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RRC Cards > Cardiac > Flashcards

Cardiac Flashcards

1
Q

most common congenital heart anomaly

A

bicuspid aortic valve

ASD #2

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2
Q

most common cause enlarged coronary sinus

A

persistent left SVC

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3
Q

most common primary cardiac tumor in adults

A

cardiac myxoma

left atrium, attached to septum, +/- Ca2+

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4
Q

“aortic root”

A

aortic annulus (basal ring) + sinuses of Valsalva + sinotubular junction

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5
Q

“annuloaortic ectasia”

A

dilatation of annulus and sinuses of Valsalva with effacement of the sinuotubular junction

tulip bulb sign

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6
Q

anomalous course of coronary arteries

A
  • interarterial (malignant)
  • retroaortic
  • prepulmonic
  • subpulmonic/transseptal
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7
Q

dilated cardiomyopathy causes

A
  • ischemia
  • infection
  • toxic: alcohol, cocaine
  • chemotherapy (doxorubicin)
  • idiopathic
  • familial
    (- peripartum)
    (- muscular dystrophies)
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8
Q

valve cusps (aortic, tricuspid, pulmonary, mitral)

A
  • aortic: “learn” - L, R, Noncoronary
  • tricuspid: “traps” - Ant, Post, Septal
  • pulmonary: “pallor” PALR - Ant, Left, Right
  • mitral: MAP - Ant, Post
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9
Q

myocarditis findings

A
  • midmyocardium & epicardium
  • wall motion abN
  • myocardial edema
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10
Q

LV aneurysm vs pseudoaneurysm

A

aneurysm: bounded by thin myocardium
- wide neck
- anterior or apical
- less rupture risk

pseudoaneurysm: contained rupture by pericardium
- narrow neck (ratio <1)
- posterolateral or inferior
- risk of rupture

both complic of MI, assoc w thrombus

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11
Q

tamponade

A
  • large or rapidly accumulating
  • RA/RV compression
  • dilated IVC
  • reflux of contrast
  • septal flattening
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12
Q

second most common benign heart tumor

A

lipoma

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13
Q

most common embryologic abnormality of aortic arch

A

aberrant right subclavian - usually incidental

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14
Q

Glenn shunt

A

SVC to right pulmonary artery

  • classic: end-to-end + prox RPA closed (to reduce RV work)
  • bidirectional: end-to-side (RPA left open, blood flow to both lungs)
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15
Q

Blalock Taussig shunt

A

subclavian artery to pulmonary artery

  • classic: opposite side of arch
  • modified: gortex shunt, same side as arch

purpose: increase pulm blood flow

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16
Q

Fontan procedure

A

total cavopulmonary connection to bypass RV & direct systemic circulation into PAs
- for single ventricle physiology (HLH, Ebstein, tricuspid atresia, double inlet ventricle)

Glenn shunt: SVC to right PA
Fontan pathway: IVC to right or left PA
- lateral tunnel or extracardiac

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17
Q

Fontan procedure complications

A

conduit related: thrombosis, stenosis, calc’n

cardiac: RA enlargement, ventric failure, arrhythmias
vascular: pulm AVM, PE, pHTN, aortopulmonary collaterals (hemoptysis)
liver: congestion, cirrhosis, regen nodules, HCC
lymphatic: chylous effusions, protein losing enteropathy, plastic bronchitis

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18
Q

Blalock Taussig shunt complication

A

stenosis at shunt’s pulm insertion site

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19
Q

LV papillary muscles: name & blood supply

A
  • anterolateral: shared LAD and LCX

- posteromedial: RCA (in right dominant patients) –> more prone to rupture 2/2 single vascular supply

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20
Q

microvascular obstruction

A
  • infarcted myocardium where obstructed microvasculature doesn’t allow contrast to perfuse the tissue (contrast does not reach interstitium)
  • area without reflow → less favourable prognosis, marker of adverse LV remodeling

Imaging: dark signal tissue surrounded by enhancing scar on both sides

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21
Q

vulnerable plaque - 4 main features on CTA

A
  1. positive remodeling
    - outer vessel diameter at plaque ≥ 1.1x adj uninvolved vessel (on long & short axis)
  2. low attenuation plaque <30 HU
  3. napkin-ring sign
    - peripheral higher attenuation of the noncalcified portion of the plaque
  4. spotty calcium
    - small calcified plaque (>130 HU separately visualized from the lumen, diameter <3 mm in any direction, length <1.5x vessel diameter & width <2/3x vessel diameter)
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22
Q

hypertrophic cardiomyopathy - types

A
  • asymmetric
  • symmetrical (or concentric)
  • apical (spade shape ventricular lumen)
  • mid ventricular
  • mass-like
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23
Q

hypoplastic left heart

A
  • cyanotic, ↑ pulm vascularity & pulm edema
  • hypoplasia of asc aorta, aortic & mitral valves, LV
  • PDA dependent (R→L shunt for survival)
  • dilated right-sided cardiac chambers & PA
  • most severe CHD: CHF, cardiogenic shock, cyanosis
  • assoc w coarctation, endocardial fibroelastosis
  • palliative repair: Norwood, bidirectional Glenn, Fontan
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24
Q

right aortic arch branching patterns and associations

A
  1. right arch w/ aberrant left subclavian - no association

2. right arch w/ mirror image branching - cyanotic heart disease (truncus arteriosus, tetralogy of fallot)

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25
Q

tetralogy of fallot - components

A

“PROV”

  • pulmonic stenosis
  • RV hypertrophy
  • overriding aorta
  • VSD
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26
Q

rib notching patterns

A
  1. Bilateral = Past L subclavian (post ductal)
  2. Right sided = Before L subclavian (pre ductal/infantile)
  3. Left sided = Proximal to anomalous R subclavian
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27
Q

most common vessel with myocardial bridging

A

LAD

then LCx and RCA

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28
Q

most common partial anomalous pulmonary venous return (PAPVR)

A
  • right superior pulmonary vein into IVC

- associated w/ sinus venosus ASD

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29
Q

more common side of absent pulmonary artery

which is associated w/ CHD

A

R > L
2:1

L w/ CHD - Tet of Fallot

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30
Q

embryologic arch to form the pulmonary arteries

A

6th arch

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31
Q

significant shunt (Qp/Qs - pulmonic/aortic)

A

> 1.5

32
Q

artifact resulting from regurgitant flow

A

dephasing artifact

33
Q

Ebstein anomaly

A
  • atrialized RV
  • apically displaced septal tricuspid leaflet
  • tricuspid regurg
34
Q

def’n of severe stenosis on coronary CT angio

def’n of obstructive CAD

A

diameter narrowing >70%
except in left main coronary artery where a severe stenosis is >50%

obstructive >50%

35
Q

enlargement of main and left pulmonary artery with a small right pulmonary artery

A

pulmonary stenosis

36
Q

cutoff on CT for pericardial thickening

A

4 mm

37
Q

beta blocker contraindications (CT angiography)

A 
sinus bradycardia
hypotension
asthma, COPD
sick sinus syndrome
2nd- & 3rd-degree AV nodal block
critical aortic stenosis
decompensated heart failure
38
Q

mid-myocardial delayed gadolinium enhancement

A 
myocarditis 
sarcoidosis (linear or nodular, RV side of septum is classic)
dilated cardiomyopathy (septal)
hypertrophic cardiomyopathy (at hinge points)
RV pressure overload (at hinge points)
39
Q

subepicardial delayed gadolinium enhancement

A

myocarditis

sarcoidosis

40
Q

diffuse subendocardial delayed gadolinium enhancement

A

amyloidosis
Loeffler endocarditis
endomyocardial fibrosis

41
Q

myocardium nulls before blood pool on TI scout sequence

A

amyloidosis

buzzwords: “difficult to suppress myocardium”

42
Q

which kind of ASD is most highly associated with partial anomalous draining of the right superior pulmonary vein?

A

sinus venosus

43
Q

mitral valve prolapse def’n & associations

A

2mm displacement of mitral valve leaflets posterior to mitral valve plane during systole

  • often assoc w mitral regurg
  • can be assoc w papillary muscle or chordae tendineae rupture
  • connective tissue disorders, adult PCKD
44
Q

transposition of the great arteries: types

A

D-transposition: ventriculoarterial discordance (RV➡aorta, LV➡PA)

  • PDA connects 2 systems
  • CXR: egg on a string

L-transposition: ventriculoarterial & atrioventricular discordance (SVC/IVC➡RA➡LV➡PA➡pulm veins➡LA➡RV➡aorta)

  • congenitally corrected; no PDA required
  • Two wrongs (atrioventricular & ventriculoarterial discordance) make a right and L= life
45
Q

surgical options for D-transposition of the great arteries

A
  • Jatene arterial switch
  • atrial inversion using intra-artrial baffle: Senning (uses atrium) or Mustard (pericardium or synthetic material)
  • Rastelli procedure (if concomitant VSD & LVOT obstruction)
46
Q

surgical options for L-transposition of the great arteries

A

double switch procedure:

  • atrial inversion surgery (Senning or Mustard) + Jatene arterial switch OR Rastelli procedure
  • to remove systemic pressure load from morphologic RV & prevent tricusp valve dysf’n
  • may 1st need pulmonary artery banding to train morphologic LV to receive higher systemic load
  • modified BT shunt if severe pulmonary stenosis or atresia
47
Q

most common type of TAPVR

A

type 1: supracardiac

48
Q

types of coarctation

A

infantile: preductal
adult: juxta-ductal, post-ductal or middle aortic

49
Q

coarctation associations

A 
bicuspid aortic valve
PDA
VSD
transposition of great vessels
truncus arteriosus
intracranial berry aneurysms
spinal scoliosis
PHACE & Turner syndromes
50
Q

pseudocoarctation

A
  • elongation, kinking or buckling of descending aorta at level of ligamentum arteriosum
  • no pressure gradient across lesion
  • benign entity with no specific intervention
51
Q

complications of Senning & Mustard procedures

A 
Stenosis of the baffle
Arrhythmias
- sinoatrial node may be injured in Senning
- intra-atrial conduction delays
Right heart failure 
- d/t RV supplying system circulation
52
Q

pulmonary sling: course of LPA

A

left PA courses between esophagus and trachea

53
Q

Ortner’s syndrome

A

cardiovocal hoarseness

2/2 compression of left recurrent laryngeal nerve by enlarged left atrium

54
Q

CXR appearance of mitral stenosis

A

left atrial enlargement:

  • right double density sign
  • splaying of carina (superior displacement of left mainstem bronchus)
  • posterior esophageal displacement
  • walking man sign on lateral
55
Q

heterotaxy associated with polysplenia

A

LEFT pulmonary isomerism

  • polysplenia
  • bilateral left lung lobation
  • azygos or hemiazygos continuation of the inferior vena cava
56
Q

pathognomonic for pulmonary sling

A

anterior indentation on esophagus

57
Q

high risk plaque features

A

positive remodeling
low attenuation plaque
spotty Ca2+
napkin ring

58
Q

ECG finding in ARVD

A

epsilon waves

59
Q

other name for apical HoCM

A

Yamaguchi

60
Q

T1 black blood phase

A

spin echo sequence

61
Q

LV myocardial thickening cutoff

A

diastolic LV wall ≥ 15 mm

echo: ≥ 12 mm

62
Q

dilated cardiomyopathy cutoff

A

LV end diastolic dimension of 60 mm

measured from anteroseptal wall to inferolateral wall at mid chamber of LV

63
Q

Loeffler endocarditis

A

aka eosinophilic endocarditis, cardiac manifestation of hypereosinophilic syndrome

  • eosinophils deposit in the subendocardium with necrosis & fibrosis of endocardium, thrombus formation
  • over time, thrombus epithelializes into subendocardium -> reduced chamber -> restrictive CM

Crack: biventricular thrombus

64
Q

Most common valve neoplasm

A

Fibroelastoma

65
Q

MR features of noncompaction

A

hypertrabeculated LV myocardium

noncompacted end-diastolic myocardium to compacted end-diastolic myocardium ratio of >2.3:1

66
Q

cyanotic heart disease (5) & non cyanotic (5)

A

cyanotic (5 T’s): TOF, TAPVR, transposition, truncus, tricuspid atresia
noncyanotic: ASD, VSD, PSA, PAPVR, aortic coarctation (adult, post ductal)

67
Q

what defines the RV

A

moderator band (important for congenital heart)

68
Q

congenital heart disease relying on admixture (5)

A
  • TAPVR (has PFO)
  • transposition
  • TOF (has VSD)
  • tricuspid atresia (has VSD)
  • hypoplastic left
69
Q

microvascular obstruction independent predictor of:

A
  • death

- adverse LV remodeling

70
Q

causes restrictive cardiomyopathy

A

things decreasing diastolic function

  • amyloidosis
  • loeffler/eosinophilic cardiomyopathy
  • endocardial fibroelastosis
  • hemochromatosis
71
Q

systolic anterior motion in hypertrophic cardiomyopathy independent risk factor for…

A

sudden death

72
Q

ratio for LV noncompaction

A

≥ 2.3 : 1

telediastolic noncompated myocardium: compacted

73
Q

most common primary malignant tumor of heart

A

angiosarcoma

right atrium

74
Q

What perfusés SA and AV nodes?

A

RCA SA node 60%

RCA AV node 90%

75
Q

Cardiac CT drugs and contraindications

A

Beta blocker - 2nd/3rd degree heart block, asthma, acute chest pain, cocaine

Nitroglycérine - hypotension SBP<100, severe aortic stenosis, hypertrophic obstructive cardiomyopathy, phosphodiesterase

76
Q

most common cause malignant pericardial effusion

A

lung cancer

77
Q

critical aortic stenosis valve area

A

1 cm^2

RRC Cards (17 decks)

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