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Cardiac Flashcards

1
Q

Microvascular obstruction

A

Islands of dark tissue in sea of Gd enhancement.

Not seen in chronic infarction.

Poor prognostic finding, associated with lack of functional recovery.

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2
Q

True versus false ventricular aneurysms

A

True: Anterolateral wall. Wide mouth.

False: Posterolateral wall. Narrow mouth.

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3
Q

Viability

A

% of transmural involvement. T1 post-contrast inversion recovery gradient echo.

<25% likely to improve with PCI
25-50% may improve
>50% unlikely to recover

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4
Q

Timing of sequela of MI

A

within 3 days - myocardial rupture
2-7 days - Papillary muscle rupture
3-7 days - ventricular pseudoaneurysm
4-6 weeks - Dressler syndrome (effusion)
months - ventricular aneurysm

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5
Q

Cardiac MRI sequences

A

Spin echo - great for anatomy
Spoiled gradient echo (GRE) - for perfusion, angiography
SSFE - great for evaluating motion (valves, regurg, etc)
IR - normalizes myocardium. Good for pathology
Delayed CE - good for evaluating myocardial disease

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6
Q

Dilated cardiomyopathy

A

Reduced EF, EDV diameter > 55 mm

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7
Q

Restrictive versus constrictive pathologies

A

Restrictive - myocardial process. Amyloid most common

Constrictive - pericardial process. Causes: TB, viral, CABG. *Calcification is diagnostic. > 0.4 cm thick

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8
Q

Myocarditis

A

Often viral (Coxsackie). Involves lateral free wall, and pericardial or mid wall.

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9
Q

Takotsubo cardiomyopathy

A

Think octopus trap (ballooning of left ventricular apex*).

Transient akinesia/dyskenesia.

Post-menopausal women after stress event.

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10
Q

Eosinophilia Cardiomyopathy (Loeffler)

A

Bilateral ventricular thrombus

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11
Q

Ischemic versus non-ischemic cardiomyopathies

A

Ischemic - Usually confluent, subendocardial delayed enhancement extending transmurally in vascular distribution

Non-ischemic - patchy, nodular, mid/epicardial delayed enhancement not in vascular distribution

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12
Q

Chronic cocaine use

A

Circumferential subendocardial

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13
Q

HOCM

A

Concentric thickening of the left ventricle. LVOT obstruction. Asymmetric septal thickening with areas of delayed mid myocardial enhancement.

AD

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14
Q

Noncompaction

A

Left ventricular congenital cardiomyopathy with spongy appearance and deep trabeculations.

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15
Q

Myxoma

A

Left atrial wall. Heterogeneous circumscribed mass.

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16
Q

Fibroelastoma

A

On valve, but not at edge. Can embolize -> stroke, TIA. Most commonly on aortic valve

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17
Q

Rhabdomyoma

A

Tuberous sclerosis. Ventricular myocardium. Multiple. T2 bright.

Fibroma is T2 dark and large!

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18
Q

Angiosarcoma

A

Most common primary malignant tumor. Right atrium, invasive.

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19
Q

Congenital/acquired absence of pericardium

A

Leftward shift of heart contacting chest wall. Partial absence of left pericardium. Can result in herniation/strangulation if pneumonectomy performed.

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20
Q

Coronary sinus

A

Draining vein. Drains from posterior heart into right atrium.

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21
Q

Right ventricle enlargement

A

Cardiac apex is up and out

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22
Q

Left ventricle enlargement

A

Cardiac apex is down and out

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23
Q

Left atrial enlargement

A

Splaying of carina (obtuse angle). Right cardiac border is prominent. Walking man sign on lateral view.

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24
Q

LCA from the Right coronary sinus

A

Malignant origin. High rate of sudden cardiac death

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25
Q

ALCAPA

A

Left coronary artery comes off the pulmonary artery. Can result in Steal syndrome (retrograde flow when pulmonary pressures decrease). Can result in death.

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26
Q

Coronary artery aneurysm

A

Kawasaki in children. Atherosclerosis in adults

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27
Q

Echogenic focus in left ventricle

A

Seen with prenatal US. Associated with Down’s syndrome

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28
Q

Aliasing

A

Seen when velocity range too low during VENC MRI

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29
Q

Aortic stenosis

A

Supra-valvular - William’s syndrome

Bicuspid aortic valve and coarctation - Turner’s syndrome

Severe (requiring surgery) if: symptomatic, gradient > 40 mmHg, velocity > 4 m/s

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30
Q

Mitral stenosis

A

Rheumatic fever causes mitral valve stenosis most commonly but also other valvular stenoses. Presents as thickening/calcifications. Can result in Ortner’s syndrome (hoarseness) from left atrial enlargement compressing recurrent laryngeal nerve.

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31
Q

Mitral valve regurgitation

A

Post MI or endocarditis. RUL pulmonary edema

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32
Q

Pulmonary stenosis

A

Supra-valvular - WIlliams syndrome
Valvular - Noonan’s syndrome (Turner’s in males)
Sub-valvular - TOF

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33
Q

Pulmonary regurgitation

A

Most common complication from TOF repair

34
Q

Ebstein’s

A

Mom with Li use. Hypoplastic tricuspid valve. RA enlargement, RV atrophy. Massive box-shaped heart

35
Q

Carcinoid syndrome

A

Degenerates right-sided valves (tricuspid and pulmonic valves). Must have Mets to liver.

36
Q

Right arch with Mirror branching

A

Left subclavian arises from front of the arch. Associated with TOF, Truncus. 90% will have TOF. 25% of TOF have right arch, while 33% of Truncus have right arch

37
Q

Right arch with Aberrant left subclavian

A

Vascular ring encircling trachea

38
Q

Left arch with aberrant right subclavian

A

Most common arch anomaly. Can be symptomatic. Dilated RSCA = Diverticulum of Kommerell

39
Q

Double aortic arch

A

Most common vascular ring. Symptoms begin at birth - dysphagia, breathing issues.

40
Q

Subclavian steal syndrome/phenomenon

A

Stenosis of the origin of the left subclavian. Most commonly from atherosclerosis (adults), and Takayasu (young adults). Left vert reversal of flow (dizziness/syncope)

41
Q

Cyanotic versus non-cyanotic congenital heart disease

A

Cyanotic - 5 Ts (Truncus, TOF, TAPVR, Transposition, Tricuspid atreia)

42
Q

Pulmonary systemic flow ratio

A

= 1; Normal
> 1; pulmonary flow > systemic flow. Left to right shunt
< 1; systemic flow > pulmonary flow. Right to left shunt

43
Q

VSD

A

Most common congenital heart defect

44
Q

Patent PDA

A

Prematurity, rubella, Cyanotic heart disease

45
Q

ASD

A

Hand/tumb defects - Holt or am

Ostium primum, endocardial cushion (lower septum) - Downs (also mitral valve clefts), less likely DiGeorge, Ellis-Van

Sinus venous (upper septum) - PAPVR (Scimitar syndrome)

Ostium secundum (mid septum) - pulmonary hypertension, Ebstein’s

46
Q

Unroofed coronary sinus

A

Fenestrated sinus results in two-way flow and *paradoxical embolism. Strongly associated with left-sided SVC.

47
Q

TAPVR

A

All pulmonary venous return goes into right heart. Cyanotic. Large PFO, or ASD to survive. Associated with asplenia.

Type 1: Supracardiac. Snowman appearance on radiograph.

Type 3: Infracardiac. Drains below diaphragm. Pulmonary edema.

48
Q

Transposition

A

Most common cause of cyanosis within 24 hrs. Survival depends on VSD (most common), ASD, or PDA.

RV -> aorta
LV -> pulmonary trunk

D-transposition - egg on string appearance. *Jatene arterial switch - PA drapes over aorta.

L-transposition (lucky) - LA -> RV -> aorta, RA -> LV -> PA. Compatible with life.

49
Q

TOF

A

Most common Cyanotic heart disease.
1. VSD
2. RVOT obstruction
3. Overriding aorta
4. RV hypertrophy

(5. ASD - pentology)

Blalock-Taussig procedure. Can result in pulmonary regurgitation.

Boot shaped heart from RV enlargement

50
Q

Truncus arteriosus

A

Shared trunk supplying PA and aorta. Associated with VSD and right arch, and DiGeorge syndrome (CATCH 22).

Can have quadricuspid aortic valve but tricuspid still more common.

51
Q

Coarctation

A

Associated with Turner’s, bicuspid aortic valve, and berry aneurysms.

Figure 3 sign, rib notching

52
Q

Cor Triatriatum Sinistrum

A

Unnecessary fibromuscular membrane in the left atrium acts like mitral stenosis. Pulmonary edema.

53
Q

Hypoplastic left heart

A

Left ventricle and aorta are Hypoplastic. Must have ASD or large PFO, and typically PDA. Associated with aortic coarctation.

54
Q

Surgery for Hypoplastic left heart

A
  1. Norwood or Sano - within days
  2. Glen - 3-6 months
  3. Fontan 1.5 - 5 years
55
Q

Norwood

A
  1. Arch augmentation and anastomosis of arch to pulmonary trunk (to RV)
  2. ASD enlarged
  3. R subclavian to Right PA shunt (via Blalock-Taussig) - left to right shunt
56
Q

Sano

A

Same as Norwood, but shunt is from RV to R pulmonary artery to avoid steal phenomenon.

57
Q

Glenn

A

SVC to RPA. Proximal RPA closed. Diverts all venous return to right lung.

Complications: SVC syndrome. PA aneurysms

58
Q

Bi-directional Glenn

A

SVC to RPA, proximal RPA kept open to allow circulation to BOTH lungs. End to side.

59
Q

Fontan

A

Used to increase circulation to lungs (tricuspid, pulmonary atresia, and Hypoplastic left heart syndrome). RA -> L PA shunt. Bypasses RV.

Complications: Enlarged RA, plastic bronchitis, liver failure.

60
Q

Pulmonary artery banding

A

Done to reduce pulmonary artery pressure.

61
Q

Atrial switch

A

Performed for transposition in the first year of life. Creates a baffle that directs IVC and SVC blood to the left atrium without mixing.

Senning - no extrinsic material
Mustard - pericardium or synthetic material used

62
Q

Rastelli

A

For transposition and VSD. Baffle directs blood from the RV to the aorta, diverting blood from VSD to the aorta. Pulmonary valve sewn. Conduit placed between RV and PA. Left heart is now the systemic circulator. Requires surgical maintenance.

63
Q

Jatene procedure

A

For D-transposition repair. Another arterial switch. PA draped over aorta.

64
Q

Ross procedure

A

Switch diseased aortic valve with pulmonary valve, and pulmonary valve with homograft

65
Q

Bentall Procedure

A

Uses composite graft for aortic valve, aortic root, and ascending aorta replacement. Used for Marfan’s.

66
Q

Orthotopic heart versus heterotopic heart transplant

A

Ortho - native heart removed

Hetero - native one kept, giving it a changes to recover

67
Q

Neonatal CHF causes

A

Vein of Galen malformation, hepatic hemangioendothelioma

68
Q

Shone syndrome

A
  1. Parachute mitral valve
  2. Coarctation
  3. Subaortic stenosis
  4. Supravalvular mitral membrane
69
Q

VSD

A
  1. Muscular (lower VSD) - may close spontaneously
  2. Membranous (upper) - will not close

Eisenmenger - pHTN, reversal of shunt direction

70
Q

FFRCT threshold

A

< 0.75 - signficant stenosis

71
Q

Stunned versus hibernating myocardium

A

Stunned - resolves within weeks.

Hibernating - does not resolve.

No late Gd enhancement seen in both.

72
Q

Interatrial course of the RCA

A

Stress test first. If symptomatic, surgical correction.

73
Q

Cardiac amyloidosis

A

Diffuse subendocardial delayed enhancement, concentric thickening of LV.

Early nulling of myocardium before or at same time as blood pool (blood pool is usually bright, but is dark in this case, with the subendocardium demonstrating diffuse enhancement)

74
Q

Myotonic dystrophy cardiomyopathy

A

Intramyocardial fat deposition. Inferolateral wall fibrosis (late Gd enhancement).

75
Q

Constrictive pericarditis

A

RF: Radiation, etc…

Pericardial thickening, effusion, septal bounce or ventricular interdependence

76
Q

Left pulmonary artery, left main bronchus anatomy

A

Hyparterial (bronchus lower than artery)

77
Q

Right pulmonary artery, right main bronchus anatomy

A

Eparterial (bronchus higher than artery)

78
Q

Metastasis to the heart

A

Usually pericardial. Through lymphatic spread.

79
Q

Marfan’s syndrome

A

Annuloaortic ectasia (pear or tulip bulb appearance). Can also be seen with Ehler’s Danlos.

80
Q

Rapidly progressive aortic aneurysm

A

Mycotic aneurysm

81
Q

Surgical repair for Ascending aortic aneurysm

A

5.5 cm.

5.0 cm in Marfan’s patient

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