Chapter 232 - Basic Biology; 236 - Imaging

Question 1

Normal ef
Normal end diastolic volume
Normal end systolic volume

Answer 1

Normal ef 67 +/-8%
Normal end diastolic volume 75 +/- 20cc
Normal end systolic volume 25 +/- 7

Question 2

O2 requirement of heart

Answer 2

15% of that of entire organism

Question 3

Heart source of energy

Answer 3

Ffa - plasma (ffa metab = 70% in resting/fed state)

Glucose - plasma, glycogenolysis

Question 4

Shifts between heart preference for glycolysis vs beta oxidation

Answer 4

Gluc - increase cardiac work, inotropes, hypoxia, ischemia

Ffa - beta adrenergic stimulation

Question 5

Bernoulli equation

Answer 5

P=4v^2

Question 6

Coronary artery calcium ct scoring

Answer 6

Agatson score

• minimal 0-10
• mild 10-100
• moderate 100-400
• severe >400

Question 7

Radiation dose per imaging

Answer 7

Cac measurement in ct: 1-2mSv
Typical mp spect scan: 4- 11
Mp pet scan: 2.5-4
Coronary cta: 5-15
Coronary angio: 7

**1 yr equivalent background radiation: 3msv

Question 8

Pathognomonic findings of infarct and and microvascular obstruction on cmr

Answer 8

Infarct: Late gadolinium enhancement in areas or ccoronary artery distribution; sensitivity acute -99% chronic -94%

Microvascular obstruction: dense hypoenhanced areas within the core of a birght region of infarction

Question 9

Assessment of lv systolic and diastolic fxn

Answer 9

Systolic = normal ef >55%; low normal ef 50-55%
Diastolic = mitral relaxation velocity - prognostic significance
Mitral deceleration time <150ms - restrictive physiology and severe diastolic dysfunction

Question 10

Assessment of rv fxn

Answer 10

Fractional area chabge: correlate with outcomes

Question 11

Contrast induced nephropathy return to baseline of renal function

Answer 11

7-10 days

Question 12

Gadolinium nephropathy

Answer 12

Nephrogenic systemic fibrosis - unchelated form of gadolinium

Question 13

Hallmark of myocardial ischemia on 2d echo

Answer 13

• Wall motion abnormalities

- reduced systolic wall thickening

Question 14

Rate of major adverse cardiac event annually if PET/SPECT is normal

Answer 14

<1% annnually

Question 15

Normal coronary flow reserve

Answer 15

> 2.0

Question 16

Fractional flow reserve

Answer 16

Pressure differential between a coronary segment distal to a stenosis and the aortaPressure differential between a coronary segment distal to a stenosis and the aorta

Normal=1

Question 17

Low risk ett

Answer 17

> 10 mets without chest pain or ecg changes

= managed medically

Question 18

High risk ett

Answer 18

• Typical angina with >2mm st dep
• ste
• sustained arrhythmia
• drop in bp

Management: refer for coronary angio

Question 19

Aortic valve estimation of area most accurate technique

Answer 19

• continuity principle
  <1.0cm2 severe
  <0.6cm2 critical

Question 20

Aortic regurg estimation

Mitral regurg estimation

Answer 20

Aortic - vena contracta

Mitral - proximal isovelocity surface area (pisa)

Question 21

Rheumatic mitral stenosis distinct appearance

Answer 21

• hockey stick type deformity: tethering at the leaflet tips with relative pliabikity of the leaflets themselves

Question 22

Ff up imaging post myocardial infarct timing

Answer 22

1-6mos

Question 23

Pet vs dobu echo sensi vs speci comparison

Answer 23

Sensitive - pet

Specific - dobu echo

Question 24

Cardiac mri findings

Answer 24

Cardiac mri findings

• infarct or ischemia: lge of subendocardium following coronary distribution
• infiltrative: lge subepicardium and intramuscular not following coronary distribution
• t2 enhancement: edema - myocarditis
• t2 flair: iron deposition - hemochromatosis

**PET FDG: sarcoidosis

Question 25

Clinical diagnosis of chemotx associated cardiotoxicity

Answer 25

- >10% reduction in lvef to <55% in those without symptoms | - >5% reduction in lvef to <55% in those with symptoms

Question 26

2d echo findings of pericardial effusion

Answer 26

- distance between parietal and visceral peritoneum >1cm - rv free wall diastolic collapse - respiratory flow variation: echo equivalent of pulsus paradoxus

Question 27

Atrial myxomas most common chamber in heart

Answer 27

75% la 20% ra 5% mixed or ventricular

Question 28

Initial test of choice for px with mechanical aortic or mitral valve and suspicion of IE TRANSESOPHAGEAL echo

Answer 28

- vegetation size should be measured because has prognostic significance

Question 29

Gorlin syndrome

Answer 29

- cardiac fibromas - bifid ribs - gingival hyperplasia

Question 30

Patent foramen ovale test

Answer 30

``` Bubble test (agitated saline test) - manuevers to increase ra pressure >la: sniff maneuver, valsalva maneuver ```

Question 31

Iron toxicity cardiomyopathy cmr finding

Answer 31

t2 value (rate of signal reduction/decay in the myocardium) <20ms

Question 32

Elective cardiac catheterization risk

Answer 32

``` Allergic rxn <5% Access Bleeding 1.5-2% Death 0.1% Mi <0.1% Stroke 0.01% Ciaki 2-7% Ci aki in high risk 20-30% Dialysis 0.3-0.7% ```

Question 33

Ci aki definition and prevention

Answer 33

Increase by >0.5mg/dl or >25% crea within 48-72hrs Prevention 1. Nss x 1-1.5cc/kg/hr 3-12hrs pre and 6-24hrs post contrast 2. Metformin hold 24hrs pre and 48hrs post 3. Nahco3 3cc/kg 1hr pre and 6hrs post 4. Limit contrast volume <50cc

Question 34

Coranary angio antiplatelets and anticoag

Answer 34

- ok with antiplatelets, load if with planmed pci - hold warfarin 2-3days target inr <1.7 - hold noacs 24-48hrs

Question 35

Test to assess palmar arch patency prior to catheterization

Answer 35

- allen test and barbeau test

Question 36

Normal hemodynamic values: ra, rv-pa, la, lv-ao

Answer 36

``` Ra: 0-5 La: 4-12 Rv/pa: 17-32/1-7 Lv: 90-130/5-12 Ao: 90-130/60-85 ```

Question 37

Systemic vascular resistance | Pulmo vascular resistance

Answer 37

S: 900-1400 P: 40-120

Question 38

Cardiac index

Answer 38

CI 2.8-4.2 Lmin/m2

Question 39

AV O2 difference

Answer 39

AV O2 difference 3.5-4.8%

Question 40

Hocm hemodynamic sign on cardiac catheterization

Answer 40

Brockenbrough-Braunwald sign: after pvc, increase in lv pressure but decrease aortic pressure

Question 41

Hemodynamic measurements Tamponade vs constrictive pericarditis vs Restrictive cm

Answer 41

Tamponade - ra: increased - y descent: decreased or absent - diastole pressures: equalization in all chambers constrictive pericarditis - ra: increased - y descent: prominent, square root sign - diastole pressures (most specific sign of constriction): rv increase, lv decrease** chapter 235 **chapter 265 equalization of all pressures Restrictive cm - ra: increased (>60mmhg) - y descent: prominent, square rt sign - diastole pressures: both rv and lv increase but separation by >5mmhg

Question 42

Intracardiac shunt hemodynamic assessment | Significant shunt ratio and indication for surgery

Answer 42

- step up: left to right shunt - step down: right to left shunt Shunt ratio for asd - >1.5: significant - >2.0 + lv overload: indication for sx

Question 43

Circulation dominance

Answer 43

- depends on origin of av nodal branch, posterior descending artery, posterior lateral vessels - right 85% - rca - left 5% - lcx - codominant 10% * *sa nodal artery source - rca: 55-60% - lcx: 40-45%

Question 44

Stenosis of how much is considered significant

Answer 44

50%

Question 45

Most common coronary artery anomaly

Answer 45

- separare ostia for lad and lcx

Question 46

Timi flow

Answer 46

0 - no flow 1 - no distal perfusion 2 - delayed distal perfusion 3 - normal flow

Question 47

Hemodynamically sig stenosis by fractional flow reserve

Answer 47

<0.80 | - ratio of pressure of distal to stenosis vs proximal to stenosis