CARDIAC Section 2: Coronaries Flashcards
What are the three (3) coronary cusps?
Right
Left
Non-coronary (POSTERIOR)
Right coronary artery branches
- Acute Marginal (AM)
- AV Node branch
- Posterior Descending (PDA)
CONUS - 1/2 of the time this is the first branch
Left coronary artery branches
- Left anterior descending (LAD)
a. Diagnonals (D1) and (D2)
b. Septal Branches - Circumflex (LCX)
a. Marginal Branches (M1) and (M2)
65-80% of the Posterior Descending Artery (PDA) is supplied by what coronary artery?
Right Coronary Artery (RCA)
20% of the posterior descending artery (PDA) is supplied by?
Left Coronary Artery (LCA)
RCA perfuses SA node __%?
RCA perfuses SA node 60%
RCA perfuses AV node _%?
RCA perfuses AV node 90%
Coronary Dominance is determined by?
what vessel gives rise to the PDA and posterior left ventricular branches (Most are right - 85%_
if the PDA arises from the RCA and
the posterior left ventricular branches arise from the LCX
Co-dominant
Diagnosis
LCA from the right coronary sinus
LCA from the Right coronary sinu courses where?
Between the aorta Pulmonary artery
Coronary origin abnomrality that needs fixing
RCA from left cusp or LCA from right cusp?
LCA from the right cusp.
RCA from theleft cusp gets fixed IF asymptomatic
What is the MOST COMMON cause of sudden cardiac death in young patients?
Hypertrophic cardiomyopathy.
What is the 2nd Most common cause of sudden cardiac death in young patients?
Malignant coronary artery with origin from the oppisit sinus.
What are the two types of Anomalous Left Coronary Artery from Pulmonary artery (ALCAPA)
- Infantile (They die early) - CHF + Dilated cardiomyopathy
- Adult
Describe “STEAL SYNDROME”
Reversed (retrograde) flow of the LCA as pressure decreases in the pulmonary circulation
Diagnosis
Anomalous Left Coronary Artery from Pulmonary artery (ALCAPA)
This is an intramyocardial course of a coronary artery (usually the LAD).
Myocardial Bridging
This is a coronary vessel with a diameter greater than 1.5x the normal lumen.
Coronary Artery Aneurysm
Most common cause of Coronary Artery Aneurysm in ADULTS?
Atherosclerosis
Most common cause of Coronary Artery Aneurysm in CHILDREN?
Kawasakit (Sponteneously resolvies in 50%)
Most common iattrogenic cause of Coronary Artery Aneurysm?
Cardiac catheterization
A connection between a coronary artery and cardiac chamber or great vessels.
Coronary Fistula
Most common coronary Fistula?
RCA with drainage to the right cardiac chambers
When you see crazy dilatation of the coronary arteries, you think?
Coronary Fistula
Who is the idealpatient to get a coronary CT?
(1) Intermediate risk for MI and/or atypical chest pain patients. A negative coronary CT will help stop a stress test or cath from occurring. Why do a procedure with risks on someone with GERD?
(2) Suspected aberrant coronary anatomy.
(3) Evaluating stents (larger than 3mm) or CABG patency
(4) Preoperative assessment for transcatheter aortic valve implantation (TAVI/TAVR)
What makes someone intermediate riskfor a MI ?
Framingham Risk Score 10-20%
What is the difference between prospective and retrospective gating?
-Prospective: “Step and Shoot” - R-R interval *data acquisition triggered by R Wave
-Retrospective: Scans the whole time, then back calculates
What is best for valvular evaluation for CT ?
-Retrospective: This type ofgating is requiredfor evaluating the mitral and tricuspid valves.
