Cardiac Flashcards
How do you determine which coronary artery is dominant?
Whichever artery supplies the PDA.
Right 85% of the time
Acute MI with bradycardia generally implicates which artery?
R… AV node supplied by AV node artery
Which two vessels are connected by a blalock taussig shunt?
Subclavian and pulmonary arteries.
Most common congenital heart defect?
VSD
Bland-White-Garland syndrome?
Anomalous left coronary artery from the pulmonary artery (ALCAPA).
rare
serious- cause of sudden cardiac death
What is the course of a malignant left coronary artery?
between aorta and main pulmonary artery- often at acute angle from its anomalous origin
Most common type of VSD?
Perimembranous.
How do you define the right atrium?
IVC
muscular ridge that runs from the entrance of the super to inferior vena cava?
crista terminalis
This is not a clot or a tumor
flap where IVC hooks up to atrium?
eustachian valve
called “chiari network” when it appears more trabeculated
main draining vein of myocardium? where is it?
coronary sinus
AV groove posterior surface of heart and enters R atrium near tricuspid valve
what defines the R ventricle?
moderator band.
double density sign
2 right heart contours- caused by enlargemnt of the R side of the L atrium
You are shown an echogenic focus in L ventricle on prenatal U/S. What next?
look for other signs of Downs. Only means downs 13% of the time though.
tricuspid papillary muscles insert on the____?
septum
dumbell shaped fat in the intra-atrial septum?
lipomatous hypertrophy of the intra-atrial septum
spares the fossa ovalis (lipoma won’t spare)
assoc. w/ fat and old
usually does nothing, but can cause arrythmia
can be hot on PET (brown fat)
what coronary supplies the septum
L main -> LAD
What coronary supplies the AV node?
RCA 90% of the time
Diagonal branches come from…?
LAD
LAD
Which malignant course of coronary artery is always surgical?
anomalous left of the right cusp
What perfuses the SA node?
RCA 60% of the time
ALCAPA
anomalous L coronary from the pulmonary artery
- infantile die early
- adult at risk of sudden death
Steal syndrome describes a reversal of flow in the LCA as pressure decreases in the circulation
Most common cause of coronary artery aneurysm in child
Kawasaki
if you are shown crazy dilation of the coronaries what should you think of?
coronary fistula
Who gets coronary CT?
- low risk or atypical chest pain patients
- suspected aberrant coronary anatomy
Ideal coronary CT heart rate?
less than 60bpm
what do you use to lower heart rate in coronary CT?
beta blockers
Contraindications to beta blockers?
severe asthma, type 2 and 3 heart block, acute chest pain, coke
Patient HR too high and can’t get beta blocker. What kind of cardiac CT?
retrospective gating
“step and shoot” is what kind of cardiac CT?
prospective- R wave triggers data acquisition
*not helical
helical cardiac CT?
retrospective, scans the whole time and then back calculates
higher radiation
what drug is given to dilate the coronaries for cardiac CT?
nitroglycerine
contraindications to nitroglycerine?
SPB < 100mmHg
severe aortic stenosis
HCOM
viagra
When I say “supra-valvular Aortic Stenosis” you say___
Williams Syndrome
What is the most common congenital heart disease?
Pick bicuspid aortic valve if they list it, pick VSD if not.
Biscupid aortic valve is associated with what other problems?
aortic aneurysm (even without stenosis)
cystic medial necrosis
Turner’s/coarc
PCKD
MC cause of mitral stenosis?
rheumatic heart disease
shown cxr with L atrial enlargement/dbl density sign/spalying of carina/posterior esophageal displacement
Isolated RUL pulm edema is associated with what cardiac problem?
Mitral regurg
MC cause mitral regurg?
endocarditis or papillary muscle/chordal rupture post MI (austin flint murmur)
chronic: myxomatous degeneration, dilated cardiomyophathy
What syndrome is assoc with pulmonary valve stenosis?
Noonan
(male version of Turner)
What syndrome is assoc with peripheral pulmonary stenosis?
Alagille syndrome
(kids with absent bile ducts)
Causes of tricuspid regurg?
endocarditis (IV drug use)
carcinoid (serotonin weakens valve)
MC cause in adults: pulm arterial HTN
causes RV dilation, not RV hypertrophy
Massive “boxed shaped” heart.
Ebstein anomaly
mom used lithiu (more common sporadic)
tricuspid hypoplastic -> RA enlargemtn, RV decreased, tricuspid regurg
Associations with tricuspid atresia?
RV hypoplasia
almost always ASD or PFO
asplenia
pulmonary stenosis -> decreased vascularity, but if not, than increased vascularity
left sided valvular disease related to carcinoid
think primary bronchial carninoid OR right to left shunt
lungs degrade vasoactive substances
Right and Left arch is the aorta’s relationship to the ____?
trachea
What creates the “ring” in R arch with aberrant L SCA?
ligament arteriosum on the L helps encircle the trachea
R arch + mirror branching associations?
90 % will have TOF
6% will have truncus
If person has truncus, 33 % will have R arch
if Tet: 25% will have R arch
MC arch anomaly?
L arch with aberrant R SCA
sometimes dysphagia lusoria
diverticulum of Kommerell: origin of R SCA dilated
MC vascular ring?
dbl aortic arch
sx at birth: tracheal compression/difficulty swallowing
Causes of subclavian steal?
98% of the time is atherosclerosis of SCA central to the vert a.
alt: takayasu, radiation, preductal aortic coarc, blalock-taussig shunt
Congenital heart cxr
egg on string
transposition
Congenital heart cxr
snow man
TAPVR (supracardiac)
Congenital heart cxr
boot shaped
TOF
Congenital heart cxr
scimitar sword
PAPVR with hypoplasia
Cyanotic or not?
TOF
yes
Cyanotic or not?
TAPVR
yes
Cyanotic or not?
Transposition
yes
Cyanotic or not?
Truncus
yes
Cyanotic or not?
Tricuspid atresia
yes
Cyanotic or not?
ASD
no
Cyanotic or not?
VSD
no
Cyanotic or not?
PDA
no
Cyanotic or not?
PAPVR
no
Cyanotic or not?
post ductal coarc (adult)
no
MC type of VSD
membranous
A PDF should make you say:
____
____
____
premature
materanl rubella
cyanotic heart disease
MC ASD type?
secundum (50-70%)
Primum subtype is from endocardial cushion defect
hand/thumb defects + ASD
Holt Oram
ostium primum ASD/endocardial cushion defect?
Down’s
Sinus venosus VSD
PAPVR
R PAPVR is assoc with____
Sinus veosus ASD
RUL: SVC association with sinus venosus type ASD
R PAPVR + pulmonary hypoplasia
scimitar syndrome
what is required to make TAPVR survivable?
large PFO or less commonly ASD
MC TAPVR?
Type 1: veins drain above the heart (snowman)
TAPVR- full on newborn edema?
type 3- drains below diaphram into hepatic veins or IVC
MC cause of cyanosis druing first 24hrs
transposition
DM moms
difference between D and L type transpositions?
D: only connection between systemic and pulmonary circs is the PDA
L: congenitally corrected (“Lucky”) atrium hooks up with wrong ventricle and ventricle hooks up with wrong vessels)
Don’t forget: RV is defined by moderator band
MC cyanotic heart disease?
TOF
- VSD
- RVOT Obstruction
- Overriding aorta
- RV hypertophy
pentaology if ASD too
MC complication from surg is pulm regurg
single trunk supplies pulmonary and systeic circs with likely VSD
assoc with R arch
Truncus
assoc with CATCH-22 genetics DiGeorge Syndrome
left ventricla and aorta are hypopastic-> pulmonary edema
hypoplastic L heart. MUST have ASD or large PFO
typically have PDA
also strong assoc with aortic coarc and endocardial fibroelastosis
“three atrium” appearing heart- abnormal pulmonary vein drains into L atrium
cor triatriatum sinistrum
usually fatal within 2 years
pulm edema
Polypoid smooth mass involving valve
papillary fibroelastoma
difference between stunned and hibernating myocardium?
stunned will have normal perfusion study, but bad contractility while hibernating will have decreased perfusion and contractility even when resting. NOT an infarct. Will take up FDG more avidely than the normal tissue.
scar = dead
When can you expect Dressler syndrome?
4-6 weeks
= pericarditis
When can you expect papillary muscle rupture?
2-7 days
When can you expect ventricular pseudoaneurysm?
3-7 days
When can you expect ventricular aneurysm?
months- needs remodeling and thinning
When can you expect myocardial rupture?
Within 3 days
You are shown a fat sat image of the heart- what should you look for?
Probably trying to show ARVC (arrythmogenic right ventricular cardiomyopathy) where there is fibrofatyy degeneration of the RV
what does L ventricular non-compaction look like?
spongey loosely packed myocardium
MC primary malignant tumor of the heart in adults?
angiosarcoma
Bzzz: sun-ray
MC fetal cardiac tumor
Rhabdomyoma
hamartom of the L ventricle, assoc with TS
MC neoplasm to involve cardiac valves?
fibroelastoma
mobile
systemic emboli
