortic root dilation - Aortic dissection
3. Infectious endocarditis

Question 26

Which murmur INTENSIFIES with sudden squatting + expiration?

Answer 26

MITRAL REGURGITATION severity dependent on regurg fraction = regurg volume/LV stroke volume
Sudden Squatting: Increase preload (Increase venous return) + Increase afterload -> Increase LVV -> Increase regurgitant volume -> Increase SEVERITY of murmur

Expiration: Increase LAV -> Increase LVV -> Increase regurgitant volume

Question 27

Rheumatic fever most commonly involves the MITRAL VALVE. Which murmur is associated with ACUTE rheumatic fever? Which murmur is associated with CHRONIC rheumatic fever?

Answer 27

ACUTE RF: Mitral REGURG

CHRONIC RF: Mitral STENOSIS and(or) AORTIC STENOSIS (due to fusion of commissures)

Question 28

Which arrhythmia can be caused by LYME DISEASE?

Answer 28

3rd DEGREE COMPLETE HEART BLOCK

Question 29

Which congenital heart defect is most associated with PRENATAL LITHIUM EXPOSURE? What is this pathology? What murmurs is this associated with?

Answer 29

EBSTEIN ANOMALY - Displacement of TRICUSPID VALVE LEAFLETS downward into RV -> Artificially “ATRIALIZES” the ventricle - Associated with TR, HF

Question 30

What are the EKG changes of PERICARDITIS?

Answer 30

ST segment elevation + PR segment depression (LEADS I and II)

Question 31

What type of arrhythmia is BRUGADA SYNDROME?

Answer 31

BRUGADA SYNDROME = Autosomal dominant disorder of VENTRICULAR TACHYARRHYTHMIA

EKG Pattern: Pseudo RBBB (Slurred S in lateral leads, Rabbit ears in V1-V2) + ST elevation in V1-V3

Question 32

What are the 5 drugs that cause PROLONGED QT (Prolonged ventricular repolarization)?

Answer 32

A - anti-arrhythmics (IA, III)
B - antiBiotics (MACROLIDES)
C - antiPSYchotics (HALOPERIDOL)
D - antiDepressants (TCAs) 
E - antiEmetics (ONDANSETRON)

Question 33

What is ROMANO-WARD SYNDROME? Does this also have CNS defects?

Answer 33

Autosomal Dominant form of CONGENITAL LONG QT syndrome (inherited disorder of myocardial repolarization)
NO CNS - No sensorineural deafness, purely cardiac phenotype

Question 34

What is JERVELL and LANGE-NIELSON SYNDROME?

Answer 34

Autosomal Recessive form of CONGENITAL LONG QT SYNDROME (inherited disorder of myocardial repolarization)
YES, sensorineural deafness as well

Question 35

What are the organisms responsible for ENDOCARDITIS with NEGATIVE blood cultures?

Answer 35

HACEK

Haemophilus, Actinobacillus, Cardiobacterium, Eikenalla, Kingella

Question 36

You diagnose a pt with Streptococcus bovis endocarditis. What is the next screening test you should order?

Answer 36

COLORECTAL CARCINOMA