Cardiac Flashcards
What aortic valve abnormality is associated with Coarctation? pseudo-coarctation of the aorta?
Aortic coarctation is associated with bicuspid aortic valves 75% of the time (Then turners); the link between pseudocoarctation and bicuspid aortic valves is not as well established, though it has been reported. Bicuspid aortic valves are associated with ascending aortic aneurysms and dissection, even in the absence of significant aortic stenosis.
most common VSD?
Perimembranous are most common.
1) Perimembranous and 2) membranous VSDs comprise 80% of all ventricular septal defects (VSDs).
Cardiac technical dose modulation
“There are many methods of dose modulation:
EKG modulation is a feature of retrospective gating (helical acquisition).
Similarly, Z-axis mA dose modulation can only be used in helical scanning methods.
EKG padding, in which the tube is kept on at full dose for a longer period of time surrounding the optimal time of acquisition (normally 75% of the R-R interval), can be used in both prospective and retrospective techniques and leads to increased dose.
”
What are contraindictations for cardiact CT GTN
Someone who has used sildenafil (Viagra) or similar medication should not be given nitrates within 24 hours of use.
Congenital heart disease: Truncus arteriosus
A single large vessel arising from the ascending aorta to supply the pulmonary arteries is diagnostic of a type I truncus arteriosus. In a type II and type III truncus, the branch pulmonary arteries arise from the ascending and descending thoracic aorta, respectively.
When does cyanosis occur with D-transposition?
“D-transposition of the great vessels is characterized by cyanosis at birth (D = Death).
- The chest radiograph shows a characteristic ““egg-on-a-string”” sign in addition to increased pulmonary vascularity.
- Atrioventricular concordance and ventriculoarterial discordance is seen.
Treatment includes giving prostaglandin E1 to keep the ductus ateriosus open, an atrial septostomy, and eventually an arterial switch procedure (Jatene).”
What is the definition of coronary artery aneurysm? what are common causes?
”- Greater than 1.5 the normal diameter (<50% of length)
- Atheroscloeriss, kawasakis, connective tissue diseases”
What are the aortic valve index for mild/mod/severe/critical Aortic stenosis?
“• Mild: 1.5 to 2.0 cm2 (indexed: 0.9–1.1 cm2/m2)
• Moderate: 1.0 to 1.5 cm2 (indexed: 0.6–0.9 cm2/m2)
• Severe: < 1.0 cm2 (indexed: < 0.6 cm2/m2)
• Critical: < 0.75 cm2 (indexed: < 0.45 cm2/m2)
REMEMBER 1.5 and 1”
What are findings in Hypertrophic cardiomyopathy?
- enlargement (>15mm)
- Systolic anterior motion of mitral valve
- DCE at Right ventricle insertion points
”- 1) Septal myocardial hypertrophy, 2) delayed enhancement at the right ventricular insertion points, and 3) outflow tract obstruction are characteristic of hypertrophic cardiomyopathy.
- This pattern of enhancement is often seen with the septal variant of hypertrophic cardiomyopathy (HCM), whereas more diffuse, ill-defined mid-myocardial enhancement is seen in other variants of HCM. However, mild enhancement at the right ventricular insertion points can be seen in patients with pulmonary hypertension, so its presence alone should not make a diagnosis of HCM. Both the septal and diffuse variants can lead to outflow tract obstruction, which is sometimes referred to as hypertrophic obstructive cardiomyopathy (HOCM). However, not all cases of septal or diffuse HCM cause outflow obstruction. In the past, it was felt that this obstruction was the cause of sudden cardiac death in these patients. However, it is now believed that areas of myocardial scarring, as manifest by delayed enhancement, lead to conduction abnormalities and ventricular arrhythmias, which is the cause of sudden cardiac death. Treatment includes beta blockers and calcium channel blockers to improve diastolic relaxation, septal myomectomy for symptomatic relief in refractory cases, and automated implantable cardioverter-defibrillator (AICD) placement in those at high risk for sudden cardiac death.
- Septum >15mm or more
- Risk of Sudden death at 30mm!”
What are the two types of transposition? Which one can survive without correction?
“Levo-transposition of the great vessels (L-TGA) is characterized by atrioventricular discordance and ventriculoarterial discordance and is also called ““congenitally corrected”” TGA.
- You can think of this as ““2 wrongs make a right.””
- Another way to remember how to distinguish between L-TGA and dextro-transposition of the great vessels (D-TGA) is that L = life (can survive without correction) and D = death (fatal without correction).
- In TGA, you can recognize the right ventricle by its increased trabeculations, moderator band, and chordal attachments to the septum, and you can recognize the left ventricle by its smooth wall and lack of chordal attachments to septum.
- In L-TGA, the pulmonary artery arises anteriorly from the left ventricle while the aorta arises posteriorly from the right ventricle. Associated lesions include ventricular septal defects (60-70%), right ventricular outflow tract obstruction (30-50%), and systemic atrioventricular valve abnormalities (90%).”
What is coronary artery scoring system called? what is the HU threshold for Coronary artery calcification
Angston scoring system
>130 HU and area >1mm2
what are the signs of cardiac tamponade
“flattening of the anterior surface of the heart
RV compression
Reflux into hepatic veins
Enlargement of SVC and IVC”
“PAPVR:
1) what is the associated ASD
2) what Qp/Qs ratio is it treated?”
“1) Sinus venosus
2) Qp/Qs (pulmonary to systemic flow): of greater than 1.5”
What are the most common associations with coarctation of the aorta?
“1) bicuspid
2) turners”
What are the criteria for diagnosing pulmonary hypertension?
”* PA pressure >25mmHg
- RV hypertrophy when 4mm or greated
- Main PA > Ao (96% PPV)
- Main PA >30”
