Cardio Imaging

Question 1

What are the indications for an echocardiogram?

Answer 1

Evaluative congenital heart defects, changes in heart size, pumping strength (ejection fraction and CO), damage to heart muscle, valvular dysfunction, presence of pericardial effusion, guidance of pericardiocentesis

Question 2

What are the three types of an echocardiogram?

Answer 2

Transthoracic echocardiogram (TTE)
Doppler echo
Stress echo

Question 3

What are the pros for TTE?

Answer 3

Usually first line cardiac imaging modality bc its widely available, noninvasive and no radiation risk

Question 4

What are the risks for echocardiogram?

Answer 4

During stress echo, exercise (not the echo) may cause temporary dysrhthymia and rarely heart attacks

Question 5

What are the pros for a Doppler echo?

Answer 5

Finds blood flow abnormalities in cardiac arteries missed by traditional ultrasound

Question 6

What are the indications for the a continuous wave Doppler?

Answer 6

Measures high velocities

Pulmonary HTN or aortic stenosis

Question 7

What are the indications for pulsed Doppler?

Answer 7

Assess low velocities

Mitral/tricuspid inflow, atrial appendage flow, ventricular outflows

Question 8

What are the indications for a color flow Doppler?

Answer 8

Assess regurgitation, intracardiac shunts (ASD, VSD), and pulmonary vein flow

Question 9

What are the risks for a Doppler echo?

Answer 9

None

Question 10

What are transducer positions?

Answer 10

Usually performed with patient left lateral decubitus

Left handed scanning is more ergonomic and lower risk of sonographer othropedic injuries

Question 11

An apical view US is best for viewing what?

Answer 11

Heart chambers

Question 12

What is the MC congenital cardiac anomaly?

Answer 12

Ventricular septal defect

Question 13

What are the sx for a septal defect?

Answer 13

Small lesions may be asymptomatic with harsh pansystolic murmur
Large lesions may cause signs of heart failure

Question 14

What is the modality of choice for septal defects?

Answer 14

An echo allows direct visualization of the septal defect with no radiation exposure

Question 15

CTA with EKG-gating allows for direct visualization of the defect but with risk of what?

Answer 15

Radiation exposure

Question 16

What is coarctation of the aorta?

Answer 16

Aortic narrowing near insertion of the ductus arteriosus

Question 17

What are the sx for coarctation of the aorta?

Answer 17

HTN in UE, weak pulses in LE (brachial-femoral delay)

Question 18

What is the imaging of choice for coarctation of the aorta?

Answer 18

Echo establishes sx and severity in most pts

CTA can be a complimentary imaging tool important prior to intervention

Question 19

What are the indications for a multiple gated acquisition (MUGA) scan?

Answer 19

Detect for causes of reduced ejection fraction (ie. Heart failure, damaged myocardium from MI or cardiomyopathy)
Can help answer why a pt has angina, dizziness, dyspnea or fatigue

Question 20

What are the pros for a MUGA scan?

Answer 20

Accurate, reproductive, non-invasive
Measured EF is more precise vs other cardiac tests
Can localize abnormally functioning myocardium to find blocked coronary arteries

Question 21

What are the risks for a MUGA scan?

Answer 21

Low level of radioactivity unions to cause any short/long term damage, allergic reaction to tracer

Question 22

When is a MUGA scan contraindicated?

Answer 22

Renal disease, pregnant women or breastfeeding

Question 23

What is the gold standard for CAD?

Answer 23

Coronary angiography

Question 24

Wha are the indications for a coronary angiography?

Answer 24

CAD, angina, acute MI, valvular disease, CHF

Question 25

What are the contraindications for coronary angiography?

Answer 25

Renal failure, contrast medium allergy, coagulopathy, uncontrolled HTN, decompensated HF, GI hemorrhage, pregnancy, active infection

Question 26

What are the cons for coronary angiography?

Answer 26

Expensive, procedural risks

Question 27

What are the indications for CT?

Answer 27

Locate aneurysm, blockages, blood clots, vascular malformations, stenosis, injury, vessel rupture/dissection, pulmonary embolism

Question 28

What are the risks for CT?

Answer 28

Minimal radiation exposure, allergic reaction to contrast, tissue damage via contrast leakage

Question 29

What are the pros for CT?

Answer 29

Quick, non-invasive, may eliminate need for surgery, allows surgeries to be performed more accurately, cheaper than catheter angiography

Question 30

What are the contraindications for CT?

Answer 30

Severe kidney disease

Question 31

What is the most posterior most of the heart on CT?

Answer 31

LA

Question 32

What is the most anterior part of the heart on a CT?

Answer 32

RV

Question 33

What is aortic dissection?

Answer 33

Longitudinal intimal tear forming a false lumen | Associated with chronic HTN and Marfan’s

Question 34

What are the sx of aortic dissection?

Answer 34

Sudden onset tearing chest pain radiating to the back, unequal BP in arms, diminished or unequal peripheral pulses, new diastolic murmur from aortic regurgitation

Question 35

What is the imaging of choice for aortic dissection?

Answer 35

CXR shows mediastinal widening | CTA is choice of imaging bc it can diagnose/classify the dissection and evaluate for distal complications

Question 36

What is thoracic aortic aneurysm?

Answer 36

Associated with cystic medial degeneration seen in Marfan’s | Aortic root dilation can lead to aortic regurgitation and associated sx

Question 37

What are the sx for thoracic aortic aneurysm?

Answer 37

Mass effect on airway and esophagus

Question 38

What is the imaging of choice for choice aortic aneurysm?

Answer 38

CTA

Question 39

What is a posterioanterior (PA) film?

Answer 39

Pt facing film plate with X-ray tube behind them | Most commonly used

Question 40

What is an anterioposterior (AP) film?

Answer 40

Pts back a giants film plate with X-ray machine in front

Question 41

What is the importance of the PA/AP CXR views?

Answer 41

In AP view the mediastinum appears widened due to AP magnification Don’t consider the heart to be enlarged if viewing in AP

Question 42

What are some DDx for cardiomegaly?

Answer 42

CHF, HTN with left ventricular hypertrophy, valvular disease, cardiomyopathies, pulmonary dz with RV hypertrophy, myocarditis, normal athletic heart

Question 43

What is the imaging of choice for cardiomegaly?

Answer 43

CXR is sufficient to dx cardiomegaly | Other imaging modalities can be used to narrow down the differential

Question 44

What are some DDx for widened mediastinum?

Answer 44

Anthrax, aortic dissection, thoracic aortic aneurysm, pneumomediastinum, mediastinal mass

Question 45

What is the imaging of choice for widened mediastinum?

Answer 45

CXR is sufficient to dx | Other imaging modalities can be used to narrow down the differential