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Cardiac Flashcards

1
Q

How do you determine which coronary artery is dominant?

A

Whichever artery supplies the PDA.

Right 85% of the time

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2
Q

Acute MI with bradycardia generally implicates which artery?

A

R… AV node supplied by AV node artery

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3
Q

Which two vessels are connected by a blalock taussig shunt?

A

Subclavian and pulmonary arteries.

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4
Q

Most common congenital heart defect?

A

VSD

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5
Q

Bland-White-Garland syndrome?

A

Anomalous left coronary artery from the pulmonary artery (ALCAPA).

rare

serious- cause of sudden cardiac death

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6
Q

What is the course of a malignant left coronary artery?

A

between aorta and main pulmonary artery- often at acute angle from its anomalous origin

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7
Q

Most common type of VSD?

A

Perimembranous.

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8
Q

How do you define the right atrium?

A

IVC

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9
Q

muscular ridge that runs from the entrance of the super to inferior vena cava?

A

crista terminalis

This is not a clot or a tumor

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10
Q

flap where IVC hooks up to atrium?

A

eustachian valve

called “chiari network” when it appears more trabeculated

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11
Q

main draining vein of myocardium? where is it?

A

coronary sinus

AV groove posterior surface of heart and enters R atrium near tricuspid valve

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12
Q

what defines the R ventricle?

A

moderator band.

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13
Q

double density sign

A

2 right heart contours- caused by enlargemnt of the R side of the L atrium

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14
Q

You are shown an echogenic focus in L ventricle on prenatal U/S. What next?

A

look for other signs of Downs. Only means downs 13% of the time though.

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15
Q

tricuspid papillary muscles insert on the____?

A

septum

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16
Q

dumbell shaped fat in the intra-atrial septum?

A

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)

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17
Q

what coronary supplies the septum

A

L main -> LAD

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18
Q

What coronary supplies the AV node?

A

RCA 90% of the time

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19
Q

Diagonal branches come from…?

A

LAD

LAD

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20
Q

Which malignant course of coronary artery is always surgical?

A

anomalous left of the right cusp

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21
Q

What perfuses the SA node?

A

RCA 60% of the time

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22
Q

ALCAPA

A

anomalous L coronary from the pulmonary artery

  1. infantile die early
  2. adult at risk of sudden death

Steal syndrome describes a reversal of flow in the LCA as pressure decreases in the circulation

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23
Q

Most common cause of coronary artery aneurysm in child

A

Kawasaki

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24
Q

if you are shown crazy dilation of the coronaries what should you think of?

A

coronary fistula

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25
Who gets coronary CT?
1. low risk or atypical chest pain patients 2. suspected aberrant coronary anatomy
26
Ideal coronary CT heart rate?
less than 60bpm
27
what do you use to lower heart rate in coronary CT?
beta blockers
28
Contraindications to beta blockers?
severe asthma, type 2 and 3 heart block, acute chest pain, coke
29
Patient HR too high and can't get beta blocker. What kind of cardiac CT?
retrospective gating
30
"step and shoot" is what kind of cardiac CT?
prospective- R wave triggers data acquisition \*not helical
31
helical cardiac CT?
retrospective, scans the whole time and then back calculates higher radiation
32
what drug is given to dilate the coronaries for cardiac CT?
nitroglycerine
33
contraindications to nitroglycerine?
SPB \< 100mmHg severe aortic stenosis HCOM viagra
34
35
When I say "supra-valvular Aortic Stenosis" you say\_\_\_
Williams Syndrome
36
What is the most common congenital heart disease?
Pick bicuspid aortic valve if they list it, pick VSD if not.
37
Biscupid aortic valve is associated with what other problems?
aortic aneurysm (even without stenosis) cystic medial necrosis Turner's/coarc PCKD
38
MC cause of mitral stenosis?
rheumatic heart disease shown cxr with L atrial enlargement/dbl density sign/spalying of carina/posterior esophageal displacement
39
Isolated RUL pulm edema is associated with what cardiac problem?
Mitral regurg
40
MC cause mitral regurg?
endocarditis or papillary muscle/chordal rupture post MI (austin flint murmur) chronic: myxomatous degeneration, dilated cardiomyophathy
41
What syndrome is assoc with pulmonary valve stenosis?
Noonan | (male version of Turner)
42
What syndrome is assoc with peripheral pulmonary stenosis?
Alagille syndrome | (kids with absent bile ducts)
43
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
44
Massive "boxed shaped" heart.
Ebstein anomaly mom used lithiu (more common sporadic) tricuspid hypoplastic -\> RA enlargemtn, RV decreased, tricuspid regurg
45
Associations with tricuspid atresia?
RV hypoplasia almost always ASD or PFO asplenia pulmonary stenosis -\> decreased vascularity, but if not, than increased vascularity
46
left sided valvular disease related to carcinoid
think primary bronchial carninoid OR right to left shunt lungs degrade vasoactive substances
47
Right and Left arch is the aorta's relationship to the \_\_\_\_?
trachea
48
What creates the "ring" in R arch with aberrant L SCA?
ligament arteriosum on the L helps encircle the trachea
49
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
50
MC arch anomaly?
L arch with aberrant R SCA sometimes dysphagia lusoria **diverticulum of Kommerell:** origin of R SCA dilated
51
MC vascular ring?
dbl aortic arch sx at birth: tracheal compression/difficulty swallowing
52
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
53
_Congenital heart cxr_ egg on string
transposition
54
_Congenital heart cxr_ snow man
TAPVR (supracardiac)
55
_Congenital heart cxr_ boot shaped
TOF
56
_Congenital heart cxr_ scimitar sword
PAPVR with hypoplasia
57
_Cyanotic or not?_ TOF
yes
58
_Cyanotic or not?_ TAPVR
yes
59
_Cyanotic or not?_ Transposition
yes
60
_Cyanotic or not?_ Truncus
yes
61
_Cyanotic or not?_ Tricuspid atresia
yes
62
_Cyanotic or not?_ ASD
no
63
_Cyanotic or not?_ VSD
no
64
_Cyanotic or not?_ PDA
no
65
_Cyanotic or not?_ PAPVR
no
66
_Cyanotic or not?_ post ductal coarc (adult)
no
67
MC type of VSD
membranous
68
A PDF should make you say: \_\_\_\_ \_\_\_\_ \_\_\_\_
premature materanl rubella cyanotic heart disease
69
MC ASD type?
secundum (50-70%) Primum subtype is from endocardial cushion defect
70
hand/thumb defects + ASD
Holt Oram
71
ostium primum ASD/endocardial cushion defect?
Down's
72
Sinus venosus VSD
PAPVR
73
R PAPVR is assoc with\_\_\_\_
Sinus veosus ASD RUL: SVC association with sinus venosus type ASD
74
R PAPVR + pulmonary hypoplasia
scimitar syndrome
75
what is required to make TAPVR survivable?
large PFO or less commonly ASD
76
MC TAPVR?
Type 1: veins drain above the heart (snowman)
77
TAPVR- full on newborn edema?
type 3- drains below diaphram into hepatic veins or IVC
78
MC cause of cyanosis druing first 24hrs
transposition DM moms
79
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
80
MC cyanotic heart disease?
TOF 1. VSD 2. RVOT Obstruction 3. Overriding aorta 4. RV hypertophy pentaology if ASD too MC complication from surg is pulm regurg
81
single trunk supplies pulmonary and systeic circs with likely VSD assoc with R arch
Truncus assoc with CATCH-22 genetics DiGeorge Syndrome
82
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
83
"three atrium" appearing heart- abnormal pulmonary vein drains into L atrium
cor triatriatum sinistrum usually fatal within 2 years pulm edema
84
Polypoid smooth mass involving valve
papillary fibroelastoma
85
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
86
When can you expect Dressler syndrome?
4-6 weeks = pericarditis
87
When can you expect papillary muscle rupture?
2-7 days
88
When can you expect ventricular pseudoaneurysm?
3-7 days
89
When can you expect ventricular aneurysm?
months- needs remodeling and thinning
90
When can you expect myocardial rupture?
Within 3 days
91
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
92
what does L ventricular non-compaction look like?
spongey loosely packed myocardium
93
MC primary malignant tumor of the heart in adults?
angiosarcoma Bzzz: sun-ray
94
MC fetal cardiac tumor
Rhabdomyoma hamartom of the L ventricle, assoc with TS
95
MC neoplasm to involve cardiac valves?
fibroelastoma mobile systemic emboli

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