Cardiac

Question 1

Complications of Myocardial Infarction - Mechanical

Answer 1

Mechanical:

• cardiogenic shock
• CCF
• mitral regurg. (if LV infarct and papillary muscle rupture) - cardiac rupture: wall (tamponade) or septum (shunt)
• ventricular aneurysm a month later

Question 2

Complications of Myocardial Infarction - Arrhythmias

Answer 2

• VF that day (most common cause of sudden death)

- 90%(!) have other arrhythmia

Question 3

Complications of Myocardial Infarction - Pericardial

Answer 3

• Early pericarditis (dusky tissue)
• Pericardial effusion (?tamponade)
• Dressler’s Dyndrome: CP, fever, effusion, weeks/months later (autoimmune response)
• Fibrinous Pericarditis: if infarct reaches pericardium

Question 4

Histological evolution of MI

Answer 4

Normal for first 6 hours;
6-24 hours: necrosis and loss of nuclei;
1-4 days: polymorphs then macrophages;
5-10 days: debris removal;
1-2 weeks: granulation tissue, new vessels, myofibroblasts, collagen synthesis;
4+ weeks: scar tissue.

Question 5

Causes of heart failure (6)

Answer 5

• IHD
• Hypertension
• Valve disease
• Dilated cardiomyopathy
• Myocarditis
• Arrhythmias

Question 6

Complications of heart failure

Answer 6

• Sudden death
• Systemic emboli
• DVT/PE
• Arrhythmias
• Pulmonary oedema (pink transudate) (+ infection)
• Hepatic cirrhosis (nutmeg liver)

Question 7

Three types of cardiomyopathy,

and do they cause systolic or diastolic dysfunction?

Answer 7

Dilated - Systolic (doesn’t stretch)
Hypertrophic - Diastolic (doesn’t fill)
Restrictive - Diastolic

Question 8

Causes of dilated cardiomyopathy

Answer 8

Idiopathic, 
Alcohol, 
Giving birth, 
Gentic, 
Sarcoid, 
Myocarditis.

Question 9

Causes of hypertrophic cardiomyopathy

Answer 9

Genetic,

Inborn errors of metabolism.

Question 10

Causes of restrictive cardiomyopathy

Answer 10

Sarcoid,
Amyloid,
Radiation-induced fibrosis.

Question 11

Genetics of hypertrophic cardiomyopathy

Answer 11

Autosomal Dominant,
Sarcomeric protein genes,
beta-MHC (myosin heavy chain) most common,
also MYBP-C and Trop-T.

Question 12

What does acute rheumatic fever affect?

Answer 12

Heart: pancarditis;
Joints: arthritis and synovitis;
Skin: erythema marginatum, subcutaneous nodules;
Neuro: Encephalopathy, Sydenham’s chorea.

Question 13

Steps of atherosclerosis

Answer 13

1. Endothelial injury
2. LDL accumulation
3. LDL oxidised (foreign, so inflam)
4. Macr use scavenger R, become foam cells
5. Apoptosis: more inflam and more chol
6. Adhesion molecules, so more macr
7. Fibrous cap by smooth muscle

Question 14

Modifiable atherosclerosis RFs

Answer 14

T2DM,
Hypertension,
Hyperchol,
Smoking.

Question 15

Non-modifiable atherosclerosis RFs

Answer 15

Male,
Old,
FHx.

Question 16

Acute rheumatic fever criteria

Answer 16

Jones:

• Carditis
• Arthritis
• Sydenham’s Chorea
• Erythema marginatum
• Subcutaneous nodules

Question 17

Criteria for Infective Endocarditis

Answer 17

Duke’s: 2M / M+3m / 5m

• Persistent (2+) blood cultures
• Vegetations on echo
• Serology of Brucella/Coxiella/Bartonella
• RF (murmur, IVDU)
• Fever or CRP
• Immune complexes (splinter haemorrh., haematuria)
• Vascular phenomena
• Other positive echo
• One blood culture

Question 18

Rheumatic fever buzzwords (histology)

Answer 18

Lancefield Group A strep, 
Antigenic mimicry, 
Beady fibrous warty vegetations (verrucae), 
Aschoff bodies, 
Anitschkov myocytes.

Question 19

Chronic rhaematic valve disease

Answer 19

Mitral prolapse (sometimes Aortic). 
Middle aged woman SOB and chest pain, mid-systolic click and late systolic murmur.

Question 20

5 types and causes of Pericarditis

Answer 20

• Fibrinous: MI, uraemia;
• Purulent : Staph;
• Granulomatous: TB;
• Haemorragic: tumour;
• Fibrous (constrictive): any of the above.