Cardiac imaging Flashcards

1
Q

What are the main tests cardiologists request? [4]

A

Main tests:
- Chest X-ray
- Echocardiography (Thoracic/Oesophageal)
- Further Imaging (MRI, Nuclear medicine, Ultrasound, CT) (non-invasive)
- Coronary angiography (invasive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathology indicated by this CXR? [1]

A

Pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What pathology is indicated by this CXR? [1]

A

Mediastinum is wider: thoracic aortic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Echocardiography uses what type of imaging to produce images? [1]

A

Ultrasound waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which of the following uses ultrasound waves?

Echocardiography
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography

A

Which of the following uses ultrasound waves?

Echocardiography
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which of the following allows for calculating velocities and hence pressure gradients of blood flow

Echocardiography
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography

A

Which of the following allows for calculating velocities and hence pressure gradients of blood flow

Echocardiography: Doppler
Cardiac MRI
Nuclear MPS
Chest x-ray
CT-coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What pathologies are Echos good for investigating? [4]

A

Valves: if narrower, then the flow / velocity will increase; endocarditis

Myocardial diseases: MI ; LV thrombus

Great vessels: dilation

Thrombus/infection/tumor

Arrhythmias

Cryptogenic (unknown cause) stroke: Looking for thrombus at apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What axis is this echo taken from?

long-axis
short-axis
four chamber-plane

A

What axis is this echo taken from?

long-axis
short-axis
four chamber-plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Label A-C

A

A: long-axis
B: four chamber-plane
C: short-axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What axis is this echo taken from?

long-axis
short-axis
four chamber-plane

A

What axis is this echo taken from?

long-axis
short-axis
four chamber-plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What colours do the doppler echo show?

A

Red: towards
Blue: away
Green: areas of turbulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which valves are more commonly pathological? [2]

A

Aortic and pulmonary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

** ECHO and cardiomyopathy **

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which pathologies can preclude useful ECHO assesment? [2]

A

High BMI & COPD can preclude useful assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are transesophageal cardiograms (TEE) more useful than transthoracic echocardiograms (TTE)?

A

TEE is better because don’t have chest wall to look through: can therefore use higher frequency wavelength: see structures more clearly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is TEE useful for IDing if TTE is normal or unclear? [4]

A

Post-operative (if particularly invasive: TTE can be disrupted by wound repairs)

Accurate valve assessment (mitral)

Endocarditis

Pre-ablation assessment of left atrial appendage(bc often have a thrombus in LA, if interefere will cause a stroke)

17
Q

What would you be highly suspicious of identifying with a TEE if you had a TTE but no findings? [1]

A

Endocarditis [1] (life-threatening inflammation of the inner lining of the heart’s chambers and valves)

18
Q

Name 3 AEs of TEE

A
  • Oesophageal stricture (tightening) diverticula (outpouching) / tumour
  • Varices
19
Q

What are CT-Coronary angiographys useful for diagnosing?

A

New onset chest pain
If no previous documented CAD
Useful in CABG patients to assess grafts

20
Q

What specifically can CTCAs ID? [2]

A

Zero coronary artery calcification (CAC) score in patients with stable angina has a high negative predictive value for the exclusion of obstructive CAD and is associated with a good medium-term prognosis

Narrowing / stenosis of arteries

21
Q

How do you perform a CTCA? [3]

A

Give BB prior to: clearer image
ECG gating: pick an area after T wave, when heart is at stillest (during diastole) to take image
Breath hold (any movement will cause blurring)

22
Q

Which modality if the gold standard for assessing LV function?

Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging

A

Which modality if the gold standard for assessing LV function?

Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging

23
Q

What is MRI good for assesing?

A
  • Crystal clear images
  • Useful for distinguishing cardiomyopathy types
  • ## Gold standard for assessing LV function
24
Q

Which modality is useful for assessing cardiomyopathy types?

Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging

A

Which modality is useful for assessing cardiomyopathy types?

Contrast enhanced echo
Nuclear myocardial perfusion scintigraphy
CT coronary angiography
Cardiac MRI
SPECT imaging

25
What do you need to check prior to MRI? [2]
Patient's **renal function**: risk for **Retroperitoneal fibrosis**. Need to have **eGFR < 30** **Pacemakers**
26
What are MRIs useful for IDing? [4]
Discriminating between MI and myocarditis. **MI with non-obstructive coronary arteries: MINOCA.** (e.g. if present with STEMI / NSTEMI but no diagnosis from CTCA or ECHO imaging. So use MRI) **Cardiomyopathies** (Fe / Lipid storage disorders) **Storage disorders** **Thrombus/mass discrimination**
27
Explain how myocardial perfusion scanning (MPS) works
Give someone a tracer, look at differential flow and can infer if narrowing is causing a flow limiting problem in a non-invasive way Uses nuclear tracers (to determine tissue activity)
28
Which modality is very good for assessing MI? Contrast enhanced echo Nuclear myocardial perfusion scintigraphy CT coronary angiography Cardiac MRI SPECT imaging
Which modality is very good for assessing MI? Contrast enhanced echo **Nuclear myocardial perfusion scintigraphy (MPS)** CT coronary angiography Cardiac MRI SPECT imaging
29
How do you conduct MPS imaging? [2]
Performed during **pharmacological stress** (give adenosine) and rest Areas of **reduced uptake** (and **lighting** **up**) suggest ischemia
30
Negatives for MPS? [3]
Radiation Requires stressing agents (some Ptx with asthma can’t have) Time consuming