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radiology > Cardiac > Flashcards

Cardiac Flashcards

1
Q

what is the RA defined by?

A

IVC

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2
Q

what imp structures are in the RA?

A
  • crista terminalis

- Eustachian valve

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3
Q

eustachian valve

A

-valve of IVC

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4
Q

chiari network

A

Eustachian valve (IVC) trabeculated appearance

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5
Q

coronary sinus route

A

AV groove –> RA

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6
Q

what defined right Vt?

A

moderator band

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7
Q

TV vs MV

A

TV papillary m inserts on septum. No fibrous conn btw TV and P

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8
Q

signs of LA enlargement

A 
double density (direct)
splaying carina (indir)
walking man sign (indir)
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9
Q

walking man sign

A

pst displacement left main stem bronchus on lateral radiograph –> upside down V w/ intersection of right bronchus

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10
Q

MV

A

-papillary m inserts on lateral/pst walls and apex left Vt (not septum)

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11
Q

echogenic focus in LV

A
  • calcified papillary m
  • resolve by 3rd TM
  • 13% ass w/ DS
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12
Q

lipomatous HTr interatrial septum

A
  • dumbbell/bilobed, SPARES F.O.
  • obese, elderly
  • asyx (supraVt arryth)
  • brown fat –> HOT on pet
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13
Q

multiple interatrial lipomas

A

TS

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14
Q

interatrial fatty lesions

A
  • lipomatous HTr interatrial septum-dumbbell, spares f.o.
  • lipoma- encapsulated, does not spare f.o
  • both PET-HOT
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15
Q

interatrial lipoma

A
  • encapsulated
  • normal fat signal on MR
  • pet hot
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16
Q

coronary cusps

A

R, L, non (pst)

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17
Q

right coronary branches

A
  • conus (ant), 20-30% from aorta–> RVOT
  • SA (pst)
  • acute marginal–> RV free wall
  • AVN-junction of av/iv
  • PDA (65-80%)–> pst IV septum
  • PLA–> pst LV
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18
Q

how often does RCA perfuse SA and AV node?

A

SA-60%

AV-90%

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19
Q

dominance

A

R (85%)-PDA, PLA from RCA
L (7%)-PDA, PLA, AVN from left CX
co (7%)-PDA from RCA, PLA from left CX

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20
Q

order of obtaining chamber views

A
  • axial –> 2 chamber/vertical long axis –> 4 chamber view/horz long axis. –> short axis
  • 3 chamber/LVOF/apical long axis view
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21
Q

dividing anomalies of coronary arteries

A

org, course, termination

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22
Q

benign anomalies of coronary artery

A

does not course btw aorta and pulmonary a

-retroaortic, prepulmonic, septal

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23
Q

anomalies of coronary arteries that are always malignany

A

arise from pulmonary artery

-ALCAPA (bland-white-garland syndrome) > ARCAPA

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24
Q

potentially malignant anomalies of coronary arteries

A
  • LCA from RCS
  • RCA from LCS
  • LCx or LAD from RCS
  • a from NCS
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25
Q

LCA branches

A
  • btw PA and LAA
  • LAD, Lcx, ramus (15%)
  • LAD–> ant IV septum. Diagonal –> anterolat wall. Septal –> septum
  • Lcx –> AV groove. OMA –> pstlat LV
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26
Q

bland white garland syndrome

A

ALCAPA

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27
Q

compl malignant anomalous courses of CAs. Rx.

A
  • sudden cardiac death w/ exercise

- Rx= surgical bypass

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28
Q

Mx ALCAPA/ARCAPA

A
  • children: direct implantation of anomalous CA

- adults: bypass

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29
Q

pres ALCAPA/ARCAPA

A

85% CHF ~2 mo old

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30
Q

intramural course of coronary artery-app, compl, mx

A
  • short segm course through aortic wall (slit-like)
  • SCD
  • mx=
    • intramural coronary a bypass, reimplantation
    • unfooring
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31
Q

myocardial bridging-MC location, syx, mx,

A
  • midLAD
  • asyx; angina, MI, dead-(+) during systole and w/ depth
  • dx-stress test
  • mx-BB, CCB, PCI, sx (unroofing, myotomy, CABG)
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32
Q

MC (and most serious) malignant org

A

-interarterial LCA from RCS

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33
Q

mx interarterial LCA from RCS and RCA from LCS

A
  • left: repair

- right: repair if syx

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34
Q

mcc’s SCD

A

1) hypertrophic cardiomyopathy

2) interarterial LCA from RCS

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35
Q

types ALCAPA

A

1) infantile

2) adult

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36
Q

coronary artery steal syndrome

A

ALCAPA

-reversed flow in LCA as P decrease in pulmonary circulation

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37
Q

ALL OF THE CA ANOMALIES to consider

A
  • benign-retroaortic, prepulmonic, septal
  • interarterial LCA from RCS
  • IA RCA from LEC
  • ALCAPA
  • ARCAPA
  • intramural course
  • myocardial bridging
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38
Q

CA aneurysm-size, causes

A
  1. 5x

- MC-ather, Kawasaki in kids, cath

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39
Q

coronary fistula

A
  • btw CA and cardiac chamber or GV

- RCA –> r heart –> big, dilated CAs (coronary aneurysms)

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40
Q

main people who get coronary CT

A

1) low risk, atypical

2) anomalies

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41
Q

mx given prior to coronary CT

A
  • bb (HR <60)

- NG

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42
Q

BB CI

A
  • asthma, COPD, 2nd/3rd˚ HB, acute cp, recent cocaine use

* use retrospective gating

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43
Q

NG CI

A
  • hypoTN (<100)
  • severe AS
  • HOCM
  • phosphodiesterase (viagra, sildenafil)
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44
Q

how to quantify velocity of flowing blood

A

velocity-encoded cine MR/velocity mapping/phase-contrast

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45
Q

Ortner’s Syndrome

A

hoarseness caused by L recurr laryngeal n ISO LA enlargement

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46
Q

mc cong cardiac abN

A
  • bicuspid (although pres in adulthood)

- VSD

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47
Q

3 types of bicuspid aortic valve

A

-sub, supra, valvular (90%)

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48
Q

supravalvular AS

A

williams syndrome

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49
Q

BC AV + CoArc

A

-turners syndrome

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50
Q

compl BC AV

A
  • AS=mc

- cystic medial necr –> aortic aneurysm, AR

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51
Q

AR causes

A
  • BC AV
  • endocarditis
  • marfans
  • htn induced aortic root dilation
  • aortic diss
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52
Q

rheumatic fever heart disease

A
  • group A beta hemolytic strep
  • acute-pancarditis
  • chronic-inflamm valves –> fibrinoid necrosis in cusps & cords –> valvular/ct thickening, commisure fusion
  • stenosis > mixed
  • MV > AV (Rare to have isolated AV) > TV > PV
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53
Q

pulmonic stenosis divisions, causes

A

95% congenital (TOF), usually isolated

  • supravalvular (williams)
  • valvular-MC. –> Vt Htr. Noonans.
  • subvalvular-Alagille syndrome (kids w/ ø bd’s)
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54
Q

AS causes

A
  • htn
  • BC AV
  • williams syndrome (supravalvular)
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55
Q

BC AV ass

A
  • Turners
  • CoArc
  • ADPKD
  • VSD, PDA
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56
Q

mitral stenosis

A

-RF MCC

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57
Q

pulm regurg

A

failure TOF valve sx

-mx: okay if fixed before 150mL end-diastolic

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58
Q

TR

A
  • pulm htn=mc
  • endo
  • carcinoid
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59
Q

testable pearl re: TR affect on RV

A

dilation, not Htr

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60
Q

Epstein anomaly-causes, app

A
  • sporadic (mc), moms on Li
  • TV hypoplasia, pst leaf displaced apically –> RA+, RV atrialized (-), TR
  • “box shape” on cxr
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61
Q

left valvular carcinoid

A

1) 1˚ bronchial carcinoid

2) R to L shunt

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62
Q

Aortic Arch variants

A

2:
- bovine (common org left BCA and LCA)-MC branch variant
3:
- Right arch w/ mirror branching (cong heart) or left arch w/ mirror branching
- innominate brachiocephalic
- -pulmonary sling-left pulm artery arises from R
4:
- left arch aberrant right SCA-MC vessel anomaly
- R arch aberrant left SCA
- L vert off the aorta
- double aortic arch (R CCA SCA, L SCA CCA)-MC vascular ring

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63
Q

“mirror branching”

A

arch relationship to trachea

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64
Q

Right mirror branching vs right arch w/ aberrant subclavian

A
  • mirror: subclavian arise from FRONT of arch

- subclavian-back of arch

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65
Q

vessels off double aortic arch

A

from R–> L: R CCA –> L SVA –> R SVA –> L CCA

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66
Q

R arch with mirror branching-ass

A
  • asyx
  • stronger ass w/ Truncus BUT TOF MC overall
    • 90% w/ RAMB have TOF (6% truncus)
    • pts with truncus- 33% MIRA, 25% TOF
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67
Q

what completes the ring in right arch L SVA

A

lig arteriosum around trachea

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68
Q

L arch aberrant R CVA

A
  • dysphagia lusorum

- divertiulum kommerell

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69
Q

SS phenomenon vs syndrome

A

syndrome=cerebral ischemic symptoms

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70
Q

causes SS phenom/syndrome

A

atherosclerosis 98%

-Takayasu, radiation, preductal aortic coarctation, black-Taussig Shunt

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71
Q

heart tumors in kids

A

1) rhabdomyoma- MC. Hamartoma. TS. LV.
- those NOT ass w/ TS less likely to regress
- T2+
2) fibroma-2nd MC. IV septum.
- Dark. enh+++ (and delayed)

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72
Q

heart tumors adults

A
  • mets- MC. pericardium.
  • angiosarc-mc 1˚ mal. RA + pericardium
    • big bulky, ugly
    • “sunray”-enhancement along epicardial vess
  • myxoma-mc 1˚ tumor. LA on interatrial septum, prolapse thru MV.
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73
Q

metastatic involvement of heart

A

pericardium (effusion, ln)

-Melanoma Myocardium

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74
Q

mc met to heart

A

lung

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75
Q

myxoma ass

A

MEN syndrome, Blue Nevi (Carney complex)

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76
Q

Aunt Minnie congenital heart appearances: egg on string, snow man, boot shaped, figure 3, box shaped, scimitar sword

A
  • transposition
  • TAPVR
  • TOF
  • CoA
  • Ebstein
  • PAPVR w/ hypoplasia
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77
Q

big box on cxr

A

-ebsteins
infantile hemangioendothelioma
vein of Galen malformation

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78
Q

6 T’s of cyanosis

A 
TOF
TAPVR
Transposition
Truncus
TA
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79
Q

non-cyanotic

A 
ASD
VSD
PDA
PAPVR
Aortic CoA (adult type-post ductal)
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80
Q

systematic approach to cong heart dx:

A

cyanotic or not (they must tell you)

R vs L arch
-R arch –> pulm vasc: (+) w/ truncus, (-) with TOF

  • L arch–> Heart size
    • massive (ebsteins or pulm atresia w/o VSD), non cardiac (infantile hemangioendothelioma, v of Galen malformation)
    • Normal size: pulm blood flow
  • (+) TAPVR, D transposition, Truncus, Single Vt
  • (-) TOF, tricuspid atresia, Ebsteins
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81
Q

CHF in newborn

A
  • TAPVR (infra cardiac type III)
  • congenital AS or MS
  • left sided hypoplastic heart
  • cor triatritum
  • infantile (pre-ductal) CoA
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82
Q

survival dep on admixture

A
  • TAPVR (PFO)
  • Transposition
  • TOF (VSD)
  • TA (VSD)
  • hypoplastic Left heart-ASD (or large PFO) + PDA
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83
Q

small heart ddx

A
  • adrenal insufficiency (Addisons)
  • cachectic state
  • constrictive pericarditis
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84
Q

VSD img

A
  • big heart (splaying carina), inc vasc, small aortic knob
  • membranous MC
  • 70% small ones close spon’t
  • outlet subtypes (infundibulum) must be repaired as R coronary cusp prolapses into defect
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85
Q

PDA

A

1) prematurity
2) maternal rubella
3) cyanotic heart disease

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86
Q

PDA closure

A

functionally 24 hr

anatomically 1 mo

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87
Q

PDA img

A

-big heart, big vasc, ductus bump

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88
Q

ASD sinus venosus association

A

PAPVR

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89
Q

types of asd

A
  • primum, av canal, sinus venosum

- secundum-MC

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90
Q

which asd will not close via closure device?

A
  • primum (too close to valve tissue)

- AV canal

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91
Q

cong heart dx most strongly ass w/ downs?

A

AV canal (primum)

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92
Q

unroofed coronary sinus

A
  • 2 way flow

- paradoxical emboli and chronic R heart volume overload

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93
Q

PAPVR

A

1 of 4 veins draining into RA

-ASD (secundum, sinus venosum)

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94
Q

PAPVR + hypoplasia

A

scimitar

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95
Q

TAPVR

A

4 pulm v–> right heart

  • big heart, big vasc (type III=newborn CHF)
  • large PFO (required for survival.) ASD less common
  • asplenia
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96
Q

TAPVR types

A

1) Supracardiac-MC. Snowman (S for S)
2) Cardiac-2nd MC
3) Infracardiac-v’s drain below diaphragm (hepatic or IVC)

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97
Q

why does type 3 TAPVR give newborn CHF?

A

veins draining to IVC/hepatic v’s obstructed on way through diaph

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98
Q

asplenia and cong heart disease stats

A
  • 50% asplenia have cong heart dx.

- Of these, ~100% TAPVR and 85% additional endocardial cushion defects

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99
Q

Transposition of GV-what defines transposition, what defines D vs L type? Ass?

A
  • transposition: AV ant to PV
  • D vs L- AV to right vs L of PV
  • VSD (mc), PDA (D-type), ASD
  • D type-Vt/vess CONCORDANCE. PDA+ (nec to live)
  • L type= DISCORDANCE: LA–> RV –> aorta (congenital correction), no PDA
  • L type Lucky enough to Live

Ass: VSD (40%), supra or subvalv stenosis (30%)

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100
Q

D type transposition

A
  • defined by aorta R of pulm A (like normal) but is ANT, not normal pst
  • egg on a shell
  • rx-inter-atrial baffle (mustard/senning procedure)
    • classic draped look
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101
Q

MCC of cyanosis during first 24 hrs

A

transposition

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102
Q

MC cyanotic heart disease

A

tetralogy of fallot (TOF)

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103
Q

4 findings of tetralogy of fallot. What makes a pentralogy? Ass?

A

1) VSD
2) RVOT (due to infundibulum hypoplasia)
3) overriding aorta
4) RV Htr-determines severity
* pentralogy if ASD
* right arch very likely (1/4)

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104
Q

Rx TOF

A
  • surgical
  • Blalock-Taussig (shunt procedure)-if inoperable or bridge
  • MC compl=PV regurg
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105
Q

truncus arteriosis-associations

A
  • VSD, R arch

- CATCH-22 genetics (DiGeorge Syndrome)

106
Q

CoA two types

A

infantile vs adult

107
Q

CoA ass

A
  • Turners syndrome (15-20%)
  • Bicuspid AV (80%)
  • berry aneurysms
  • VSD
  • PDA
108
Q

CoA rib notching

A

-4th-8th ribs (not 1st & 2nd bc those fed by costocervical trunk)

109
Q

hypoplastic left heart

A

LV, aorta
-need ASD or large PFO
+large PDA
-ass: aortic CoA, endocardial fibroelastosis

110
Q

Cor Triatriatum Sinistrum

A

pulm v w/ fibromuscular mem –> LA –> subdivided LA (tri-atrium)

  • acts like MS-pulm HTN, edema
  • poor outcome
111
Q

infantile vs adult CF

A
  • infantile (preductal/SVA): R <3 fx, hypoplastic AArch

- adult (postductal/SVA): BP diffs, collaterals

112
Q

normal am of fluid in pericardial space

A

50 cc

113
Q

causes pericardial effusion

A
  • renal fx (uremia)-mc
  • lupus
  • dressler
114
Q

surgeries for hypoplastic left lung

A
  • palliative, 3 step process (avoids R <3 overload)
    1) Noorwood/Sano-day’s (N-newborn)
    2) Glen-3-6 mo (G is 6th letter of alphabet)
    3) Fontan-1.5-5 year (F=Five)
115
Q

heart tx types

A
  • orthotropic-who heart except part of atrium where pulm v’s attache
  • heterotopic-adding donor to recipient heart (good for back up)
116
Q

angiosarcoma

A

mc 1˚ mal.
RA (Really Angry) + pericardium
-big bulky, ugly
-“sunray”-enhancement along epicardial vess

117
Q

Myxoma-who, where, img

A
  • mc 1˚ cardiac tumor.
  • 30-60 yo, distal emboli & fainting spells
  • younger=syndromic (Carney complex)
  • central LA on interatrial septum, from FO (trying to spread friendliness)
  • Ca+ 25%, dystrophic, in areas of hemorrhage.
  • mobile/prolapse thru MV.
  • MR: T2+, var (but at least mild) enh. Variable sign based on tissue comp
  • CT: intermediate density
118
Q

fibroelastoma

A
  • 2nd mc 1˚ cardiac tumor
  • 50-60yo, asyx (or syx from emboli/stroke/tia)
  • Aortic valve (on side of aortic cusp) (swinging from valves bc so elastic)
  • small <1cm
  • vs vegetations-veg involve valve free edge
119
Q

mc intracardiac mass

A

thrombus

  • LAA-A-fib
  • LVt-MI
120
Q

congenital/acquired absence pericardium

A
  • partially over LA, adj PA –> shift towards L –> contact L cw
  • tongue of lung btw aorta and PA
  • risk of herniation & volvulus s/p extra pleural pneumonectomy. LAA most at risk.
121
Q

cardiac mets

A
  • lung (MC)/
  • melanoma (only one that’s T2+)
  • breast

(love me blood)

122
Q

left sided central venous catheter

A
  • L SVC, left intramammary vein, left superior intercostal vein, LUL partial anomalous vein
  • arterial
  • extravascular
123
Q

etiology of L SVC

A

persistent pst cardinal v

124
Q

purpose of pacemaker, ICDC (implantable cardioverter defibrillator), biVt ICD, epicardial pacer

A
  • pacemaker-paces during bradycardia
  • ICDC-defibrillates to prevent arrest; cardiomyopathy; decreased EF (his of Vt achy, fib, sad)
  • biVt-syndronization in BBB
  • epicardial pacer-post surgical pacing; removed after d’s
125
Q

conduction devices

A

-pacemaker
-ICDC
-wireless (micra)
-subcut ICD (presternal lead att to side box; doesn’t pace)
-

126
Q

purpose of loop recorders

A

-for palpations, syncope

127
Q

types of valve repairs and diffs

A
  • mechanica=20yrs, anticoag

- bioprosthetic-10-14 yrs, no anticoagulant

128
Q

cardiac assist devices

A
  • LVAD
  • Impella
  • IABP
129
Q

closure devices

A

-ASD-amplatz, umbrella rashkind
LAA-amplatz, watchman
-pda-amplatz
scimitar-indicated in adults w/ pulmonary volume overload; R heart dilation

130
Q

division of time frame post op CABG complications

A
  • early= <1 mo

- late = >1 mo

131
Q

grafts mC used in CABG

A
  • saphenous v = #1
  • internal mammary a=#2
  • radial a, IMA,
132
Q

arterial vs venous CABG grafts

A

Venous grafts have demonstrated a tendency to develop partial or complete occlusions with time, whereas arterial grafts have shown relative resis- tance to plaque formation and obstruction. How- ever, arterial conduits are more limited in their availability and ease of procurement compared with venous grafts, specifically the saphenous vein. Therefore, saphenous vein grafts (SVGs) remain the most commonly used conduits.

133
Q

etiology of venous CABG graft complications

A

Early graft occlusion is primarily due to vascular damage that can occur at surgery, whereas vessel wall changes resulting from expo- sure to systemic blood pressure may predispose to occlusion in later stages.

134
Q

general localization of grafts

A

A right SVG (a) is attached to the anterior aorta proximally and to the posterior de- scending artery distally. A left SVG (b) has an altered appearance because it is attached to the aorta with an aortic connector device (arrow); the origin of this SVG is moved laterally to prevent kinking. A typical left IMA graft (c) is left intact at its origin and grafted to the LAD artery distally.

135
Q

early graft complications

A
  • thrombosis
  • malposition
  • kinking
  • spasm
  • iatrogenic-dissection
  • pl eff/pericardial eff
  • infection
136
Q

late graft complications

A
  • occlusion

- aneurysm

137
Q

Scimitar ass

A

ASD (70%)
right lung hypoplasia
right pulm a hypoplasia

138
Q

Ebstein ass

A

ASD (50%)

139
Q

ways of describing cardiac wall kinesis

A

normokinetic
hypokinetic
akinetic
dyskinetic

140
Q

MR sequence for quantifying global and regional cardiac systolic function

A

SSFP

141
Q

vertical long/2 chamber view-how to get it, what it shows, what it’s good for

A
  • bisect BV and LV apex in axial view
  • LV, LA, coronary sinus
    1) wall motion/global LV function
    2) MV issues-regurg, etc
142
Q

3 chamber view/apical long/LVOT view

A

through aortic room in coronal

  • LVOT tract
  • MV, AV and IL walls
143
Q

4 chamber view/horz axis

A 
-lower 1/3 through MV & LV vertical long
septal and lateral wall, apex LV
RV free wall
chamber size
MV, TV
144
Q

short axis

A

perpendicular to LV on 4 chamber view

-for quantification of ventricular volumes, size, mass and function

145
Q

normal pressures for the heart chambers-RA, LA< RV, LV< PA< AV

A 
RA: 1-8 
LA: 4-12
RV: 15-30/1-8
LV: 100-140/4-12
PA: 15-30/4-12
AV: 100-140/60-80
146
Q

carney complex

A

endocrine neo (pit)

  • skin hyperpigm
  • myxoma
147
Q

rx papillary fibroelastoma

A

if syx

-consider valve sparing-regrowth s/p partial reection of valve

148
Q

criteria to evaluate myocarditis

A

Lake Luise criteria: T2, EGE & LGE

-f/u: persistent edema/hyperemia=chronic

149
Q

mcc 2˚ restrictive cardiomyopathy

A

amyloidosis

150
Q

imaging amyloidosis

A
  • concentric myocardial thickening (LV > RV, At, valves)–> atrial dilation
  • diiffuse DGE
  • darkened blood pool
151
Q

signs of cardiac tamponade: Beck triad, pulses paradoxes, kussmaul sgx

A
  • Beck triad: 1) hypoTN 2) (+) JVP 3) (-) HS
  • pulsus paradoxus- (-) SBP (>12 mmHg) on inspiration
  • kussmaul sgx: (+) venous distention and P on inspiration
152
Q

ddx pericardial calcification

A
  • uremia (viral)

- Tb

153
Q

img dilated cardiomyopathy

A
  • ED vol > 5.5 cm
  • EF <40% (AICD < 35%)
  • midwall enh (subtend if ischemia)
  • heterog wall thickness, thinning, preserved RV mass
  • linear midway septal stripe (DGE)-30%, subclinical foci myocardial ischemia, SCD (electrical pw)
154
Q

restrictive vs constrictive cardiomyopathy

A

both char by impaired diastolic filling, identical Vt pressure tracings

  • constrictive treated with surgery. Restrictive poor prognosis
  • restrictive- pericardial thickening, diastolic septal bounce
155
Q

Rx restrictive cardiomyoapthy

A
  • decrease PL w/o CO (diuretics, NO)
  • BB/CCB
  • underlying dx
  • PM/ICD/tx
156
Q

post partum cardiomyoapthy

A

ddx of exclusion

  • last mo-5 mo pp (80% w/i 3 mo
  • EF < 45%
157
Q

Iron overload cardiomyopathy

A
  • hereditary-1˚ (AR), thalassemia

- 2˚

158
Q

Iron overload cardiomyopathy-imaging

A

1) restrictive
2) dilated cardiomyopathy
- T2*-quantifies sev of Fe depot; powerful predictor, follow resp to rx (<20msec=sign Fe depo, <10msec-(+) risk CHF, arrhythmia.
- field inhomogeneity
- diffuse (inhomog) myo (epi –> mayo –> SE)
* <3 func preserved until critical storage cap reached –> rapid decompr

159
Q

HCMO risk of SCD

A

1) thickness
2) perfusion abN
3) fibrosis

160
Q

mc cardiomyopathy

A

HCM

161
Q

HCM LVOT obstr

A

~25%

-basal septum HTr & SAM

162
Q

myocardial noncompaction-patho, triad

A
  • “spongiform cardiomyopathy”
  • developmental defect in embryologic formation of LV-part of LV failure to form solid myocardium/papillary m
  • dx: 3+ trab in 1 img plane OR 2.3:1 NC:comp
  • triad: thrombus, stroke, CHF
  • rx-if triad
163
Q

myocardial noncompaction-img

A
  • (+) LV trab, (-) kinesis –> (-) global Vt function
  • BiVt enlargement
  • LV thin wall
164
Q

myocardial noncompaction-associations

A
  • LVOT stenosis
  • Ebstein
  • TOF
  • Barth syndrome
165
Q

Barth syndrome

A
  • cardiomyopathy
  • skel mopathy
  • growth retardation
  • neutropenia
166
Q

arrythmogenic cardiomyopathy-path

A
  • familial/genetic 15-20% (AD>AR)

- fibrofatty replacement of Vt myocytes–> systolic contraction abN, aneurysm

167
Q

arrythmogenic cardiomyopathy- img

A
  • Regional RV a/dyskinesia/dyssynchronous RV contr
  • RV EDV, ef < 40%
  • RV thin wall, RV (+)
    • LV(+) (3/4)-late dx, :(
  • DGE
168
Q

arrythmogenic cardiomyopathy-minor/major criteria

A
  • RV enlargement
  • focal aneurysm
  • fat can be seen with aging
169
Q

arrythmogenic cardiomyopathy-mx

A

ICD

170
Q

catecholamine induced (takotsubo) cardiomyopathy

A
  • apical ballooning
  • hypokeniesia
  • ø abn enh
171
Q

LAA in rheumatic vs non rheumatic mitral regurg

A

enlarged in rheumatic causes of mitral regurg

172
Q

Mitral valve prolapse-path

A

-myxomatous degeneration of leaflets –> thickening, redundancy; chordal elongation, annular dilation

173
Q

Mitral valve prolapse-diagnostic criteria

A

1) 2+ mm beyond

2) classic = 5mm thick, non classic-<5mm

174
Q

Mitral valve prolapse-complications

A

~1/4 people

  • IE
  • myocardial insuff
  • stroke/systemic infarct
  • arrythm
175
Q

“severe” MR

A

<1 (N=4-6 cm2)

176
Q

mitral annular calcification

A
  • degenerative process, Ca depo on fibrous nannulus
  • stroke, CV, afib
  • marker of CV dx!
  • ass w/ MR (vs mitral valve Ca–> MS)
177
Q

Aortic stenosis heart size

A

LV HTr, no change heart size

178
Q

grading aortic stenosis

A
  • mild/mod/sev
  • valve area: >1.5, 1-1.5, <1 cm2
  • transvalvular vel: 2-2.9 , 3-3.9, 4+ m/sec
  • mean P gradient: <20, 20-39, >40 mmHg
179
Q

complications endocarditis

A
  • dep on virulence
  • cusp perforation
  • chordal rupture
  • valvular aneurysmal bulge
  • perivalvular abscess
  • fistula btw vess, chambers
  • ext beyond valve (conduction system)
180
Q

pulm edema after MI

A

poor prognostic factor

181
Q

true vs false(pseudo) aneurysms

A
  • true-focal outputting LV wall containing all m layers and ass with LAD occlusion. Can Ca. Medically mx.
  • false-contained rupture, no myocardium involved. Ass w/ occ circumflex or RCA. Surgically repaired. MC upper diaph and pst wall
182
Q

Dressler syndrome

A

autoimmune pericarditis s/ MI ass w/ pericardial/pleural effs

183
Q

Loeffler cardiomyopathy

A

eusinophilic. acute necrosis

- Subendo DGE

184
Q

causes of mid myo DGE

A

-dilated cardiomyopathy
-sarcoid
-chagas
-HCM
-restrictive CM
-ARCV
-Tako-tsubo
-

185
Q

restrictive cardiomyopathy img

A
  • pericardial thickening
  • diastolic septal bounce
  • normal Vt size
186
Q

sarcoid cardiomyopathy

A
  • restrictive cardiomyopathy
  • LV dysfunction, arrythmia
  • subepi, midmyo DGE in nodular/patchy pattern
187
Q

-systolic anterior motion anterior leaflet MV-patho

A

via (+) vel and (-) P above valve –> LVOT obstr, MR

188
Q

HCM img

A
  • diastolic dysfunction
  • abN LV myocardial thickening
  • mid myo DGE
189
Q

normal Vt thickness

A

8-12 mm

190
Q

Thebesian valve

A

coronary sinus

191
Q

Vieussens valve

A

coronary sinus & GCV

192
Q

cardiac v’s

A

-middle cardiac v-pst IV (course w/ PDA in pst Vt groove)

193
Q

crista terminalis

A

-sinus venous (smooth) vs RAA (trabecular)

194
Q

Right & left atrial appendage locations

A

partially covers AV groove & RCA/LCA

195
Q

infundibulum

A

conical pouch from which PV arise

196
Q

right vs left ventricle

A
  • thinner wall

- increased trab (esp towards apex)

197
Q

moderator band

A

electrical conduction; septum –> free wall

198
Q

TV

A

ant, pst, septal leaflets

-leaflets and pap m partially insert on septum

199
Q

MV

A
  • ant, pst leaflets –> cord tendinae –> papillary m –> lat & pst walls & apex LV
  • D-shaped. ant leaflet thinner (<2mm), smaller.
  • Pst=mural. ant=aortic (fibrous conn)
200
Q

aortic valve divisions

A
  • aortic ring –> annulus –> cusps –> sinus of valsalva –> sinotubular junction
  • sinus of valsalva = dilated portion
201
Q

2 papillary m’s in LV

A
  • anterolateral-supp by LAD, LCx

- posteromedial- RCA (in R dom pts). rupture in MI via 1 supply

202
Q

location of coronary sinuses

A
  • R=ant
  • L =left pst
  • non-coronary= right pst
203
Q

circle of vieussens

A

anastomosis of conus branch w/ LAD

204
Q

how often does sinoatrial node ranch arise from Lcx?

A

42%

205
Q

dose for PO metoprolol and sublingual nitroglycerin

A
  • 5-25 mg

- 0.5-0.8 mg

206
Q

Ca score

A 
plaque burden (not stenosis)
->100 AU: 5x risk coronary events
207
Q

significance of aberrant right subclavian in setting of thyroid surgery

A

-recurrent laryngeal n will not be in usual location

208
Q

pathophys intramural hematoma

A
  • vasa vasorum rupture

- htn, trauma

209
Q

penetrating atherosclerotic ulcer

A
  • focal intimal defect at site of atherosclerotic plaque
  • desc thoracic
  • hi rate rupture: >2cm diam, 1cm length
210
Q

penetrating atherosclerotic ulcer vs simple ulcerated atherosclerotic plaque

A

penetrating-ext beyond expected contour of aortic wall

211
Q

ductus diverticulum

A
  • at aortic isthmus

- smooth broad shoulders, obtuse angle to wall

212
Q

shape of mycotic aortic aneurysms

A

saccular

213
Q

non-atherosclerotic causes of thoracic aortic aneurysm

A
  • marfan, ehlers-danlos
  • bicuspid aortic valve
  • vasculitis-takayasu arteritis, giant cell arteritis, ankylosing spondylitis, relapsing polychondritis
  • cystic medial necrosis
  • infectious aortitis
214
Q

what’s more common-asc vs desc atherosclerotic aortic aneurysms

A

descending

215
Q

recommendations for surgery asc & desc thoracic aortic anuerysms and AAA

A
  • asc: >5.5 cm (4.5 cm for CT do & BAV aortopathy)
  • desc: >6 cm
  • abd: >5.5 cm, syx
  • annual growth >1cm/yr or 5mm/6 mo
216
Q

early/impending aorta rupture sgx’s

A
  • draped aorta sign-pst aorta draped along spine

- crescent-higher attenuation in lumen

217
Q

complications TAA rx

A
  • rupture
  • dissection
  • inf
  • enkdoleak
  • paraplegia (artery of adamkiewicz occlusion)
218
Q

tulip bulb-shaped aorta

A

annuloaortic ectasia w/ effacement of sinotubular junction

219
Q

how to measure aorta

A

double oblique reformatted images

220
Q

US screening for AAA

A
  • high risk > 65 yo
  • <4cm: 6 mo f/u –> stable? –> annual
  • 4-4.5cm: f/u 6 mo–> stable? –> 6 mo
  • 5-5.5cm- consider sx
  • > 5.5: surgery recommended
221
Q

endovascular vs open AAA repair

A

-same long term outcomes, endovascular repair requires repeat interventions

222
Q

complications AAA endovascular repair

A
  • rupture
  • dissection
  • inf
  • endolea
  • aortoenteric fistula
223
Q

endoleaks

A
  • type I-inadequate graft seal (IA= =proximal, IB=distal)
  • type II-persistent collateral flow to excluded aneurysm
  • type III-device failure through graft fabric or segments of a modular graft
  • type IV-pourous
  • type V-endotension
224
Q

known RF for type IA endoleak

A

conical thrombus containing neck at proximal EG attachment

225
Q

type I endoleak

A
  • inadequate seal at prox or distal ends
  • early complication
  • always repair (risk of rupture)
226
Q

type II endoleak-moa

A

inflow (IMA) and outflow (lumbar) perfuse growing aneurysm

227
Q

type III endoleak MOA

A

1) inadequate or ineffective sealing of overlapping comps of modular EG
2) complete sep of modular components
3) rupture or tear of EG fabric
- early-technical. Failure to adequately overlap modulator comps)
- later-device bd

228
Q

pseudocoarctation

A
  • focal narrowing of aorta
  • sim to morphology of true coarctation but no pressure differential or collaterals
  • ass w/ BAV, PDA, ASD, VSD
229
Q

infantile coArc

A
  • preductal –> LV obstr –> CHF
  • archy hypoplasia
  • no collaterals (no time to form)
230
Q

SPIN echo imaging

A
  • black blood, longer acquisition (better resolution), decreased metal artifact
  • for anatomy
231
Q

GRE echo

A
  • faster (workhorse), metal artifact

- Vt function, valve dx, myocardial perfusion, delayed img, MRA, vel/flow

232
Q

steady state free procession

A
  • Cine.
  • cardiac function and anatomy
  • most reliable accurate aortic root measurement (ECG gated breath held cine img). Superior bc motion artifact not an issue AND both systolic and diastolic measurements are possible.e
  • Fast GRE for cine
  • high temporal resolution
  • contrast btw myocaardium and blood
  • wall motion and volumetric measurement. Standard for visually and objectively evaluating global and regional systolic function in both Vts
233
Q

subepicardial enhacement

A

sarcoid

myocarditis

234
Q

inversion recovery

A
  • null myocardial signal to evaluate myocardial abN. Used in delayed enh.
  • ~330msec
235
Q

mech of DGE

A
  • cell death

- abNo depo

236
Q

interatrial septum normal width

A

3-4mm

237
Q

stunned myocardium

A
  • myocardium being perfused normally but not contracting–acute, just after MI
  • near infarcted tissue
238
Q

hibernating

A
  • hypokinesis from decreased perfusion
  • chronic. Viable and will reconstruct after perfusion.
  • near scarring or remotely away
239
Q

right vs left atrial appendages

A

R-trapezoidal w/ broad connection

L-tubular w/ narrow connection

240
Q

atrioventricular discordance

A

R and L atria connect to L and R Vt respectively

241
Q

ventriculoarterial

A

Aorta arising from morphological RV, PA arising from morphological LV

242
Q

Transposition ass w/ atrioVt and Vtarterial transposition

A
  • L type

- aorta will be anterior and to L of PA

243
Q

ventricular rupture is ass w/ true or pseudoaneurysm

A

pseudo

244
Q

upper limits normal for RV EDV

A

male: 100 mL/m2
female: 90

245
Q

major criteria arrythmogenic right ventricular dysplasia

A

isolated RV aneuryms
massive global or segm RV dil
sev (-) RV EF w/ minimal involvement of LV

246
Q

mx anomalous CA w/ inter arterial course

A

-unroofing (enlarge orifice of anomalous coronary)

247
Q

normal thickness interVt septum

A

10-12mm

248
Q

MC HCM variant

A

asymmetric septal hypertrophic variant

-dx= IV wall > 15mm and septal wall:free wall >1.5

249
Q

grid taggin

A

visualize transmural myocardial mvmt to quantify local intramyocardial motion measures, its: strain and strain rate

250
Q

moa Ebsteins

A

apical displacement of SEPTAL TV leaflet >20mm or 8 mm/m2

-ant and inf leaflets also abN with varying degrees of dysplasia and tethering

251
Q

best imaging too for RV morph and function

A

MRI

-Echo hindered by retrosternal loc and complex geo

252
Q

tricuspid atresia

A

hypoplastic Right ventricle
N sized heart, (-) pulm vasc
-muscular/fatty ridge in location of TV
-ass: 100% have ASD, VSD and 30% transposition

253
Q

what is an overriding aorta?

A

aorta arises over a VSD rather than over the LV –> de-oxy and oxy blood circ

254
Q

truncus arteriosis-pathophys, leaflets of TA, radiograph findings, classification scheme, mx

A
  • pathophys: failure of truncoconal ridges to fuse –> failed division of TA into aorta and pulm a, defect in Vt septum.
  • leaflets: 2-5 (3 MC)
  • Rgx: R. arch, CMG, pulm vasc+
  • Collett & Edward’s: var org PA from trunks (MC=type I: MPA arise from L pstlat asp
  • sx: new pulm outflow tract w/ synthetic graft material (watch CA’s!)
255
Q

mc cyanotic heart disease of newborn

A

transposition of GV

256
Q

pathophys TOGV

A

failed clockwise rotation of of aorticopulmonary septum (which normally puts AV pst & R of PV)

257
Q

tricuspid atresia: findings, ass, mx

A

-muscular fatty ridge of tissue in loc of TV sep large RA from hypoplastic RV.
+FO or ASD for flow into LA
+VSD for low into pulm circ
(-) pulm circ

  • Ass: TOGV (MC), pulm stenosis
  • Glenn (SVC –> pulm a), Fontan (RA –> pulm) + correction of intracardiac shunts or transposition
258
Q

RV “atrialization”- what does it mean, consequence

A
  • RV incorporated into RA

- this portion has abN thin wall –> tricuspid regurg

259
Q

which leaflets are abnormally displaced in Ebstein anomaly?

A

septal & pst

260
Q

Epstein appearance

A

Rgx: box shape (elongated, enlarged RA)

261
Q

Ebstein ass

A

patent FO
secundum AsD
ECG abN
Li in early pregnancy

262
Q

Rx TOF

A

surgical:

  • palliative shunt (Blalock-Taussig)
  • compplete repairr infundibular outflow obstr w/ patching of VSD (Lillehei procedure)

radiology (31 decks)

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