Cardiovascular Imaging (US, X-ray, CT, Histology of normal/health structures) Flashcards
(186 cards)
1
Q
Name the Pacemaker/ICD Complication
A
2
Q
A
3
Q
What is the difference between a myocyte vs. a myofiber?
A
- A myocyte is a single muscle cell while a myofiber is composed of a series of myocytes aligned end-to-end to produce a directionally-uniform contractile force (more-or-less).
- In the case of skeletal muscle myofibers, the multiple myocytes fused to form a single myofiber.
- But with cardiac and smooth muscles, the myocytes remain distinct and require intracellular adhesions to transmit forces throughout the myofiber.
4
Q
What is shown here?
A
5
Q
Which type of aortic dissection is this?
A
6
Q
Is this aortic regurgitation or aortic stenosis?
A
7
Q
How do you get into the parasternal short axis view?
A
After doing the long axis view, rotate the probe 90 degrees clockwise so that the probe marker is pointing to the LEFT shoulder.
8
Q
Which type of aortic dissection is this?
A
9
Q
201: This is the endocardium of the atrial wall. Note that the thickness of the layer is not uniform across the entire wall. Which space does this layer face?
* Name the sublayers that make up this layer.
A
- Lumen of the atrium
- Endothelium
Fibroelastic layer
Subendocardium
10
Q
Is this Cardiogenic Pulmonary Edema or Non-cardiogenic Pulmonary Edema?
A
Cardiogenic Pulmonary Edema
11
Q
What do you see here?
A
12
Q
What is shown here?
A
bifurcation of aorta
13
Q
What is the Cardiothoracic Ratio?
A
14
Q
How does ultrasound reduce complications of central lines?
A
Decreases complications
- Pneumothorax
- Arterial puncture
- 18% down to 6%
15
Q
What do you measure when deciding aorta size?
A
NOT JUST THE LUMEN
OUTER WALL TO OUTER WALL
16
Q
Where is the SMA?
A
17
Q
Label A and B as either parasternal long axis or parasternal short axis
A
A. Parasternal long axis
B. Parasternal short axis
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A
19
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A
20
Q
Name the Pacemaker/ICD Complication
A
21
Q
When an ultrasound machine is in cardiac mode, where is the probe marker on the screen?
A
To the left (matches where your heart is in your body)
22
Q
What is the Palla sign?
A
- enlargement of the descending interlobar branch of the right pulmonary artery, causing a “sausage” appearance towards right middle lobe.
23
Q
What is the Checklist for CIED Evaluation
A
24
Q
What occurs in this stage of CHF?
A
25
What is the Westermark sign?
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What is shown at the arrow?
eccentric clot
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301: Which tissue is identified by the arrow?
* To which layer of the ventricle wall does it belong?
Endothelium
* Endocardium
28
What is wrong with this?
Misplaced lead
29
How can you tell that this x-ray was taken in inspiration?
30
What are the types of aortic aneurysms?
31
What device is shown?
32
Is this Cardiogenic Pulmonary Edema or Non-cardiogenic Pulmonary Edema?
Non-cardiogenic Pulmonary Edema
33
Which side of the heart has a thicker ventricular wall? Why?
Left; systemic circulation requires greater force to generate the pressure needed to drive the blood through the much larger and extensive vascular network.
34
What is shown here?
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Heart, semilunar valve
411: What tissue is located is indicated here?
* Which layer of the heart would this tissue belong to?
Adipose tissue
* Epicardium
38
The left atrium is enlarged. What sign is the arrow pointing that indicates this?
39
Where are the aortic and mitral valves here?
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How is chest x-ray used in acute pulmonary embolism?
42
At what angle are the cardiac myocytes seen here cut? Explain your rational.
Transversly: Cells have a more circular shape; striations and intercalated discs can’t be observed
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302 This layer is composed primarily of which types of CT fibers
Collagen and elastic
* Note the presence of smooth muscle cells scattered though out this layer.
44
What is the type of probe you use for looing the IVC and aorta? Why
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What is shown?
AAA with clot
47
How long does it take to dx a AAA rupture with POCUS?
48
What are the differences in the aorta and IVC on ultrasound?
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202: The nucleus seen here belongs to which type of cell? How would you classify this epithelial tissue?
* Name two functions of this tissue layer.
50
In this parasternal short axis view, point out the pericardial effusion as well as the left ventricle.
51
What are the arrows pointing to?
Hilar adenopathy
52
Label the heart chambers
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Name the Pacemaker/ICD Complication
55
# Define the following terms and their function, as they relate to cardiac muscles
Intercalated disc
The region of attachment between cardiac myocytes composed of multiple junctional complexes that join and electrically-couple the myocytes to assist in effective force transmission and contractile coordination/synchronization.
56
Name the Pacemaker/ICD Complication
57
The left atrium is enlarged. What is the arrow pointing to indicate this?
58
Where is the heart, liver, and IVC in this image?
59
What is shown here?
60
Which type of aortic dissection is this?
61
What view is this?
Parasternal Short Axis
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409: This is the wall of the artery exiting the heart. In this section, the artery has been cut longitudinally, thus it appears much different, compared to specimens that are cut in cross-section (transversely).
* Would this artery be classified as elastic, muscular, or arteriole? Explain your rational?
410: Which tissue layer would form the lining of this artery’s lumen?
409: Elastic; very thick tunica media with elastic lamellae interspersed between smooth muscle fibers (\>40 layers)
410: endothelium
63
Where does the split of the iliacs occur?
Belly button
64
What is shown?
He said remember this image
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How do you estimate right atrial pressure?
67
What is left atrial appendage enlargement usually indicative of?
Rheumatic Disease
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What is wrong with this?
70
# Define the following terms and their function, as they relate to cardiac muscles
Dyad
The combination of a T-tuble and a single cistern of the SR (skeletal muscles possess a triad — a T-tubule and two SR cisterns, one on each side); their interaction ultimately leads to an increase in cytosolic Ca2+ levels.
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Label each pic as In-plane (long axis) or out of plane (short axis)
* Top: In-plane (long axis)
* Bottom: out of plane (short axis)
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304: What is the name for the structure indicated? What type of tissue is it?
* What is the function of this tissue?
Purkinje fiber (or conducting system of heart)
* Conduction of electrical signals to coordinate ventricular contraction
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# Define the following terms and their function, as they relate to cardiac muscles
Sarcoplasmic reticulum
The smooth endoplasmic reticulum (sER) of muscle cells; serves as a reservoir of Ca2+ to keep the cytosolic levels low until stimulated to release.
76
The right panel shows a normal heart. What is the red arrow pointing at in the left panel.
Effusion
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What is shown here?
78
206: Identify the cells seen here.
Adipocytes
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305: Which space is this? In a living adult, what would normally occupy this space?
Lumen of the ventricle
* blood
80
Where do you place the probe to visualize an AAA?
Anteriorly at the midline.
81
* Where are the following structures in this figure?
* Right Ventricle
* Left Ventricle
* Mitral Valve
Mitral valve is the white ring within the left ventricle
82
What is the Hampton hump?
* Westermark sign: focal peripheral hyperlucency secondary to oligemia resulting in a collapsed appearance of vessels distal to the occlusion.
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What is shown here?
Saccular aneurysm
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What is the difference between a myofiber vs. a myofibril?
* A myofibril is a bundle of the contractile filaments (thin and thick) organized within the skeletal and cardiac myocytes/myofibers into longitudinal strands.
* They are composed of the contractile proteins (actin and myosin) and their associated proteins that regulate their interactions (tropomyosin, troponin, etc).
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What kind of pacemaker is described?
* Has leads in the right atrium and right ventricle.
* This type of pacemaker helps coordinate signals to and contractions of the atria and ventricles.
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Which side of the heart is involved with the adult pulmonary circulation?
Right Side
91
Left is a normal thoracic aorta. What are the middle and right pics?
92
What occurs in this stage of CHF?
93
What does this SPECT show?
94
Where are the aortic and mitral valves here?
95
What kind of pacemaker is this?
Single Lead Ventricular Pacemaker VVI
96
Normal is on left
97
What kind of probe do you use for cardiac POCUS and why?
* Phased Array
* Has a smaller footprint
* Sees motion well
* Low frequency, so has good depth
98
Where are the vast majority of AAAs?
Renal
99
1. What is the best view to estimate ejection fraction?
2. What valves is this fraction based on, and what is the normal range of ejection fraction for a healthy adult?
3. How do you know a mitral valve is working properly to ensure correct ejection fraction?
1. Parasternal long axis
2. Mitral Valve
* 60 to 65%
3. The valve slaps up to hit the septum without getting "stuck" anywhere.
* You estimate the ejection fraction by seeing the "relative loss of function" of the mitral valve.
100
What kind of pacemaker is this?
101
# * Define the following terms and their function, as they relate to cardiac muscles
Sarcolemma
* The cell membrane of muscle cells; contains various ion channels and receptors that respond to neurotransmitters and hormones, which ultimately changes in ion channel permeability, intracellular levels of second messengers and/or enzyme activity.
* In cardiac myocytes, the overall effect includes changes in heart rate and/or contractility.
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What is shown here?
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What sign shows the celiac axis?
106
What is the size of an aortic aneurysm?
In most adults, an aortic diameter \>3.0 cm is generally considered
aneurysmal
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What is the difference in viewing the needle in In-plane (long axis) vs. out of plane (short axis) views?
In-plane (long axis)
* You can see MORE needle due to angle
Out of plane (short axis)
* You just see the part of the needle where the probe happens to be
110
In ultrasound-guided central lines, what are the two planes of view you can use?
1. In-plane (long axis)
* little more complicated
2. Out of plane (short axis)
111
307: What specific tissue is indicated here?
* Why do these cells stain lighter than the contractile cardiac myocytes?
Purkinje fiber (or conducting system of heart), which is a specialized cardiac muscle tissue
* Cells contain fewer myofibrils and contain more glycogen
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What are the reasons for increased CTR?
114
What are the 3 main things to look for in cardiac POCUS?
1. Pericardial Effusion
2. Ejection Fraction esitmation
3. Cardiac Activity
115
What is shown here
narrow ivc,
should be like image shown
116
What is shown here, and what is the process of getting this view of the indicated structure?
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119
Name the Pacemaker/ICD Complication
120
Is this aortic regurgitation or aortic stenosis?
121
What is shown here?
122
1. What are the three common sites for a central line?
2. What are the most common complications from a central line, aside from infection?
1. Sites
* Internal jugular vein
* Subclavian Vein
* Not as common anymore
* Femoral Vein
2. Arterial puncture and pneumothorax
123
The left atrium is enlarged. What is the arrow pointing to indicate this?
124
What percentage of patients die if you don't see cardiac activity?
99.999999999999%
125
303: What is the name for this indicated layer?
Subendocardium
126
What is shown here?
Abnormal aorta (too large)
127
Which type of aortic dissection is this?
128
129
What is the size of an abnormal AAA?
5 cm is usually symptomatic
130
1. What is the best view for seeing a pericardial effusion?
1. SUBXIPHOID but you can use any view
131
What is shown here?
132
# Define the following terms and their function, as they relate to cardiac muscles
Sarcomere
The functional contractile units of cardiac (and skeletal) myofibrils; consists of the contractile thin and thick filaments located between two Z-discs.
133
What is shown at the arrow?
134
What occurs in this stage of CHF?
135
In ultrasound-guided central lines, what is held in your dominant hand?
Dominant hand: Needle
Other hand: Probe
136
What kind of pacemaker is described?
* Has at least one right ventricular lead, one left ventricular lead and may have a right atrial lead as well.
* The left ventricular lead traverses the coronary sinus into a posterior or lateral cardiac vein
* This allows access to the lateral left ventricle wall for left ventricular pacing.
137
Where are the following structures in the image provided?
* Left Atrium
* Left Ventricle
* Aortic Outflow
* Right Ventricle
* Descending Aorta
138
204: Which layer of the atrial wall is indicated by the this line? Which tissue comprises the majority of this layer and what is its function?
* Which space does this layer face?
139
What is shown at the arrow?
Seen in Pulmonary Embolism
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Right side is normal
142
Where is the celiac trunk?
143
Label the boxes
144
In a parasternal long axis view, what structure is the most important structure for determining if a patient has a pericardial effusion or a pleural effusion?
yellow is pericardial effusion
145
What view is this?
PARASTERNAL LONG AXIS VIEW
146
Label the heart chambers
147
What is the arrow hovering over?
Bowel Gas
148
What view is best for viewing the right ventricle and why?
Lateral View because it is the most posterior heart chamber
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212: This large projection is a pectinate muscle that is a structure found in the atrium proper. What additional feature would indicate that this slide specimen is from the atrial wall and not the ventricular wall
The wall is relatively thin
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152
You are doing a Parasternal long axis view
* Where is the probe in relation to the intercostal spaces?
* Where is the probe marker pointing?
* What is this view BEST used for?
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What kind of pacemaker is shown?
155
Which type of aortic dissection is treated surgically and which is treated medically?
A: surgical
B: medical
156
What is shown here?
Abnormal Aorta (too large)
157
What is Twiddler Syndrome?
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159
Where are the IVC and aorta relative to the midline?
IVC: left
aorta: right
160
Name the Pacemaker/ICD Complication
161
What size of aorta indicates an aneurysm and how does size relate to the risk of rupture? (use actual numbers for this)
162
This is an image of a central line being performed. What is the mouse pointer hovering over?
Carotid Artery
163
Where is the aorta
164
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203: Which layer of the atrial wall is indicated by this line? Which tissue comprises the majority of this layer and what is its function?
167
This is clip art of an x-section of an ultrasound of the abdominal aorta. What is each shape?
White circle=aorta
Blue oval = IVC
Arch is vertebral body
168
What are the features of right heart strain from pulmonary embolism?
169
What are the 5 steps of the Seldinger technique for central lines?
170
What condition caused this? (the white arrow?)
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Where is the aorta?
173
How are most heart X-rays taken?
P to A
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How can you tell the difference between aortic regurgitation and aortic stenosis on an x-ray?
Regurge is wider
176
This does not show a real increase CTR. Why?
You can tell an expiration by the height of diaphragm as well as counting the ribs (the right only shows 4 ribs). You should see 6 or 7 ribs.
177
What device is described?
* Capable of generating a large amount of electrical energy in a single output used to defibrillate the heart.
* If the device senses a tachyarrhythmia such as ventricular tachycardia or ventricular fibrillation, it sends a defibrillation shock to cardiovert the heart.
178
Semilunar Valve
## Footnote
405: Within this location, the intermingling of the fibrous CT of the cardiac skeleton and muscular tissue of the myocardium can be observed. Name the three major functions of the cardiac skeleton.
1. Electrical insulation between the atria and ventricles
2. Support of the valves
3. Attachment of the myofibers of the myocardium
179
205: The nucleus seen here belongs to which type of cell? How would you classify this epithelial tissue?
* Name two functions of this tissue layer.
180
What pacemaker is described?
* Has one lead that paces either the right ventricle or right atrium.
* Most commonly, this lead is placed in the apex of the right ventricle
* Used to pace the heart when there is a problem with the **conduction** **pathways**.
181
What is shown here?
182
What distance of the green line would indicate an enlarged left atrium?
183
1. Which type of muscle tissue is this?
2. What are two histological characteristics that are unique to these muscles cells that distinguish them from the other two muscle tissue types?
1. Cardiac
2. Myocytes are short and blunt.
Some myocytes are branched
Intercalated discs are present
184
What is a Fleischner sign?
a disproportionately enlarged left pulmonary artery
185
What is shown here?
Saddle Embolism: When it goes over bifurcation of pulmonary artery
186
Where are the following structures in the image provided?
* Left Atrium
* Left Ventricle
* Aortic Outflow
* Right Ventricle
* Descending Aorta
