1. Cardiac p32-33 (Non-ischaemic)

Question 1

Dilated cardiomyopathy - definition

Answer 1

Dilatation with end diastolic diameter of >55mm and reduced EF

Question 2

Dilated cardiomyopathy - imaging (2)

Answer 2

Idiopathic: No enhancement OR linear mid-myocardial enhancement
Ischaemic: May show subendocardial enhancement.

Question 3

Dilated cardiomyopathy associated with

Answer 3

Mitral regurg due to mitral ring dilatation

Question 4

Restrictive cardiomyopathy - definition

Answer 4

Anything that causes a decrease in diastolic function.

Question 5

Restrictive cardiomyopathy - cause (3)

Answer 5

Commonest: Infiltration of myocardium (amyoid)
Myocardium replaced with fibrous tissue (fibroelastosis)
Damage by iron (haemochromatosis)

Question 6

Amyloidosis (cardiac) - definition & trivia (2)

Answer 6

Abnormal deposits in the myocardium causing abnormal diastolic function.
Seen in 50% of cases of systemic amyloid

Question 7

Amyloidosis (cardiac) (anatomy) (3)

Answer 7

Biatrial enlargement,
Concentric thickening of left ventricle,
Reduced systolic function of both ventricles

Question 8

Amyloidosis (cardiac) (imaging) (3)

Answer 8

Sometimes circumferential subendocardial enhancement.
Long T1 needed (350ms vs 200), so long the blood pool is darker than myocardium.
“Difficult to suppress myocardium”

Question 9

Eosinophillic cardiomyopathy (Loeffler) - buzzword

Answer 9

Bilateral ventricular thrombi (long T1 to show)

Question 10

Constrictive pericarditis - cause (2)

Answer 10

Commonly iatrogenic due to CABG or radiation.
Used to be TB or viral

Question 11

Constrictive pericarditis - imaging (3)

Answer 11

CT: Thick pericardium >4mm.
If calcified, this is diagnostic. Calcification usually runs in AV groove.
“Sigmoidisation” seen on SSFP imaging: Ventricular septum moves left in a wave during early diastole “diastolic bounce” - suggests interventricular dependence

Question 12

Constrictive vs Restrictive pericarditis (2)

Answer 12

Constrictive has thicker pericardium.
Constrictive features diastolic septal bounce

Question 13

Myocarditis - cause

Answer 13

Usually viral (e.g. Coxsackie)

Question 14

Myocarditis - imaging (2)

Answer 14

Late enhancement over non-vascular distribution.
Either midwall or epicardial distribution (not subendocardial)

Question 15

Sarcoidosis - trivia (2)

Answer 15

Cardiac involvement in 5% of systemic cases
carries increased risk of death.

Question 16

Sarcoid - Imaging & distribution (5)

Answer 16

High T2, early and late Gd enhancement.
Late Gd enhancement is middle or epicardial, non-coronary distribution.
Focal wall thickening from oedema can mimic hypertrophic cardiomyopathy.
Often affects septum.
RV and papillaries are rarely affected

Question 17

Takotsubo cardiomyopathy - clinical (2)

Answer 17

Post-menopausal women post stressful event.
Chest pain and ECG changes

Question 18

Takotsubo cardiomyopathy - imaging (3)

Answer 18

Balooning of left ventricle is buzzword.
Transient akinesia or dyskinesia of left ventricle apex WITHOUT coronary stenosis.
No delayed enhancement.

Question 19

Subendocardial enhancement on MRI

Answer 19

Infarct

Question 20

Transmural enhancement on MRI

Answer 20

Infarct

Question 21

Subendocardial circumferencial enhancement on MRI

Answer 21

Amyloid

Question 22

Midwall, non linear enhancement on MRI

Answer 22

HOCM

Question 23

Midwall, linear enhancement on MRI (septal) (2)

Answer 23

Myocarditis,
Idiopathic DCM

Question 24

Midwall, linear enhancement on MRI (lateral) (2)

Answer 24

Myocarditis,
Sarcoid

Question 25

Epicardial enhancement on MRI (2)

Answer 25

Myocarditis,
Sarcoid