Cardiac masses, afib, pulm disease Flashcards
tumor originating from right atrium
angiosarcoma
Least likely place for myxoma
valvular origins
most common malignant tumor of heart
metastatic is most common
(angiosarcoma most common of sarcomas)
greatest propensity for metastasis to heart
melanoma (50% chance)
benign primary tumors
more common than malignant
myxomas
lipomas
papillary fibroelastomas
myxomas
most common benign primary tumor
typically middle aged adults women >men
majority are in LA
mobile ,irregular and pedunculated, often attached to fossa ovalis
usually do not recur
lipomas
anywhere in heart but more common in subpericardial/extramyocardial
Lipomatous hypertrophy most commonly of interatrial septum (watersons groove/superior interatrial groove accumulation of fat)
fibroelastomas
Usually on ventricular side of MV and aortic side of AV
appears like vegetation or lambls excresence
well demarcated, can have mobile stalk, usually less than 2 cm
can embolize causing stroke/MI
primary Malignant tumors
sarcomas
lymphomas
Types of sarcoma
angiosarcomas - more common, middle age men, predilection for RA, poorly defined borders
rhabdomyosarcoma- more common in kids, usually in ventricular wall
Secondary cardiac tumors
Much more common than primary tumors
Most often from lung, breast, melanoma, leukemia/lymphoma
often involve pericardium
Pericardial effusion most common finding in metastatic disease
Mass in IVC
often RCC, growing into RA
malignant melanoma
uncommon but seen on pericardial surface (charcoal heart)
what is v wave cutoff
early peak velocity and steep decline seen on CWD of insufficient jet (Severe TR) rather than parabolic shape
carcinoid heart disease
seretonin destroys right side valves most commonly
generally happens in hepatic metastasis disease
leaflets appear thickened (funnel shaped) retracted and immobile
transpulmonary gradient >10 mm Hg indication for surgery
replacement of valves recommended
Ebsteins anomaly
large anterior sail like leaflet with apically displaced septal leaflet (>8mm/m2)
Associated with secundum ASD and WPW, severe TR, LV non-compaction
cor triatriatum dexter
less common than left sided sinister
from failure of resorption of common pulmonary veins
Important to distinguish between eustachian valve (big gap = valve)
psuedotumors
pectinate muscles
christa terminalis
LAA can have up to 4 lobes, 2 lobes most common
How long can stroke risk be elevated in patient with SEC in LAA after cardioversion
up to 10 days due to atrial stunning and low flow in LAA
left atrial appendage membrane
extension of coumadin ridge that drapes over appendage
may be congenital
LV thrombus
Occur in all regions of abnormal wall motion, but most commonly in apex. TTE > TEE, and associated with dilated ventricle.
Independent predictors of SEC in afib
LA enlargement
reduced LAA flow
LV dysfucntion
higher Fibrinogen and hematocrit
What is virchows triad
stasis, endothelial dysfunction, hypercoagulable state
Thrombus appearance
serpentine, irregular, mobile
can appear without obvious attachment
mural thrombus - laminated, immobile
Chiari network
filamentous/ net like strands attached to eustachian valve.
Can play role in thromboembolic events / arrhythmia.
Associated with aneurysmal interatrial septum and PFO
what is septomarginal trabeculae
the moderator band
carries part of R side bundle conduction (av bundle to anterior papillary muscle)
where can false tendons be found
LV ( known as LV band)
normal findings, can produce innocent murmur and lv dysfunction
anatomic variants in RA
eustachian valve
crista terminalis
thebesian valve
chiari network
persistent L SVC (dilated CS)
PFO
Atrial septal aneurysm ( >1.5cm)
Lipomatous hypertrophy of IAS
Pectinate muscles
RAA
anatomic variants in RV
trabeculations
moderator band
Anatomic variants in LA
LAA variants
coumadin ridge
cor triatriatum
Pulmonary veins
Anatomic variants in LV
LV band- false tendon
Papillary muscles
Other anatomical variants
Transverse sinus
lambls excresences
catheters and cannulas
masses/tumors
crista terminalis
landmark used to identify sinus venosus vs ostium secundum ASD
Site thought to be responsible for atrial tachyarrhythmias
Differentiating RUPV and RLPV on echo
RLPV is closer to probe, more horizontal
RUPV is further from probe, angled toward probe, closer to SVC
differentiating LUPV and LLPV on echo
LUPV next to coumadin ridge and LAA, angled up to probe
LLPV more horizonal , closer to probe and further to left.
Physiologic determinants of pulmonary venous waves
A: LA contractility and LV stiffness
S1: LA relaxation
S2: RV stroke volume, LA compliance, LV contractility
D: LV relaxation, LV compliance
