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FRCR 2A (Crack The FRCR 2A) > 1. Cardiac p10-20 (Chambers, coronaries, valves, great vessels) > Flashcards

1. Cardiac p10-20 (Chambers, coronaries, valves, great vessels) 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
Malignant origin of coronary artery (Clinical significance)
Courses between pulmonary artery and aorta, can get compressed --> sudden cardiac death.
26
ALCAPA syndrome - definition
Anomalous Left Coronary Artery from Pulmonary Artery
27
ALCAPA syndrome - types (2)
Infantyle type --> die early Adult type --> risk of sudden death Associated with STEAL syndrome: Reversal of LCA flow as pressure decreases in pulmonary circulation
28
ALCAPA syndrome - Association
Associated with STEAL syndrome: Reversal of LCA flow as pressure decreases in pulmonary circulation
29
Myocardial bridging - Definition
Intramyocardiac course of coronary artery, usually LAD.
30
Myocardial bridging - Sequelae (2)
Symptoms in systole as diameter decreases. Can cause ischaemia. Can be issue for CABG planning.
31
Coronary artery aneurysm - definition
Coronary vessel diameter 1.5x normal.
32
Coronary artery aneurysm - causes (3)
Adults commonest cause: Atherosclerosis Kids commonest cause: Kawasaki Iatrogenic (Cardiac catheter) can also cause
33
Coronary fistula - definition and distribution
Connection between coronary artery and great vessel or chamber. Usually RCA and right chambers.
34
Coronary fistula - Association
Associated with coronary aneurysms
35
Ideal patients for coronary CT (2)
Low risk/atypical chest pain (prevents risky cath angio for e.g. GORD) Suspected aberrant coronary artery
36
Ideal HR for coronary CT (2)
Ideally <60. Slower is better. Beta blockers used to help
37
Contraindications to beta blockers (4)
Severe asthma, Heart block (2nd or 3rd degree), Acute chest pain, Recent cocaine use
38
Can't give beta blockers for coronary CT?
Retrograde gated study rather than prospective
39
Prospective vs retrospective gating (definition, pros/cons)
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
Nitroglycerine in coronary CT (purpose)
Dilates coronary arteries
41
Contraindications to nitroglycerine (4)
Hypotension(SBP<100) Severe AS HOCM Sildenafil use
42
VENC (definition)
Velocity ENcoded Cine MR Imaging - used to quantify velocity of flowing blood
43
Aortic stenosis (Types) (3)
Congenital (bicuspid) Acquired (degenerative or rheumatic heart)
44
Aortic stenosis severity grading
Based on velocity of blood flow (VENC)
45
Aortic stenosis appearance (2)
Concentric LV Hypertrophy Dilatation of the ascending aorta (Valvular (90%), subvalvular or supravalvular)
46
Supravalvular aortic stenosis associated with
Williams syndrome
47
Bicuspid aortic valve & coarctation associated with
Turners syndrome
48
Commonest congenital heart disease
Bicuspid aortic valve
49
Bicuspid aortic valve associations (4)
Aortic aneurysm (even in absence of stenosis) Cystic Medial Necrosis Turners and coarctation Polycystic kidney disease
50
Aortic regurg associated with (4)
Bicuspid valve Marfans Aortic root dilatation (HTN) Bacterial endocarditis
51
Haemodynamic impact of aortic regurg determined by
Rapidness of onset (less time for adaptation)
52
Mitral stenosis - commonest cause
Commonest cause is Rheumatic Heart Disease
53
Mitral stenosis - CXR appearance
CXR shows left atrial enlargement
54
Mitral regurg - acute causes (2)
Endocarditis Papillary muscle or chordae rupture post MI
55
Mitral regurg - chronic causes (2)
Primary: myxomatous degeneration Secondary: Dilated cardiomyopathy leading to mitral annular dilatation
56
Mitral regurg causes
Isolated right upper lobe oedema
57
Pulmonary stenosis - associations (4)
Supravalvular - Williams syndrome Valvular - Noonan's syndrome Subvalvular - TOF Peripheral pulmonary stenosis - Alagille syndrome
58
Pulmonary regurg - cause
Commonly congenital valve disease, post op (commonly TOF post repair)
59
Multivalve disease, think...
Rheumatic fever (immune response to group A beta-haemolytic strep)
60
Tricuspid regurg associations (3)
Commonest cause in adults: Pulmonary HTN Others: Endocarditis (IVDU) Carcinoid syndrome (serotonin degrades valve)
61
Cherub syndrome
Sami-Good-Heart-Balasmeh
62
Tricuspid regurg - pathophysiology (2)
More common than stenosis due to weaker annulus Causes RV dilatation, not hypertrophy
63
Epstein anomaly - association
Associated with maternal lithium use, can be sporadic
64
Epstein anomaly, appearance (3)
Tricuspid valve is hypoplastic, posterior leaf displaced apically. Tricuspid regurg Enlarged RA, Smaller RV, Box shaped heart on CXR
65
Tricuspid atresia associations (3)
Almost always ASD or PFO Asplenia Right arch
66
Tricuspid atresia - pathophysiology (2)
Occurs with RV hypoplasia Usually has pulmonary stenosis and therefore decreased vascularity (increased vascularity if no pulmonary stenosis)
67
Carcinoid syndrome - sequelae (2)
Valvular disease only after tumour has metastasized to liver. Serotonin usually degrades tricuspid and pulmonary valves.
68
Carcinoid syndrome - distribution (3)
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) (79 decks)

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