Cardiac

Question 1

Massive enlargement of the main pulmonary artery

2

Answer 1

Idiopathic pulm rterial hypertension

Eisenmengers

Question 2

Coarctation of Aorta
Associated conditions
4

Answer 2

Bicuspid AV - 85%
Turners
AR
PDA

Question 3

Coronary artery aneurysms
Causes 3
Criteria
Anticoagulation

Answer 3

Atherosclerosis
Trauma/iatro
Vasculitis ( Kawasaki)

1.5x normal diameter

if >8mm anticoag

Question 4

Heart disease with
Normal heart size
+ LAA
no signposts

Answer 4

MS

Restricted compliance : Restrictive CM, hypertrophic CM, constrictive pericarditis

Question 5

Normal heart size with aortic enlargement

or no signposts

Answer 5

AS

Acute MI
Restrictive CM
Hypertrophic CM
Constrictive pericarditis

Question 6

d-TGA features

RF
Post surgical

Answer 6

LV to PA
RV to Ao

Cardiomegaly
Plethora
Cyanosis
Narrow mediastinum

Arterial switch –> Pulm stenosis
Atrial switch - RV dys, baffle stenosis, clot

Question 7

Cyanosis
Cardiomegaly
Pulm plethora
Type 4 lesions
T

Answer 7

narrow superior mediastinum:
TGA
Truncus
TAPVR
(T) ingle ventricle

Question 8

Vascular rings

Causes 2

Answer 8

Right arch with aberrant L SCA

Double aortic arch

Question 9

Occult cardiac shunts

3

Answer 9

Sinus Venosus ASD (SVC or IVC connects to LA)
PAPVC
Supracristal VSD (subpulmonic)

Question 10

Cardiomegaly with LAE

Answer 10

MR

Question 11

Cardiomegaly with Aortic enlargement or

No signposts

Answer 11

AR

Idiopathic DCM
Ischaemic CM
TR
RVF
Pericardial effusion

Question 12

In intracardiac shunts what is Qp/Qs?

Answer 12

Ratio of pulmonary flow to systemic flow

Ratio > 1.5 requires surgical correction or evidence of RV overload

Question 13

Non cyanotic heart disease with pulmonary plethora :
LAE
no LAE
Group 1

Answer 13

LAE:
VSD
PDA

No LAE
ASD
PAPVR

Question 14

Non cyanotic heart disease with pulmonary plethora :
AoA Enlargement
No AoA E

Answer 14

AAE:
PDA

No AAE
VSD

Question 15

Order of RCA branching
1
2 - %
3

Answer 15

1. Conus branch ( to infundibulum)
2. SAN artery (60%)
3. Acute Marginal branches
4. (PDA)

Question 16

Morphologically right ventricle

two features

Answer 16

Moderator band

Contraction of outflow tract(contains muscle)

Question 17

CT features of high risk coronary plaque

4

Answer 17

Calcific densities- punctate
Positive remodelling(expansion of vessel)
Napkin ring sign
Hypodensities within plaque

Question 18

Sinus of Valsalva Aneurysm
demo
CMR criteria

Answer 18

Rare (0.15-3.5%)
Right sinus 72 %
Localised weakness of elastic lamina(cong/acq)
CMR criteria : origin above aortic annulus, saccular shape, normal root/AA dimensions
Inform ASAP

Question 19

Lipomatous hypertrophy of RA
demo
CMR features

Answer 19

rel common 1-8%
pseudomass, age/BMI
most asymptomatic/SVT
CMR: freq septal location with thickening > 2cm, spares fossa ovalis, rarely involved RA free wall
FS TSE diagnostic

Question 20

Anatomic cardiac pseudomasses

3

Answer 20

Prominent crista terminalis
Prominent chiari network/ eustacian valve
Moderator band

Question 21

DDx for LV non compaction

Answer 21

DCM
ARVC
Athlete- hypertrabeculations

Trabecular mass > 20% or
Non com/compacted ratio > 2.3

Question 22

Myocardial fatty infiltration vs ARVC features

Answer 22

ARVC :
 young-middle aged, male
location : RVOT, RV free wall, RV septum, LV free wall
Subepicardium
Thin myocardium
Enlarged RV

Question 23

Features of true perfusion defect on CMR

4

Answer 23

Non Gd enhancing dark zone
Persists through atleast 3 beats
Spreads from subendocardium to subepicardium
More conspicous during stress

Question 24

AMI vs acute myocarditis

Answer 24

AMI : subendocardial LGE + oedema

myocarditis : subepicardial

Question 25

LCA origin from Right sinus possible pathways 4 ARCA>ALCA

Answer 25

Interarterial ( malignant) retroarotic - commenest Prepulmonic Septal/subpulmonic

Question 26

Anomalous origin of LCA from PA | ALCAPA

Answer 26

``` Bland white garland Xd Obligatory ischaemia 0.25-0.5% of CHD Infantile - direct reimplan Adult - ligation/CABG ```

Question 27

Coronary artery fistula | drainage

Answer 27

``` usually drains to low pressure chamber RV 41% RA 26% PA 17% CS 7% ```

Question 28

``` Functionally significant/ potentially malignant coronary artery anomalies 4 Origin Course Termination ```

Answer 28

Origin from opposite sinus with interarterial course ALCAPA CA fistula Coronary atresia/hypoplasia

Question 29

Signs of constrictive pericarditis | 3

Answer 29

calcified, thickened pericardium mass effect on vessels/chambers early diastolic flattening of IVS - MRI

Question 30

Congenital absence of pericardium

Answer 30

complete/partial Levorotation of heart absence of pericardial recess ( PA-AA) - lung dips into it

Question 31

Cardiac myxoma

Answer 31

``` 90% LA 90% solitary May be ass with Carney complex attached to fossa ovalis may contain Ca+ delayed CE ```

Question 32

Caseous necrosis of mitral annular calcification

Answer 32

``` not related to TB ? aetiology mass effect can rupture white on NC and CE exclude circum aneurysm ```

Question 33

Malignant cardiac tumours

Answer 33

Secondary ( local: lung, breast and mets ) x 20 more common Primary Sarcomas ( 95%): angiosarcoma adults, rhabdomyosarcoma paeds, fibrosarcoma Lymphoma 5%