Cardiac Flashcards
Massive enlargement of the main pulmonary artery
2
Idiopathic pulm rterial hypertension
Eisenmengers
Coarctation of Aorta
Associated conditions
4
Bicuspid AV - 85%
Turners
AR
PDA
Coronary artery aneurysms
Causes 3
Criteria
Anticoagulation
Atherosclerosis
Trauma/iatro
Vasculitis ( Kawasaki)
1.5x normal diameter
if >8mm anticoag
Heart disease with
Normal heart size
+ LAA
no signposts
MS
Restricted compliance : Restrictive CM, hypertrophic CM, constrictive pericarditis
Normal heart size with aortic enlargement
or no signposts
AS
Acute MI
Restrictive CM
Hypertrophic CM
Constrictive pericarditis
d-TGA features
RF
Post surgical
LV to PA
RV to Ao
Cardiomegaly
Plethora
Cyanosis
Narrow mediastinum
Arterial switch –> Pulm stenosis
Atrial switch - RV dys, baffle stenosis, clot
Cyanosis Cardiomegaly Pulm plethora Type 4 lesions T
narrow superior mediastinum: TGA Truncus TAPVR (T) ingle ventricle
Vascular rings
Causes 2
Right arch with aberrant L SCA
Double aortic arch
Occult cardiac shunts
3
Sinus Venosus ASD (SVC or IVC connects to LA)
PAPVC
Supracristal VSD (subpulmonic)
Cardiomegaly with LAE
MR
Cardiomegaly with Aortic enlargement or
No signposts
AR
Idiopathic DCM Ischaemic CM TR RVF Pericardial effusion
In intracardiac shunts what is Qp/Qs?
Ratio of pulmonary flow to systemic flow
Ratio > 1.5 requires surgical correction or evidence of RV overload
Non cyanotic heart disease with pulmonary plethora :
LAE
no LAE
Group 1
LAE:
VSD
PDA
No LAE
ASD
PAPVR
Non cyanotic heart disease with pulmonary plethora :
AoA Enlargement
No AoA E
AAE:
PDA
No AAE
VSD
Order of RCA branching
1
2 - %
3
- Conus branch ( to infundibulum)
- SAN artery (60%)
- Acute Marginal branches
- (PDA)
Morphologically right ventricle
two features
Moderator band
Contraction of outflow tract(contains muscle)
CT features of high risk coronary plaque
4
Calcific densities- punctate
Positive remodelling(expansion of vessel)
Napkin ring sign
Hypodensities within plaque
Sinus of Valsalva Aneurysm
demo
CMR criteria
Rare (0.15-3.5%)
Right sinus 72 %
Localised weakness of elastic lamina(cong/acq)
CMR criteria : origin above aortic annulus, saccular shape, normal root/AA dimensions
Inform ASAP
Lipomatous hypertrophy of RA
demo
CMR features
rel common 1-8% pseudomass, age/BMI most asymptomatic/SVT CMR: freq septal location with thickening > 2cm, spares fossa ovalis, rarely involved RA free wall FS TSE diagnostic
Anatomic cardiac pseudomasses
3
Prominent crista terminalis
Prominent chiari network/ eustacian valve
Moderator band
DDx for LV non compaction
DCM
ARVC
Athlete- hypertrabeculations
Trabecular mass > 20% or
Non com/compacted ratio > 2.3
Myocardial fatty infiltration vs ARVC features
ARVC : young-middle aged, male location : RVOT, RV free wall, RV septum, LV free wall Subepicardium Thin myocardium Enlarged RV
Features of true perfusion defect on CMR
4
Non Gd enhancing dark zone
Persists through atleast 3 beats
Spreads from subendocardium to subepicardium
More conspicous during stress
AMI vs acute myocarditis
AMI : subendocardial LGE + oedema
myocarditis : subepicardial
LCA origin from Right sinus
possible pathways
4
ARCA>ALCA
Interarterial ( malignant)
retroarotic - commenest
Prepulmonic
Septal/subpulmonic
Anomalous origin of LCA from PA
ALCAPA
Bland white garland Xd Obligatory ischaemia 0.25-0.5% of CHD Infantile - direct reimplan Adult - ligation/CABG
Coronary artery fistula
drainage
usually drains to low pressure chamber RV 41% RA 26% PA 17% CS 7%
Functionally significant/ potentially malignant coronary artery anomalies 4 Origin Course Termination
Origin from opposite sinus with interarterial course
ALCAPA
CA fistula
Coronary atresia/hypoplasia
Signs of constrictive pericarditis
3
calcified, thickened pericardium
mass effect on vessels/chambers
early diastolic flattening of IVS - MRI
Congenital absence of pericardium
complete/partial
Levorotation of heart
absence of pericardial recess ( PA-AA) - lung dips into it
Cardiac myxoma
90% LA 90% solitary May be ass with Carney complex attached to fossa ovalis may contain Ca+ delayed CE
Caseous necrosis of mitral annular calcification
not related to TB ? aetiology mass effect can rupture white on NC and CE exclude circum aneurysm
Malignant cardiac tumours
Secondary ( local: lung, breast and mets ) x 20 more common
Primary
Sarcomas ( 95%): angiosarcoma adults, rhabdomyosarcoma paeds, fibrosarcoma
Lymphoma 5%
