Cardiac masses, afib, pulm disease

Question 2

tumor originating from right atrium

Answer 2

angiosarcoma

Question 3

Least likely place for myxoma

Answer 3

valvular origins

Question 4

most common malignant tumor of heart

Answer 4

metastatic is most common
(angiosarcoma most common of sarcomas)

Question 5

greatest propensity for metastasis to heart

Answer 5

melanoma (50% chance)

Question 6

benign primary tumors

Answer 6

more common than malignant
myxomas
lipomas
papillary fibroelastomas

Question 7

myxomas

Answer 7

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

Question 8

lipomas

Answer 8

anywhere in heart but more common in subpericardial/extramyocardial
Lipomatous hypertrophy most commonly of interatrial septum (watersons groove/superior interatrial groove accumulation of fat)

Question 9

fibroelastomas

Answer 9

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

Question 10

primary Malignant tumors

Answer 10

sarcomas
lymphomas

Question 11

Types of sarcoma

Answer 11

angiosarcomas - more common, middle age men, predilection for RA, poorly defined borders
rhabdomyosarcoma- more common in kids, usually in ventricular wall

Question 12

Secondary cardiac tumors

Answer 12

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

Question 13

Mass in IVC

Answer 13

often RCC, growing into RA

Question 14

malignant melanoma

Answer 14

uncommon but seen on pericardial surface (charcoal heart)

Question 15

what is v wave cutoff

Answer 15

early peak velocity and steep decline seen on CWD of insufficient jet (Severe TR) rather than parabolic shape

Question 16

carcinoid heart disease

Answer 16

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

Question 17

Ebsteins anomaly

Answer 17

large anterior sail like leaflet with apically displaced septal leaflet (>8mm/m2)
Associated with secundum ASD and WPW, severe TR, LV non-compaction

Question 18

cor triatriatum dexter

Answer 18

less common than left sided sinister
from failure of resorption of common pulmonary veins
Important to distinguish between eustachian valve (big gap = valve)

Question 19

psuedotumors

Answer 19

pectinate muscles
christa terminalis
LAA can have up to 4 lobes, 2 lobes most common

Question 20

How long can stroke risk be elevated in patient with SEC in LAA after cardioversion

Answer 20

up to 10 days due to atrial stunning and low flow in LAA

Question 21

left atrial appendage membrane

Answer 21

extension of coumadin ridge that drapes over appendage
may be congenital

Question 22

LV thrombus

Answer 22

Occur in all regions of abnormal wall motion, but most commonly in apex. TTE > TEE, and associated with dilated ventricle.

Question 23

Independent predictors of SEC in afib

Answer 23

LA enlargement
reduced LAA flow
LV dysfucntion
higher Fibrinogen and hematocrit

Question 24

What is virchows triad

Answer 24

stasis, endothelial dysfunction, hypercoagulable state

Question 25

Thrombus appearance

Answer 25

serpentine, irregular, mobile
can appear without obvious attachment

mural thrombus - laminated, immobile

Question 26

Chiari network

Answer 26

filamentous/ net like strands attached to eustachian valve.
Can play role in thromboembolic events / arrhythmia.
Associated with aneurysmal interatrial septum and PFO

Question 27

what is septomarginal trabeculae

Answer 27

the moderator band
carries part of R side bundle conduction (av bundle to anterior papillary muscle)

Question 28

where can false tendons be found

Answer 28

LV ( known as LV band)
normal findings, can produce innocent murmur and lv dysfunction

Question 29

anatomic variants in RA

Answer 29

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

Question 30

anatomic variants in RV

Answer 30

trabeculations
moderator band

Question 31

Anatomic variants in LA

Answer 31

LAA variants
coumadin ridge
cor triatriatum
Pulmonary veins

Question 32

Anatomic variants in LV

Answer 32

LV band- false tendon
Papillary muscles

Question 33

Other anatomical variants

Answer 33

Transverse sinus
lambls excresences
catheters and cannulas
masses/tumors

Question 34

crista terminalis

Answer 34

landmark used to identify sinus venosus vs ostium secundum ASD
Site thought to be responsible for atrial tachyarrhythmias

Question 35

Differentiating RUPV and RLPV on echo

Answer 35

RLPV is closer to probe, more horizontal
RUPV is further from probe, angled toward probe, closer to SVC

Question 36

differentiating LUPV and LLPV on echo

Answer 36

LUPV next to coumadin ridge and LAA, angled up to probe
LLPV more horizonal , closer to probe and further to left.

Question 37

Physiologic determinants of pulmonary venous waves

Answer 37

A: LA contractility and LV stiffness
S1: LA relaxation
S2: RV stroke volume, LA compliance, LV contractility
D: LV relaxation, LV compliance