Cardiac Flashcards
Valvular Masses
1) Thrombus
2) Vegetation (predilection for TV in IVDUs)
3) Papillary fibroelastoma
Aortic Stenosis
1) Congenital
- Bicuspid valve
- Supravalvular –> William’s syndrome
2) Acquired
- Degenerative
- Rheumatic heart dz
Aortic Regurgitation
1) Endocarditis
2) Marfan’s
3) Aortic root dilation
4) Aortic dissection
5) Bicuspid valve
Mitral Stenosis
Rheumatic heart dz
Mitral Regurgitation
1) Rupture of papillary muscles post-MI
2) Endocarditis
3) Myxoid degeneration
4) Dilated cardiomyopathy (mitral annular dilation)
Pulmonary Stenosis
Supravalvular –> William’s syndrome
Valvular –> Noonan’s syndrome
Subvalvular –> TOF
Pulmonary Regurgitation
Post valve surgery from congenital heart dz (classically TOF)
Tricuspid Regurgitation
1) Pulmonary HTN
2) Endocarditis
3) Carcinoid syndrome
Rib Notching (Bilateral)
1) Coarctation of aorta (ribs 4-8)
2) Aortic thrombosis (lower ribs)
3) SVC obstruction
4) NF1
Rib Notching (Right Unilateral)
1) Coarctation of aorta proximal to left subclavian
2) Blalock Procedure (upper 3-4 ribs)
Rib Notching (Left Unilateral)
1) Coarctation of aorta w/ aberrant right subclavian distal to coarctation
Acyanotic Congenital Heart Disease
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
Cyanotic Congenital Heart Disease
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
Patterns of LGE
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
Causes of Dilated Cardiomyopathy
1) Idiopathic
2) Ischemia
3) Myocarditis
4) Alcohol
5) Cyclosporin
6) Familial
Hypertrophic Cardiomyopathy
1) HCM
2) Aortic stenosis
3) Diastolic heart failure (HTN)
4) Athletes heart
5) Infiltration (amyloid, sarcoid)
Restrictive Cardiomyopathy
1) Idiopathic
2) Amyloid
3) Sarcoid
4) Hemochromatosis
5) Hypereosinophilic syndrome
Constrictive Pericarditis
1) Uremia
2) TB
3) Radiation
4) Repeated viral infection
5) Post-CABG
Pericardial Mass
1) Pericardial cyst
2) Tumor (1ry or mets)
3) Hematoma
DDx Noncardiogenic Pulmonary Edema
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
L –> R Shunt
1) ASD
2) VSD
3) PDA
4) PAPVR
R –> L Shunt
1) TOF
2) Truncus arteriosus
3) Tricuspid atresia
4) TAPVR
5) Hypoplastic left heart
Pulmonary Hypertension
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
ASD
1) Ostium Secundum (most common)
2) Ostium Primum –> Down syndrome
3) Sinus Venosus –> PAPVR
* **ASD + Hand abnormalities –> Holt-Oram
VSD
1) Preimembranous (most common)
2) Inlet
3) Muscular
4) Outlet
Vascular Rings
1) Double Aortic Arch
- Most common symptomatic ring
2) Right Aortic Arch w/ Aberrant Left Subclavian
- Most common ring
3) Pulmonary sling
Pericardial Effusion
1) Infection
2) Malignancy
3) Uremia
4) Collagen vascular dz (SLE, RA)
5) CHF
6) Trauma
7) Post-surgical
8) XRT
9) Dressler syndrome
Cardiomegaly (Adult)
1) AR
2) MR
3) TR
4) Dilated cardiomyopathy
5) Pericardial effusion
6) Ischemic cardiomyopathy
7) High output states
- Pregnancy
- Thyrotoxicosis
- Shunt
Cardiomegaly (Child)
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
DDx for Wall-to-Wall Heart
1) TR
2) Dilated cardiomyopathy
3) Pericardial effusion
DDx Coronary Artery Aneurysm
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
Aortic Wall Thickening & Enhancement
1) Takayasu’s
2) Giant cell arteritis
3) Infectious aortitis
Cardiac Mass
1) Thrombus (#1)
2) Mets (#2)
3) 1ry cardiac mass
Cardiac Mets
1) Lung (most common)
2) Lymphoma (2nd most common)
3) Breast
4) Melanoma (most likely to go to heart)
Qp/Qs Ratio
Fixing shunt indicated when Qp/Qs > 1.5
