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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
Q

Who gets coronary CT?

A
  1. low risk or atypical chest pain patients
  2. suspected aberrant coronary anatomy
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26
Q

Ideal coronary CT heart rate?

A

less than 60bpm

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27
Q

what do you use to lower heart rate in coronary CT?

A

beta blockers

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28
Q

Contraindications to beta blockers?

A

severe asthma, type 2 and 3 heart block, acute chest pain, coke

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29
Q

Patient HR too high and can’t get beta blocker. What kind of cardiac CT?

A

retrospective gating

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30
Q

“step and shoot” is what kind of cardiac CT?

A

prospective- R wave triggers data acquisition

*not helical

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31
Q

helical cardiac CT?

A

retrospective, scans the whole time and then back calculates

higher radiation

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32
Q

what drug is given to dilate the coronaries for cardiac CT?

A

nitroglycerine

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33
Q

contraindications to nitroglycerine?

A

SPB < 100mmHg

severe aortic stenosis

HCOM

viagra

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34
Q
A
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35
Q

When I say “supra-valvular Aortic Stenosis” you say___

A

Williams Syndrome

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36
Q

What is the most common congenital heart disease?

A

Pick bicuspid aortic valve if they list it, pick VSD if not.

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37
Q

Biscupid aortic valve is associated with what other problems?

A

aortic aneurysm (even without stenosis)

cystic medial necrosis

Turner’s/coarc

PCKD

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38
Q

MC cause of mitral stenosis?

A

rheumatic heart disease

shown cxr with L atrial enlargement/dbl density sign/spalying of carina/posterior esophageal displacement

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39
Q

Isolated RUL pulm edema is associated with what cardiac problem?

A

Mitral regurg

40
Q

MC cause mitral regurg?

A

endocarditis or papillary muscle/chordal rupture post MI (austin flint murmur)

chronic: myxomatous degeneration, dilated cardiomyophathy

41
Q

What syndrome is assoc with pulmonary valve stenosis?

A

Noonan

(male version of Turner)

42
Q

What syndrome is assoc with peripheral pulmonary stenosis?

A

Alagille syndrome

(kids with absent bile ducts)

43
Q

Causes of tricuspid regurg?

A

endocarditis (IV drug use)

carcinoid (serotonin weakens valve)

MC cause in adults: pulm arterial HTN

causes RV dilation, not RV hypertrophy

44
Q

Massive “boxed shaped” heart.

A

Ebstein anomaly

mom used lithiu (more common sporadic)

tricuspid hypoplastic -> RA enlargemtn, RV decreased, tricuspid regurg

45
Q

Associations with tricuspid atresia?

A

RV hypoplasia

almost always ASD or PFO

asplenia

pulmonary stenosis -> decreased vascularity, but if not, than increased vascularity

46
Q

left sided valvular disease related to carcinoid

A

think primary bronchial carninoid OR right to left shunt

lungs degrade vasoactive substances

47
Q

Right and Left arch is the aorta’s relationship to the ____?

A

trachea

48
Q

What creates the “ring” in R arch with aberrant L SCA?

A

ligament arteriosum on the L helps encircle the trachea

49
Q

R arch + mirror branching associations?

A

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
Q

MC arch anomaly?

A

L arch with aberrant R SCA

sometimes dysphagia lusoria

diverticulum of Kommerell: origin of R SCA dilated

51
Q

MC vascular ring?

A

dbl aortic arch

sx at birth: tracheal compression/difficulty swallowing

52
Q

Causes of subclavian steal?

A

98% of the time is atherosclerosis of SCA central to the vert a.

alt: takayasu, radiation, preductal aortic coarc, blalock-taussig shunt

53
Q

Congenital heart cxr

egg on string

A

transposition

54
Q

Congenital heart cxr

snow man

A

TAPVR (supracardiac)

55
Q

Congenital heart cxr

boot shaped

A

TOF

56
Q

Congenital heart cxr

scimitar sword

A

PAPVR with hypoplasia

57
Q

Cyanotic or not?

TOF

A

yes

58
Q

Cyanotic or not?

TAPVR

A

yes

59
Q

Cyanotic or not?

Transposition

A

yes

60
Q

Cyanotic or not?

Truncus

A

yes

61
Q

Cyanotic or not?

Tricuspid atresia

A

yes

62
Q

Cyanotic or not?

ASD

A

no

63
Q

Cyanotic or not?

VSD

A

no

64
Q

Cyanotic or not?

PDA

A

no

65
Q

Cyanotic or not?

PAPVR

A

no

66
Q

Cyanotic or not?

post ductal coarc (adult)

A

no

67
Q

MC type of VSD

A

membranous

68
Q

A PDF should make you say:

____

____

____

A

premature

materanl rubella

cyanotic heart disease

69
Q

MC ASD type?

A

secundum (50-70%)

Primum subtype is from endocardial cushion defect

70
Q

hand/thumb defects + ASD

A

Holt Oram

71
Q

ostium primum ASD/endocardial cushion defect?

A

Down’s

72
Q

Sinus venosus VSD

A

PAPVR

73
Q

R PAPVR is assoc with____

A

Sinus veosus ASD

RUL: SVC association with sinus venosus type ASD

74
Q

R PAPVR + pulmonary hypoplasia

A

scimitar syndrome

75
Q

what is required to make TAPVR survivable?

A

large PFO or less commonly ASD

76
Q

MC TAPVR?

A

Type 1: veins drain above the heart (snowman)

77
Q

TAPVR- full on newborn edema?

A

type 3- drains below diaphram into hepatic veins or IVC

78
Q

MC cause of cyanosis druing first 24hrs

A

transposition

DM moms

79
Q

difference between D and L type transpositions?

A

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
Q

MC cyanotic heart disease?

A

TOF

  1. VSD
  2. RVOT Obstruction
  3. Overriding aorta
  4. RV hypertophy

pentaology if ASD too

MC complication from surg is pulm regurg

81
Q

single trunk supplies pulmonary and systeic circs with likely VSD

assoc with R arch

A

Truncus

assoc with CATCH-22 genetics DiGeorge Syndrome

82
Q

left ventricla and aorta are hypopastic-> pulmonary edema

A

hypoplastic L heart. MUST have ASD or large PFO

typically have PDA

also strong assoc with aortic coarc and endocardial fibroelastosis

83
Q

“three atrium” appearing heart- abnormal pulmonary vein drains into L atrium

A

cor triatriatum sinistrum

usually fatal within 2 years

pulm edema

84
Q

Polypoid smooth mass involving valve

A

papillary fibroelastoma

85
Q

difference between stunned and hibernating myocardium?

A

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
Q

When can you expect Dressler syndrome?

A

4-6 weeks

= pericarditis

87
Q

When can you expect papillary muscle rupture?

A

2-7 days

88
Q

When can you expect ventricular pseudoaneurysm?

A

3-7 days

89
Q

When can you expect ventricular aneurysm?

A

months- needs remodeling and thinning

90
Q

When can you expect myocardial rupture?

A

Within 3 days

91
Q

You are shown a fat sat image of the heart- what should you look for?

A

Probably trying to show ARVC (arrythmogenic right ventricular cardiomyopathy) where there is fibrofatyy degeneration of the RV

92
Q

what does L ventricular non-compaction look like?

A

spongey loosely packed myocardium

93
Q

MC primary malignant tumor of the heart in adults?

A

angiosarcoma

Bzzz: sun-ray

94
Q

MC fetal cardiac tumor

A

Rhabdomyoma

hamartom of the L ventricle, assoc with TS

95
Q

MC neoplasm to involve cardiac valves?

A

fibroelastoma

mobile

systemic emboli

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