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FRCR 2A (Crack The FRCR 2A) > 1. Cardiac (Chambers, coronaries, valves) > Flashcards

1. Cardiac (Chambers, coronaries, valves) Flashcards

1
Q

Right atrium defined by…

A

IVC

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2
Q

Crista Terminalis

A

Muscular ridge running from entrance of IVC to entrance of SVC (normal)

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3
Q

Eustachian valve

A

Flap in the IVC as it joins right atrium

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4
Q

Chairi network

A

Trabeculated appearance of eustachian valve

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5
Q

Coronary sinus (purpose+anatomy)

A

Main draining vein of myocardium.
Runs in AV groove (posterior surface) and enters right atrium near tricuspid valve

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6
Q

Right ventricle defined by

A

Moderator Band

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7
Q

Tricuspid vs mitral papillary muscles

A

Tricuspid insert on septum, mitral don’t

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8
Q

Right vs Left Valves

A

Right valves searated by thick muscle (crista superventricularis)
left valves sit side-by-side

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9
Q

Most posterior chamber

A

Left atrium

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10
Q

Double density sign

A

CXR: Superimposed 2nd contour of the right heart from the right side of enlarged left atrium

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11
Q

Indirect signs of left atrial enlargement (2)

A

Splaying of carina (>90 degrees),
Walking man sign: posterior displacement of left main bronchus, upside-down V shape with intersection of right main bronchus on lateral CXR

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12
Q

Left papillary muscle insertion

A

Lateral, posterior walls and apex of left ventricle

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13
Q

Chordae tendonae

A

Connect mitral valve leaflets to papillary muscle

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14
Q

Echogenic focus in left ventricle (pre-natal)

A

Calcified papillary muscle, usually goes away by 3rd trimester, associated with Downs.

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15
Q

Lipomatous hypertrophy of the intra-atrial septum (Appearance) (2)

A

Dumbbell fat density in the atrial septum, sparing fossa ovale.
Can be hot on pet (brown fat).

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16
Q

Lipomatous hypertrophy of the intra-atrial septum (Associations) (2)

A

Can cause supraventricular arrhythmia.
Associated with being old and fat.

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17
Q

Coronary cusps & associated arteries (3)

A

Right coronary cusp –> RCA
Left coronary cusp –> LCA
Non-coronary cusp (posterior) –> none

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18
Q

Left main coronary artery branches

A

LCX (circumflex) –> Obtuse marginals
LAD –> Septal branches & Diagonals

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19
Q

Right main coronary artery branches

A

Acute marginals
AV node branch
Posterior descending (PDA)

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20
Q

Dominance determined by

A

Which artery supplies the PDA (RCA in 65-80%)

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21
Q

Which artery perfuses SA node?

A

RCA (60%)

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22
Q

Which artery perfuses AV node?

A

RCA (90%)

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23
Q

Co-dominance defined as

A

PDA arises from RCA & posterior left ventricular branches arise from LCX

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24
Q

Malignant origin of coronary artery (types (+Rx)) (2)

A

Anomalous LCA from Right coronary sinus (most serious, always repair).
Anomalous RCA from Left coronary sinus (repair if symptomatic).

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25
Q

Malignant origin of coronary artery (Clinical significance)

A

Courses between pulmonary artery and aorta, can get compressed –> sudden cardiac death.

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26
Q

ALCAPA syndrome - definition

A

Anomalous Left Coronary Artery from Pulmonary Artery

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27
Q

ALCAPA syndrome - types (2)

A

Infantyle type –> die early
Adult type –> risk of sudden death
Associated with STEAL syndrome: Reversal of LCA flow as pressure decreases in pulmonary circulation

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28
Q

ALCAPA syndrome - Association

A

Associated with STEAL syndrome: Reversal of LCA flow as pressure decreases in pulmonary circulation

29
Q

Myocardial bridging - Definition

A

Intramyocardiac course of coronary artery, usually LAD.

30
Q

Myocardial bridging - Sequelae (2)

A

Symptoms in systole as diameter decreases. Can cause ischaemia.
Can be issue for CABG planning.

31
Q

Coronary artery aneurysm - definition

A

Coronary vessel diameter 1.5x normal.

32
Q

Coronary artery aneurysm - causes (3)

A

Adults commonest cause: Atherosclerosis
Kids commonest cause: Kawasaki
Iatrogenic (Cardiac catheter) can also cause

33
Q

Coronary fistula - definition and distribution

A

Connection between coronary artery and great vessel or chamber.
Usually RCA and right chambers.

34
Q

Coronary fistula - Association

A

Associated with coronary aneurysms

35
Q

Ideal patients for coronary CT (2)

A

Low risk/atypical chest pain (prevents risky cath angio for e.g. GORD)
Suspected aberrant coronary artery

36
Q

Ideal HR for coronary CT (2)

A

Ideally <60. Slower is better. Beta blockers used to help

37
Q

Contraindications to beta blockers (4)

A

Severe asthma,
Heart block (2nd or 3rd degree),
Acute chest pain,
Recent cocaine use

38
Q

Can’t give beta blockers for coronary CT?

A

Retrograde gated study rather than prospective

39
Q

Prospective vs retrospective gating (definition, pros/cons)

A

Prospective: acquisition triggered by R wave. Always axial.
+: Reduced radiation (scanner isn’t always on)
-: no functional info.
Retrospective: Scans whole time, then back calculates. Helical.
+: Provides functional information
-: higher dose.

40
Q

Nitroglycerine in coronary CT (purpose)

A

Dilates coronary arteries

41
Q

Contraindications to nitroglycerine (4)

A

Hypotension(SBP<100)
Severe AS
HOCM
Sildenafil use

42
Q

VENC (definition)

A

Velocity ENcoded Cine MR Imaging - used to quantify velocity of flowing blood

43
Q

Aortic stenosis (Types) (3)

A

Congenital (bicuspid)
Acquired (degenerative or rheumatic heart)

44
Q

Aortic stenosis severity grading

A

Based on velocity of blood flow (VENC)

45
Q

Aortic stenosis appearance (2)

A

Concentric LV Hypertrophy
Dilatation of the ascending aorta (Valvular (90%), subvalvular or supravalvular)

46
Q

Supravalvular aortic stenosis associated with

A

Williams syndrome

47
Q

Bicuspid aortic valve & coarctation associated with

A

Turners syndrome

48
Q

Commonest congenital heart disease

A

Bicuspid aortic valve

49
Q

Bicuspid aortic valve associations (4)

A

Aortic aneurysm (even in absence of stenosis)
Cystic Medial Necrosis
Turners and coarctation
Polycystic kidney disease

50
Q

Aortic regurg associated with (4)

A

Bicuspid valve
Marfans
Aortic root dilatation (HTN)
Bacterial endocarditis

51
Q

Haemodynamic impact of aortic regurg determined by

A

Rapidness of onset (less time for adaptation)

52
Q

Mitral stenosis - commonest cause

A

Commonest cause is Rheumatic Heart Disease

53
Q

Mitral stenosis - CXR appearance

A

CXR shows left atrial enlargement

54
Q

Mitral regurg - acute causes (2)

A

Endocarditis
Papillary muscle or chordae rupture post MI

55
Q

Mitral regurg - chronic causes (2)

A

Primary: myxomatous degeneration
Secondary: Dilated cardiomyopathy leading to mitral annular dilatation

56
Q

Mitral regurg associated with

A

Isolated right upper lobe oedema

57
Q

Pulmonary stenosis - associations (4)

A

Supravalvular - Williams syndrome
Valvular - Noonan’s syndrome
Subvalvular - TOF
Peripheral pulmonary stenosis - Alagille syndrome

58
Q

Pulmonary regurg - cause

A

Commonly congenital valve disease, post op (commonly TOF post repair)

59
Q

Multivalve disease, think…

A

Rheumatic fever (immune response to group A beta-haemolytic strep)

60
Q

Tricuspid regurg associations (3)

A

Commonest cause in adults: Pulmonary HTN
Others:
Endocarditis (IVDU)
Carcinoid syndrome (serotonin degrades valve)

61
Q

Cherub syndrome

A

Sami-Good-Heart-Balasmeh

62
Q

Tricuspid regurg - pathophysiology (2)

A

More common than stenosis due to weaker annulus
Causes RV dilatation, not hypertrophy

63
Q

Epstein anomaly - association

A

Associated with maternal lithium use, can be sporadic

64
Q

Epstein anomaly, appearance (3)

A

Tricuspid valve is hypoplastic, posterior leaf displaced apically.
Tricuspid regurg
Enlarged RA, Smaller RV, Box shaped heart on CXR

65
Q

Tricuspid atresia associations (3)

A

Almost always ASD or PFO
Asplenia
Right arch

66
Q

Tricuspid atresia - pathophysiology (2)

A

Occurs with RV hypoplasia
Usually has pulmonary stenosis and therefore decreased vascularity (increased vascularity if no pulmonary stenosis)

67
Q

Carcinoid syndrome - sequelae (2)

A

Valvular disease only after tumour has metastasized to liver.
Serotonin usually degrades tricuspid and pulmonary valves.

68
Q

Carcinoid syndrome - distribution (3)

A

Rare to affect left valves, lungs degrade vasoactive substances.
If left sided disease, think either:
- Primary bronchial carcinoid
- Right to left shunts

FRCR 2A (Crack The FRCR 2A) (55 decks)

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