Tracy Exam #1

Question 1

A few things can detect cardiac trauma.

Answer 1

radiography
electrocardiography
cardiac enzyme studies
Echo (TTE and TEE)

Question 2

Cardiac trauma, we’re gonna do a TEE. Why? This structure in heart is especially enhanced visually.

Answer 2

It enhances imaging of cardiac structures.
Thoracic aorta especially good to see here.

Question 3

Iatrogenic injury in regards to blunt chest trauma usu due to

Answer 3

CPR

Question 4

Which are more common. Blunt injury or penetrating injury.

Answer 4

Blunt.

Question 5

Life threatening results of cardiac trauma are usu from

Answer 5

Hemorrhage
Cardiac tamponade

Question 6

A patient has cardiac blunt chest trauma. What are some consequences down the road for immediate survivors? (6)

Answer 6

MI
Aneurysms
VSDs
Valve damage
Recurrent pericarditis
Constrictive pericarditis

Question 7

What are common forms of blunt chest trauma? (5)

Answer 7

Steering wheel contusion (Motor Vehicle Accident, or MVA)
Sport injury
Fall from heights
Blow from blunt object
CPR

Question 8

3 hallmarks of blunt cardiac trauma… the pain from these hallmarks may mask what?

Answer 8

fractured ribs
fractured clavicle
fractured sternum

the pain from these fractures may mask underlying cardiac problems

Question 9

in blunt cardiac trauma, it can be a good sign that there are overlying fractures. That means the impact was absorbed by bones and not entirely by

Answer 9

the heart.

Question 10

Heart injury: Blunt trauma can affect the myocardium (7)

Answer 10

1. contusion
2. laceration
3. rupture
4. septal perforation
5. aneurysm or pseudoaneurysm
6. hemopericardium, tamponade
7. thrombosis / systemic embolism

Question 11

Heart injury: Blunt trauma can affect the pericardium (6)

Answer 11

1. pericarditis
2. postpericardiotomy syndrome
3. constrictive pericarditis
4. pericardial laceration
5. hemorrhage
6. cardiac herniation

Question 12

Heart injury: Blunt trauma can affect the endocardial structures (4)

Answer 12

1. papillary muscle rupture
2. chordae tendineae rupture
3. AV valve rupture
4. semilunar valve rupture

Question 13

Heart injury: Blunt trauma can affect the coronary arteries (3)

Answer 13

1. thrombosis
2. laceration
3. fistula

Question 14

pericardial effusion is usu associated with (cardiac injury). there is usu _______ and it can happen ________.

Answer 14

cardiac contusion
great vessel tear
myocardial tear

*there is usu blood
can happen immediately or over time

Question 15

long term complication of pericardial effusion is

Answer 15

constrictive pericarditis

Question 16

(cardiac injury) bloody pericardial effusion on echo looks

Answer 16

more echogenic

Question 17

(cardiac injury) clots on echo look

Answer 17

more echogenic

Question 18

(cardiac injury) serous effusion on echo look

Answer 18

less echogenic

Question 19

(cardiac injury) located effusion on echo

Answer 19

use different views to ID

Question 20

TEE pitfalls… what can be mistaken?

Answer 20

Eustachian Valve, mistaken for lesion
Chiari network, mistaken for lesion
Lipomatous hypertrophy of IAS, mistaken for atrial mass
Coumadin ridge, prominent muscle ridge between LAA and atrial insertion of LUPV
Moderator band, mistaken for mass
Lambl excrescences, mistaken for mass
Valve strands, mistaken for lesion
Prosthetic valve sutures, mistaken for lesion
Pericardial fat, mistaken for mass
Pulmonary parenchyma, mistaken for pleural effusion
Hiatal hernia, mistaken for mass

Question 21

TEE tomographic views: exact views vary relative to the position of the (3)

Answer 21

heart
esophagus
diaphragm

Question 22

pericardial effusion (if blunt chest trauma) usually associated with either:

Answer 22

cardiac contusion
great vessel tear
myocardial tear

Question 23

after heart injury (blunt chest trauma) how does pericardial effusion fluid look? Does it look different?

Answer 23

it is bloody

Question 24

how does tamponade appear on echo?

Answer 24

small right sided chambers
respiratory variation
diastolic collapse of RA and RV

Question 25

patient just had tamponade surgery… follow up echo will be used to evaluate

Answer 25

if PE has resolved… also if any complications like pericardial restriction

Question 26

pneumothorax associated with

Answer 26

rib fractures

Question 27

pneumothorax can be seen in what exam?

Answer 27

x-ray

Question 28

this can actually shift the heart position making an echo pretty difficult

Answer 28

pneumothorax

Question 29

a cardiac contusion is a

Answer 29

bruise to the myocardium

Question 30

cardiac contusion (what damages can result)

Answer 30

cellular injury
hemorrhage
resulting necrosis of myocardial fibers