Cardiac

Question 1

Valvular Masses

Answer 1

1) Thrombus
2) Vegetation (predilection for TV in IVDUs)
3) Papillary fibroelastoma

Question 2

Aortic Stenosis

Answer 2

1) Congenital
- Bicuspid valve
- Supravalvular –> William’s syndrome
2) Acquired
- Degenerative
- Rheumatic heart dz

Question 3

Aortic Regurgitation

Answer 3

1) Endocarditis
2) Marfan’s
3) Aortic root dilation
4) Aortic dissection
5) Bicuspid valve

Question 4

Mitral Stenosis

Answer 4

Rheumatic heart dz

Question 5

Mitral Regurgitation

Answer 5

1) Rupture of papillary muscles post-MI
2) Endocarditis
3) Myxoid degeneration
4) Dilated cardiomyopathy (mitral annular dilation)

Question 6

Pulmonary Stenosis

Answer 6

Supravalvular –> William’s syndrome
Valvular –> Noonan’s syndrome
Subvalvular –> TOF

Question 7

Pulmonary Regurgitation

Answer 7

Post valve surgery from congenital heart dz (classically TOF)

Question 8

Tricuspid Regurgitation

Answer 8

1) Pulmonary HTN
2) Endocarditis
3) Carcinoid syndrome

Question 9

Rib Notching (Bilateral)

Answer 9

1) Coarctation of aorta (ribs 4-8)
2) Aortic thrombosis (lower ribs)
3) SVC obstruction
4) NF1

Question 10

Rib Notching (Right Unilateral)

Answer 10

1) Coarctation of aorta proximal to left subclavian

2) Blalock Procedure (upper 3-4 ribs)

Question 11

Rib Notching (Left Unilateral)

Answer 11

1) Coarctation of aorta w/ aberrant right subclavian distal to coarctation

Question 12

Acyanotic Congenital Heart Disease

Answer 12

1) Pulmonary Edema –> inc pulm venous flow
- Hypoplastic left heart
- Aortic coarctation
- Cor tiratriatum sinistrum
- CHF
- Neonatal sepsis
2) Shunt Vascularity –> inc pulm arterial flow
- ASD
- VSD
- PDA
- Endocardial cushion defect
- PAPVR

Question 13

Cyanotic Congenital Heart Disease

Answer 13

1) Dec Pulmonary Vascularity w/ Cardiomegaly
- Ebstein’s anomaly
2) Dec Pulmonary Vascularity w/o Cardiomegaly
- TOF
3) Inc Pulmonary Vascularity w/o Cardiomegaly
- Truncus arteriosus
- Transposition of great vessels
- Total anomalous pulmonary venous return
- Tricuspid atresia
- Single ventricle

Question 14

Patterns of LGE

Answer 14

1) Mesocardial
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Pulmonary HTN
2) Subendocardial
- Infarction
- Amyloid
- Hypereosinophilic syndrome
- Cardiac transplant
- Histiocytoid cardiomyopathy
3) Subepicardial
- Myocarditis
- Sarcoid
4) Transmural
- Infarction
- Severe myocarditis
- Chronic sarcoid
5) Patchy
- Sarcoid
- Amyloid
- Myocarditis

Question 15

Causes of Dilated Cardiomyopathy

Answer 15

1) Idiopathic
2) Ischemia
3) Myocarditis
4) Alcohol
5) Cyclosporin
6) Familial

Question 16

Hypertrophic Cardiomyopathy

Answer 16

1) HCM
2) Aortic stenosis
3) Diastolic heart failure (HTN)
4) Athletes heart
5) Infiltration (amyloid, sarcoid)

Question 17

Restrictive Cardiomyopathy

Answer 17

1) Idiopathic
2) Amyloid
3) Sarcoid
4) Hemochromatosis
5) Hypereosinophilic syndrome

Question 18

Constrictive Pericarditis

Answer 18

1) Uremia
2) TB
3) Radiation
4) Repeated viral infection
5) Post-CABG

Question 19

Pericardial Mass

Answer 19

1) Pericardial cyst
2) Tumor (1ry or mets)
3) Hematoma

Question 20

DDx Noncardiogenic Pulmonary Edema

Answer 20

1) Sepsis
2) Drugs
3) Anaphylactic rxn
4) ICH
5) Inc ICP
6) Near drowngin/Asphyxiation
7) High altitude pulmonary edema
8) Re-expansion pulmonary edema

Question 21

L –> R Shunt

Answer 21

1) ASD
2) VSD
3) PDA
4) PAPVR

Question 22

R –> L Shunt

Answer 22

1) TOF
2) Truncus arteriosus
3) Tricuspid atresia
4) TAPVR
5) Hypoplastic left heart

Question 23

Pulmonary Hypertension

Answer 23

Group 1 --> Pulmonary Arterial HTN
- Idiopathic
- Veno-occlusive dz
- Pulmonary capillary hemangiomatosis
Group 2 --> Left Sided Heart Failure
- LV dysfunction
- Congenital shunts
Group 3 --> Chronic Hypoxic Lung Disease
- COPD
- ILD
- OSA
Group 4 --> Chronic Arterial Obstruction
- Chronic pulmonary embolism
- Pulmonary artery stenosis
Group 5 --> Multifactorial
- Sarcoidosis
- Fibrosing mediastinitis
- Anemia

Question 24

ASD

Answer 24

1) Ostium Secundum (most common)
2) Ostium Primum –> Down syndrome
3) Sinus Venosus –> PAPVR
* **ASD + Hand abnormalities –> Holt-Oram

Question 25

VSD

Answer 25

1) Preimembranous (most common)
2) Inlet
3) Muscular
4) Outlet

Question 26

Vascular Rings

Answer 26

1) Double Aortic Arch
- Most common symptomatic ring
2) Right Aortic Arch w/ Aberrant Left Subclavian
- Most common ring
3) Pulmonary sling

Question 27

Pericardial Effusion

Answer 27

1) Infection
2) Malignancy
3) Uremia
4) Collagen vascular dz (SLE, RA)
5) CHF
6) Trauma
7) Post-surgical
8) XRT
9) Dressler syndrome

Question 28

Cardiomegaly (Adult)

Answer 28

1) AR
2) MR
3) TR
4) Dilated cardiomyopathy
5) Pericardial effusion
6) Ischemic cardiomyopathy
7) High output states
- Pregnancy
- Thyrotoxicosis
- Shunt

Question 29

Cardiomegaly (Child)

Answer 29

1) Pericardial effusion
2) High-output states
- Vein of Galen malformation
- Hemangioendothelioma
3) Ebstein’s anomaly
4) Cardiomyopathy
5) Large VSD, ASD, PDA
6) Truncus, TGA
7) LVOT Lesion
- Hypoplastic left heart
- Aortic stenosis
- Aortic coarctation

Question 30

DDx for Wall-to-Wall Heart

Answer 30

1) TR
2) Dilated cardiomyopathy
3) Pericardial effusion

Question 31

DDx Coronary Artery Aneurysm

Answer 31

1) Atherosclerosis (most common in adults)
2) Kawasaki’s (most common in paeds)
3) Iatrogenic
- Surgery
- Coronary angio
4) Infection/Drugs
5) Trauma
6) Vasculitis

Question 32

Aortic Wall Thickening & Enhancement

Answer 32

1) Takayasu’s
2) Giant cell arteritis
3) Infectious aortitis

Question 33

Cardiac Mass

Answer 33

1) Thrombus (#1)
2) Mets (#2)
3) 1ry cardiac mass

Question 34

Cardiac Mets

Answer 34

1) Lung (most common)
2) Lymphoma (2nd most common)
3) Breast
4) Melanoma (most likely to go to heart)

Question 35

Qp/Qs Ratio

Answer 35

Fixing shunt indicated when Qp/Qs > 1.5