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PBR 2 and 3 > Page 26 > Flashcards

Page 26 Flashcards

1
Q

Four-chambered heart lies in the left hemithorax

A

Levoposition

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2
Q

Orientation: Cardiac apex is normally located to the left of midline

A

Levocardia

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3
Q

Cardiac apex is to the right of midline

A

Dextrocardia

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4
Q

Heart is displaced to the right lying in the right hemithorax

A

Dextroposition

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5
Q

Include a trilobed lung (with eparterial bronchus) in the chest and liver in abdomen

A

Right-sided organs

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6
Q

Include a bilobed lung (with hyparterial bronchus) in chest and spleen in abdomen

A

Left-sided organs

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7
Q

Normal cardiac positioning, morphologic RA on the right and morphologic LA on the
left

A

Situs solitus

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8
Q

All major organs are reversed or mirrored from normal position, morpho RA is on the
left and morpho LA is on the right

A

Situs inversus totalis

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9
Q

Assoc w/ polysplenia. Each lung contains 2 lobes and hyparterial bronchi

A

Left isomerism

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10
Q

Assoc w/ asplenia. Each lung with 3 lobes.

A

Right isomerism

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11
Q

RA: receives systemic venous return from

A

1) SVC - free opening
2)IVC - partially guarded by Eustachian valve
3)coronary sinus - guarded by Thebesian valve

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12
Q

RA: divided into 2 portions by crista terminalis

A

1) smooth posterior wall -sinus venosus, SVC IVC in continuity 2) trabeculated anterior wall -from embryonic RA

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13
Q

RA: triangular or pyramid shape with broadbase containing pectinate muscles

A

RA appendage

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14
Q

RA: medial or posterior wall

A

Interatrial septum - fossa ovalis is located

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15
Q

Most anterior cardiac chamber

A

RV

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16
Q

RV: divided into 2 portions by crista supraventricularis

A

1)posterior/inferior portion(heavily trabeculated) -inflow/sinus portion; 2)less trabeculated anterior/superior portion - outflow tract or pulmonary conus

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17
Q

RV: muscular band carrying part of RBB conduction system (consistent feature)

A

Moderator band (septomarginal band)

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18
Q

RV: smooth cephalic portion

A

Infundibulum (conus arteriosus)

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19
Q

How to distinguish RV from LV?

A

By having having coarser trabeculae (particularly at apex), moderator band, apical displacement of R AV valve, lack of fibrous continuity b/w inlet and outlflow valves, and much thinner wall

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20
Q

LPA location

A

extends posteriorly coursing over the top of the L main stem bronchus (L hyparterial bronchus)

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21
Q

RPA location

A

extends horizontal to the right, bifurcates and exits the R hilum as truncus anterior (supplies RUL) and interlobar artery (supplies RML RLL) = L hyparterial bronchus, 2) portion of PV return to the right heart or SVC (PAPVR)

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22
Q

What are the normal variance of pulmonary venous drainage?

A

1) direct drainage from the right middle lobe to LA

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23
Q

PAPVR from the R lung is 2x as common as from the L. T or F?

A

TRUE

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24
Q

Congenital malformation in which all 4 PV drain into systemic veins (SVC or IVC) or directly into RA

A

TAPVR

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25
Q

directly into RA
TAPVR
In TAPVR, an ASD is required for survival. T or F?

A

TRUE

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26
Q

Most superior and posterior cardiac chamber

A

LA

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27
Q

LA: borders

A

Nestled b/w R and L bronchi, posterior wall abuts anterior wall esophagus

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28
Q

LA: part where pulm veins enter

A

Posterior part

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29
Q

Mitral valve leaflets

A

1) anterior leaflet -near IV septum, 2)smaller posterior leaflet -posterior and to the left

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30
Q

LV: inflow portion

A

Posterior to anterior mitral leaflet

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31
Q

LV: outflow portion

A

Anterior and superior to anterior mitral leaflet

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32
Q

Interventricular septum is concave to?

A

Bulging into RV

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33
Q

Aortic valve: tricuspid

A

1) right - right coronary, 2)left - left coronary, 3)posterior -noncoronary cusp

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34
Q

Branches of aortic arch

A

1) right brachiocephalic, 2)L common carotid, 3)L subclavian

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35
Q

Pectinate muscles: what chamber?

A

LA (fewer) and RA

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35
Q

Chordae tendineae: what chamber

A

LV

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35
Q

Moderator band: what chamber?

A

RV

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36
Q

Papillary muscles: what chamber?

A

RV and LV

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36
Q

Trabeculae: what chamber?

A

RV (coarser) and LV (FINE)

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36
Q

Conduction system: recorded as P wave on ECG

A

SA node

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36
Q

Source of 2nd heart sound

A

Aortic and pulmonic valve closure

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36
Q

Remnant of ductus arteriosus

A

Ligamentum arteriosum

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37
Q

What is the value of oblique measurement to confirm LA enlargement?

A

> 7cm (measured from inferior midpoint L main bronchus to the R border of LA)

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37
Q

Conduction system in the IV septum: first to activate

A

Anterior or septal RV

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37
Q

What are the indirect signs of LA enlargement?

A

1) splaying of carina (tracheal bifurcation >90degrees), 2)posterior displacement of of L mainstem bronchus (lat view), 3) superior displacement of L mainstem bronchus (frontal view)

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38
Q

Conduction system in the IV septum: last to activate

A

Posterior or basal LV

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38
Q

Source of 1st heart sound

A

AV valve closure

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38
Q

This standard view in oarasternal window is useful to evaluate size and contractility of ventricles and assess morphology and function of mitral and aortic valves

A

Long axis view

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38
Q

Cardiac enlargement: increase convexity along right heart border

A

RA enlargement

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38
Q

Type of echocardiography: probe is passed into patient’s esophagus

A

TEE transesophageal echocardiography

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38
Q

Cardiac enlargement: rounding of L heart border and apex pointing downward

A

LV enlargement

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38
Q

Type of echocardiogram: probe is placed on the chest or abdomen

A

TTE transthoracic echocardiography

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39
Q

Main TTE windows

A

Physical location of transducer - suprasternal, parasternal, apical, and subcostal (subxiphoid)

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39
Q

Cardiac enlargement: uplifting of apex

A

RV enlargement

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39
Q

This standard view in apical window is usefule for visualization of all 4 chambers
including apex, ejection fraction assessment (Simpson method), and mitral flow assessment

A

Four-chamber view

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39
Q

This standard view in apical window including aortic valve is useful for aortic stenosis

A

Five-chamber view

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39
Q

TEE advantage

A

Useful in imaging LA and LAnappendage when thrombus or clot is suspected

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39
Q

TEE disadvantage

A

More invasive and requires sedation

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40
Q

What is the largest coronary artery yet variable in length?

A

L main coronary artery

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41
Q

What are the 2 branches of LMCA?

A

1) LAD - course anteriorly 2)LCx -course posteriorly

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42
Q

Trifurcation of LMCA will produce what branch?

A

Ramus intermedius (20-30%) -course anterolaterally similar to diagonal br or posteriorly similar to OM br

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43
Q

Coronary artery that runs along anterior surface of LV

A

LAD

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43
Q

What are the portions of LAD?

A

1) proximal -origin to 1st branch (septal/diagonal); 2)mid-LAD -end of proximal LAD to 1/2 distance to LV apex; 3) distal LAD -end of midLAD to termination

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43
Q

Coronary artery that course anteriorly in the R AV groove

A

RCA

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43
Q

What are the branches of RCA?

A

1) conus branch 2) acute marginal br - anterior surface RV, 3) PDA -course posterior interventricular sulcus, 4)PLV post left ventricular- along posterior AV groove b/w inferior aspect of LA and LV, 5)small septal branches 6) sinoatrial nodal branch 7)atrioventricular nodal branch

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44
Q

What are the branches of LAD?

A

1) diagonal (2-4) branches- anterolateral LV; 2) septal (numerous but small) branches - anteroseptal LV

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44
Q

Coronary artery that courses posterolaterally b/w LV and LA

A

LCx

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44
Q

RCA branch: first br and supply RVOT or conus

A

Conus branch - may also arise from right coronary sinus (origin of RCA)

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45
Q

What are tha branches of LCx?

A

1) obtuse marginal (OM) -inferolateral LV (at least 2- smaller first, larger second); 2) distal Lcx

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45
Q

Co-dominance?

A

(20%) 2 PDA arising from RCA and from Lcx (LCx is also larger)

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45
Q

RCA branch: referred to as the arterial circle of Vieussens

A

Conus branch acting as a collateral pathway for blood flow to the LAD

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45
Q

What are the 3 territories of RCA?

A

1) proximal -origin to 1/2 distance toacute margin of heart, 2)mid-RCA -end of proximal RCA to acute margin of heart, 3) distal RCA -end of mid-RCA to origin of PDA

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45
Q

Right dominance vs Left dominance

A

Right dominance (majority 70%)- distal RCA divides into PDA and PLV, diminutive distal LCx. Left dominance (10%) - distal LCx will be larger in size and give rise to PDA

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46
Q

RCA branch: to supply inferior wall of LV

A

PDA

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46
Q

RCA branch: course superiorly toward the posterior annulus of mitral valve

A

Atrioventricular nodal branch

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46
Q

RCA branch: to supply imferior and inferolateral LV base

A

PLV

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46
Q

RCA branch: arising from PDA to supply inferolateral aspect of LV septum

A

Small septal branches

46
Q

Small vessel which may be supplied by both RCA (course posterior) and LCx (course medial) and terminates along posterior aspect of SVC/RA

A

Sinoatrial nodal branch

47
Q

Imaging method to best visualize anomalous coronary anatomy

A

ECG-gated CT angiography

47
Q

Coronary anomalies are divided based on?

A

1) origin, 2)course, 3) termination

48
Q

BENIGN anomalous origin: LAD and LCx have independent origins from left sinus of Valsalva

A

Absence of L main coronary artery

49
Q

Valsalva Absence of L main coronary artery BENIGN anomalous origin: commonly affecting RCA where it originates from ascending aorta (>1cm above sinotubular jxn)

A

High origin of RCA

50
Q

BENIGN anomalous origin: commonly affecting LCA or LCx arising from right sinus of Valsalva (either from aorta or proximal RCA) and course posteriorly b/w aortic root and LA

A

Retroaortic course

50
Q

BENIGN anomalous origin: LAD or LCx arises from right sinus Valsalva and course anteriorly around RVOT

A

Prepulmonic or precardiac course

51
Q

BENIGN anomalous origin: LAD arising from right coronary sinus coursing
inferomedially before diving into IV septum

A

Septal (intramuocardial) course

51
Q

Possibly ALIGNANT anomalous origin: LCA arises from pulmonary artery

A

ALCAPA or Bland-Garland-White syndrome

51
Q

BENIGN anomalous origin: RCA or LMCA arising from noncoronary sinus

A

Noncoronary sinus

51
Q

Possibly MALIGNANT anomalous origin: coronary artery arises from opposite sinus and course medially b/w aorta and pulmonary artery

A

Interarterial course - can lead to myocardial ischemia, infarction, sudden cardiac death

52
Q

Possibly MALIGNANT anomalous origin: all coronary artery branches arise from a single vessel

A

Single coronary artery

52
Q

T or F. A single RCA is more common than a left.

A

TRUE

52
Q

Possibly MALIGNANT anomalous origin: osteum of RCA or LCAdoes not develop

A

Ostial atresia - commonly affects LCA

52
Q

draining to pulmonary artery Coronary artery fistula Coronary artery plaques (fibroatheroma) classification

A

1) calcified, 2) noncalcified, 3)mixed

53
Q

Anomalous course: involves mid-LAD where a band of myocardial tissue extends around the vessel

A

Intramyocardial course or MYOCARDIAL BRIDGING

53
Q

Anomalous course: RCA course within RA

A

Intracavitary course

53
Q

T or F. Low attenuation plaque w/ a larger lipid-rich necrotic core has higher propensity to ruptue.

A

TRUE

53
Q

Anomalous course: one coronary artery arising from sinus of Valsalva, which then divides in its proximal portion into 2nparallel arteries that mirror their courses

A

Split or double coronary artery

53
Q

High attenuation plaquecorresponds to larger and thick fibrous cap has smaller
likelihood of rupture.

A

TRUE

54
Q

Anomalous termination: dilated and tortuous affected coronary artery with a portion draining to pulmonary artery

A

Coronary artery fistula

54
Q

T or F. Positive remodelling and negative remodelling occur together

A

TRUE

54
Q

Coronary CTA finding of “napkin-ring sign”

A

Indicative of a thin-cap atheromatous vulnerable plaque (rim of high attenuation surrounding an area of low attenuation) representing inflamed fibrous cap surrounding necrotic lipid core

54
Q

What is “negative remodelling”?

A

Inward growth of plaque causing stenosis

55
Q

Coronary CTA finding of “in-stent” restenosis

A

Area of hypoattenuation within the stent

55
Q

What is “positive remodelling”?

A

Outward growth or expansion of both coronary and associated plaque

55
Q

Coronary stent diameter that is more likely to be evaluable

A

3mm or more

55
Q

Degrees of coronary stenosis by CTA

A

Minimal (1-24% narrowing), Mild (25-49% narrowing), moderate (50-69% narrowing), Severe (70-99% narrowing), Occlusion (100%)

55
Q

Excellent tool for assessing the patency of CABG

A

ECG-gated CTA of the thorax

56
Q

Coronary artery aneurysm diameter

A

1.5x the adjacent normal coronary artery

56
Q

What are complications of CABG?

A

SVG aneurysm -not uncommon, thrombosis, pseudoaneurysms -uncommon usually at the anastomotic site

56
Q

What are the grafts used in CABG?

A

Left internal mammary (LIMA) graft and saphenous vein graft (SVG)

57
Q

Type of aortic dissection involving ascending aorta which may extend into aortic root

A

Type A

58
Q

3 catastrophic mechanical complications of MI

A

1)LV free wall rupture (LV pseudoaneurysm), 2)ventricular septal rupture (VSR), 3)papillary muscle rupture (within first week)

59
Q

LV true aneurysm vs psuedoaneurysm

A

Pseudoaneurysm -inferior and inferolateral walls, narrow neck (<50% of max diameter of distal outpouching), contained by surrounding pericardium or scarring; True aneurysm - anterior walls, broad neck, surrounded by thin myocardium

60
Q

Classification of cardiac tumors

A

1) primary (benign vs malignant) 2)secondary (mets)

60
Q

Findings of asymmetric edema most notably in the RUL, echo shows flair posterior
leaflet with severe mitral regugitation in px with worsening dyspnea

A

LV posteromedial papillary muscle rupture

60
Q

Classification of cardiac masses

A

1) tumors , 2)tumor-like lesions

60
Q

DDx: tumor-like lesions

A

Thrombus, vegetation, lipomatous hypertrophy, caseous necrosis of mitral valve, pericardial cyst, fat necrosis

61
Q

DDx: Myocardial perfusion defect

A

Fatty metaplasia or calcification of myocardium, LV aneurysm, and thrombus

61
Q

MALIGNANT features

A

Large (>5cm), multiple, RIGHTsided, irregular ill-defined borders with direct invasion thru tissue planes, (+)hemorrhagic pericardial effusion, pericardial invasion or multiple nodular masses, heterogeneous (dt hemorrhage and necrosis), prominent early enhancement and variable delayed enhancement

61
Q

BENIGN features

A

Small (>5cm), single, LEFTsided, smooth well-defined borders w/ no extension thru tissue planes, pericardium not involved, homogenous w/ absent to minimal early enhancement and variable delayed enhancement

61
Q

DDX: Benign cardiac tumors

A

Myxoma, lipoma, fibroelastoma, rhabdomyoma, fibroma, hemangioma, teratoma

62
Q

Cardiac tumor associated with Carney complex

A

Myxoma

62
Q

DDx : Malignant cardiac tumors

A

Angiosarcoma, rhabdomyosarcoma, fibrosarcoma, lymphoma, melanoma

62
Q

Ddx: INTRAMURAL (benign) cardiac masses

A

Fibroma, rhabdomyoma, lipoma, paraganglioma, lipomatous hypertrophy (interatrial septum)

62
Q

Cardiac tumor demonstrating chemical shift/india ink artifact

A

Lipoma

62
Q

First imaging technique used to evaluate cardiac masses

A

Transthoracic echocardiography

62
Q

Current modality of choice in evaluating cardiac masses

A

Cardiac MRI

62
Q

Ddx: INTRAMURAL (malignant) cardiac masses

A

Metastasis, sarcoma, lymphoma

63
Q

Ddx: INTRACAVITARY (benign) cardiac masses

A

Thrombus, myxoma, lipoma, rhabdomyoma

63
Q

Ddx: INTRACAVITARY (malignant) cardiac masses

A

Metastasis, sarcoma

63
Q

Cardiac tumor with increased risk for embolization

A

Villous or papillary myxoma

63
Q

Lipomatous hypertrophy of interatrial septum vs true lipoma

A

Both have identical signal characteristics; lipomatous hypertrophy - sparing of fossa ovalis

64
Q

Cardiac mass that is small and highly mobile with propensity to attach to the valve
leaflets

A

Valvular papillary fibroelastoma

64
Q

Valvular fibroelastoma vs vegetation

A

Vegetation -mild or absent delayed enhancement within vegetation, valvular or perivalvulae regurgitation, subpoeural cavity nodules in lung; Fibroelastoma - with delayed Gd enhancement, no valvular destruction

64
Q

Best modality to detect and evaluate papillary fibroelastoma

A

Echocardiography

64
Q

Cardiac tumor associated with tuberous sclerosis

A

Rhabdomyom

64
Q

Ddx for cardiac mass in neonate or infant

A

Rhabdomyoma, fibroma, teratoma, and rhabdomyosarcoma

64
Q

What is Gorlin syndrome?

A

AD syndrome of basal cell ca, odontogenic keratocyst and other neoplasm

64
Q

These are hamartomas of enlarged cardiac myocytes located within ventricular myocardium or intracavitary and attached to myocardium

A

Rhabdomyom

64
Q

Cardiac tumor associated with Gorlin syndrome (Basal cell nevus syndrome

A

Cardiac finroma

65
Q

Heterogeneous mass, predom hyperintense on both T1 and T2, with intense enhancement

A

Cardiac hemangioma

66
Q

MC location of cardiac hemangioma

A

Intramural (any part of heart). Can also be intracavitary

67
Q

MC location paraaganglioma

A

LA wall (roof or posterior wall)

67
Q

MC route of metastatic spread to the heart

A

Direct invasion or lymphatic extension to pericardium and epicardium

67
Q

What is Kasabach-Merritt syndrome?

A

Multiple hamangiomas causing recurrent thrombocytopenia and consumptive coagulopathy

67
Q

Cardiac tumor associated with Kasabach-Merritt syndrome

A

Cardiac hemangioma

68
Q

Cardiac tumor producing catecholamines causing hypertension. Extremely hypeintense on T2 with intense enahncement.

A

Paraganglioma

68
Q

Cardiac tumor associated with Carney triad

A

Paraganglioma

68
Q

What comprises carney triad?

A

Extra-adrenal pheochromocytoma, GIST, pulmonary chondroma. Carney complex = myxoma

68
Q

Cardiac mass MC located in the LV myocardium with similar signal caharacteristics to normal myocardium

A

Cardiac hamartoma

68
Q

Location of cardiac sarcomas

A

Intramural and/or intracavitary

68
Q

Tumor thrombus vs bland thrombus

A

Presence of heterogeneous enhancement on CT will help distinguish tumor thrombus from bland thrombus

68
Q

Cardiac sarcoma subtype: RA

A

Angiosarcoma

68
Q

Frequently involved in cardiac sarcoma metastasis

A

Lungs - Dyspna as MC symptom

69
Q

Cardiac sarcoma subtype: LA

A

Undifferentiated sarcoma, osteosarcoma

69
Q

Cardiac sarcoma subtype: posterior wall of LA or IVC

A

Leiomyosarcoma

70
Q

Cardiac sarcoma subtype: no chamber predilection

A

Rhabdomyosarcoma

71
Q

Cardiac sarcoma subtype: LA or RA

A

Liposarcoma

72
Q

The only cardiac sarcoma that predominantly arises in the RA in the region of the R AV groove

A

Cardiac angiosarcoma

72
Q

Cardiac sarcoma vs myxoma on LA involvement

A

Myxomas are not infiltrative and do not invade into pulmonary veins in contrast to sarcomas

73
Q

MC location of primary cardiac lymphoma

A

RA (R atrioventricular groove) similar to angiosarcoma, (next RV, then Left chambers)

73
Q

T or F Primary cardiac lymphomas are more common than secondary cardiac

A

FALSE

74
Q

Usual type of cardiac lymphoma

A

Non-Hodgkin lymphoma

74
Q

Acute vs chronic thrombus

A

Acute = hyperintense on T1 and T2. Chronic =hypointense on both T1 and T2. Both dark in delayed enhancement.

74
Q

Thrombus vs tumor

A

Thrombus is hypodense on Ct and does not enhance.

75
Q

Imaging of choice in distinguishing thrombus from tumor

A

Cardiac MRI

75
Q

Distinguishing feature of cardiac lymphomas

A

Tendency to extend along pericardium encasing adjacent vascular structures. Infiltrative with homogeneous signal throughout the lesion dt absence of necrosis or hemorrhage

75
Q

Septal thickness: normal vs lipomatous hypertrophy

A

Normal = less than 1cm; lipomatous = more than 2cm

75
Q

Dumbell-shape fatty massin the interatrial septum with sparing of fossa ovalis

A

Lipomatous hypertrophy of interatrial septum (avid FDG uptake)

75
Q

What are the mimickers of cardiac masses?

A

Lipomatous hypertrophy, moderator band, papillary muscles

76
Q

How can we differentiate true cardiac masses?

A

Most cardiac masses do not deform the outer contour of the heart

76
Q

MV apparatus: attach the papillary miscles to leaflets and prevent proplapse of
leaflets to atrium

A

Choedae tendineae

76
Q

Blood supply: posteromedial papillary miscle

A

RCA

76
Q

MV apparatus: aid the valves to rapidly coapt during systole to prevent regurgitant flow

A

Contraction of papillary muscles

76
Q

Mitral valve apparatus

A

1)valve leaflets (anterior and posterior), 2)chordae tendineae, 3)papillary muscles

77
Q

Tricuspid valve: leaflets

A

1) anterior 2)posterior 3)septal -attached by chordae tendineae to 3 papillary muscles (anterior, posterior, and septal)

77
Q

Blood supply: anterolateral papillary miscle

A

LAD or LCx

78
Q

Aortic valve: 3 cusps

A

Named accdg to sinuses of Valsalva: 1)left - LCA, 2)right - RCA, 3)posterior -noncoronary cusp

79
Q

Facing sinuses of Valsalva

A

Left and right cusps abut/face the pulmonary valve, thus the term

80
Q

Primary modality for evaluation of suspected valve disease

A

Echocardiography

81
Q

Chronic degeneration of mitral valve fibrous ring seen as “O” or “C” shape dense structure

A

Mitral annular calcifications (MACs)

82
Q

Quantitative gold standard for complete visualization of heart and measurement of blood flow

A

Cardia MRI

83
Q

MC type of subaortic stenosis resulting in murmur

A

Subaortic membrane

83
Q

Clinical gold standard for noninvasive measurement of blood flow and used to quantify severity of valvular stenosis or regurgitation

A

Phase-contrast MR

84
Q

What are the 2 primary metrics in quantifying valvular regurgitation?

A

1)regurgitant volume -amount of blood flow backwards, 2)regurgitant fraction -Rvol divided by forward flow volume

85
Q

MC CHD affecting 1% of adults

A

Bicuspid aortic valve (BAV) -2 leaflets are partially or completely fused

86
Q

Valvular disease associated with aortic coarctation

A

BAV

87
Q

Valvular disease: fish-mouth opening of valve during systole

A

BAV

88
Q

MCC of acquired aortic valve disease

A

Degenerative calcification and chronic leaflet deterioration

89
Q

Aortic stenosis grading (by measuring the estimates of aortic valve area AVA)

A

Moderate = AVA <1.5cm2; Severe = AVA <1cm2; Critical = <0.5cm2

90
Q

Bowing of mitral leaflet 2mm or more beyond the annular plane into LA in ventricular systole

A

MVP -rupture or elongation of chordae tendineae

91
Q

MC affected leaflet in MVP

A

middle scallop of posterior leaflet (P2 segment)

92
Q

What are the conditions associated with MVP?

A

Marfan syndrome, COA, ASD (ostium secundum)

PBR 2 and 3 (41 decks)

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