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My FRCR2A > Cardiac/Vascular > Flashcards

Cardiac/Vascular Flashcards

1
Q

Left sided SVC

A

90% drain into an enlarged coronary sinus
10% drain into left atrium

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2
Q

PDA
10% cases with congenital heart disease

A

In a normal patient duct will close within hours of birth
In duct dependent circulating it stays open for days
It will classically then close around day 5 and child will deteriorate
Prostaglandins can be given to re open the duct.

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3
Q

Abdominal aorta and branches

A
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4
Q

Thromboangiitis obliterans

A

Disease linked to smoking and manifests as small vessel vascularised.

Arterial occlusion and corkscrew shaped collaterals.

Patients are younger than those affected by atherosclerotic problems

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5
Q

Popliteal artery entrapment syndrome (PAES)

A

Anomalous insertion of medial head of gastrocnemius - compresses popliteal artery leading to exertional claudicant symptoms.

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6
Q

Cystic adventitial degeneration

A

Mucous cysts in wall of popliteal artery
High T2
Variable T1

Strong male preponderance.

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7
Q

Diaphragmatic openings

A
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8
Q

Amniotic fluid embolus

A

Rare serious complication of pregnancy
- amniotic fluid enters the venous system causing an anaphylactic reaction and DIC.

Features of ARDS
- pulmonary oedema
- diffuse ground glass opacification

(Will not be seen as filling defect on CTPA)

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9
Q

IVC filter

A
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10
Q

IVC tributaries

A
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11
Q

Pulmonary trunk anatomy

A
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12
Q

May - Thurner syndrome
- left leg swelling and left DVT secondary to obstruction of left common iliac vein compressed by right common iliac artery

A
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13
Q

Fibrosis mediastinitis

A

Most commonly seen as a partially calcified mass in middle mediastinum - subcarinal and right paratracheal regions
- causes vascular compression and leads to right heart strain.
-SVC obstruction is most common complication

Peribronchial cuffing and septal thickening are secondary to pulmonary venous congestion
Wedge shaped infarcts seen as consolidation

Two aetiologies
1) Histoplasma
2) IGG4

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14
Q

VQ imaging
- used in pregnancy, contrast allergy or risk of contrast induced nephrostomy

CXR must be normal

A

In pregnancy or lactation, VQ has a reduced breast dose to mother, however may be higher to the foetus in uterine secondary to tracer accumulation.

Can perform perfusion only at half mother/foetus dose

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15
Q

Scimitar vein
Partial anomalous pulmonary venous drainage circulation

A

Anomalous vein drain in from a hypoplastic lung on CXR

Other CXR findings of PAPVC
- right lung drained by the vein is hypoplastic and consequentially heart is malpositioned (dextro position)

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16
Q

Brachial artery anatomy

A

Continuation of axillary artery beginning at lower margin of teres MAJOR.

Gives off profunda brachii immediately distal to teres major. Supplies deep compartment and run between long and medial head triceps

GIves off superior ulnar collateral artery and then inferior ulnar collateral artery

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17
Q

Post procedure lung biopsy complications

A

Contraindications to CT guided lung biopsy

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18
Q

Management of Pseudoaneurysm

Risk factors: anticoagulation, haemodialysis, calcified arteries, obesity
Procedural: Low puncture sites SFA / profundus
Sub-optimal post procedural pressure.

A

<2cm can usually be managed with compression (attempt to occlude neck).
For thrombin injection - average pseudoaneurysm size is approx 3cm.

If not amenable to either then surgical ligation.

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19
Q

Elevated hemi diaphragm

A
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20
Q

Angiogram

A
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21
Q

Aortic aneurysm screening
- men >65
- or m+w with family history

A
22
Q

Contraindications of thrombolysis

A
23
Q

Popliteal stenosis

A
24
Q

Aorta and pulmonary trunk run through a common pericardial sheath.

Left aortic sinus - left coronary artery origin.
Right aortic sinus - right coronary artery
Posterior sinus - no coronary artery

A
25
Q

Step artefact - misregistragtion of anatomical landmarks worsening by irregular heart rhythm or large field of view with short detector row.

A

Motion artefact caused by breathing or fast/irregular HR

26
Q

Patterns of late enhancement in cardiomyopathies.

A
27
Q

Adenosine stress MRI > Dobutamine with regard sensitivity and specificity.

1/2 life 10 seconds

Causes vessel vasodilation, and will highlight hypoperfusion.

Contraindications
2nd/3rd degree heart block
Bronchospasm
Hypotension <90
MI within 48 hrs
Uncontrolled arrhythmia
Severe/critical aortic stenosis.

A

Dobutamine MRI (now superseded)
- increases HR + BP
Stops if;
HR 85% resting
New wall motion abnormality
BP >240/220
Systolic falls by 40
Persistent arrhythmias
Patient too symptomatic

28
Q

Usual contraindication to performing the MRI

A

Hypertension >220/110
Unstable angina
Severe aortic stenosis
Uncontrolled AF
HCOM
Congestive cardiac failure

29
Q

Valvular disease

A
30
Q

ARVC
Arrhythmogenic right ventricular cardiomyopathy

A

Familial 50%
Fibro - fatty degeneration of right ventricular wall.

31
Q

Hypertrophic cardiomyopathy

  • can be associated with autosomal dominant inheritance
A

Non dilated thickening of the ventricular wall. If associated with left ventricular outflow obstruction can be fatal.
(Due to pulling of the anterior leaflet of the mitral valve into the outflow tract)

  • midwall hyperenhancement at the junction of right and left ventricles.
32
Q

Sarcoidosis
- mid wall high T2 signal, predominately septal base.
- interventricular septum or left ventricle most commonly
- EPICARDIAL or mid wall
- nodular

A

Amyloidosis
- diffuse sub endocardial gad enhancement.
- causes restrictive cardiomyopathy
- speckled, granular
(Remember if history of myeloma - amyloidosis should be considered).

33
Q

Cardiac myxoma

A

Commonly affect left atrium
Most common cardiac primary tumour
Attach to inter-atrial septum
Demonstrate post-gad enhancement

34
Q

Constrictive pericarditis

A

Pericardial inflammation leads to fibrous thickening
- usual cause is post - operative / idiopathic / TB

Clinical features:
Malaise, dyspnoea, neck vein distension, paradoxical JVP

Imaging: right ventricle becomes flattened and septum can curve towards the left.
Pericardium fibrotic >2mm
Pleural effusions and ascites

35
Q

Aberrant left pulmonary artery

A

This is the only vessel to pass between the trachea and Oesophagus and therefore the only vessel to cause an anterior indentation of the Oesophagus.

36
Q

Posterior indentation

A

Right sided arch with aberrant left subclavian
Left sided arch with aberrant right
Double aortic arch (also indents anterior trachea).

37
Q

Cardiac metastases

A

More common than cardiac sarcomas
In contrast to myxoma/fibroblastoma - malignant lesions have a broad attachment to heart

(Malignant melanoma is most common to met to heart — but also is not it’s most common met).

38
Q

Atrial myxoma
-most common benign heart neoplasm

Small mass attached to interatrial septum by a stalk.
ISO/hypointense T1

A
39
Q

Cardiac sarcoma

A

RARE
Malignant
Many types
BROAD based

40
Q

Alcoholic cardiomyopathy

A

Dilated cardiomyopathy occurs in patients with alcohol abuse
Thinning of both ventricles which also appear hypokinetic on dynamic studies.
Mid myocardial fibrosis can occur + will delayed enhance

41
Q

Contra-indications for beta blocker administration

A
42
Q

Pericardial layers
- double walled sac

2 layers
+ external fibrous pericardium
+internal serous pericardium

A

The fibrous pericardium is thicker, tougher and is continuous with the central tendon of the diaphragm.

The serous pericardium
- parietal, fused to and inseparable from fibrous pericardium
- visceral layer contacts the epicardium.

43
Q

Pericarditis - Constrictive v Restrictive

A

Both: biatrial dilatation with normal ventricular size

Constrictive:
1) Thickened pericardium
2) Interventricular dependence - diastolic septal bounce or sigmoidisation of septum.

Restrictive: subendocardial late gad enhancement
Ie leading cause is restrictive cardiomyopathy.

44
Q

Inter-arterial left main coronary artery
- this is very significant and most likely to cause symptoms.
- origin of the left main or LAD from the right coronary sinus and therefore a course between the ascending aorta and pulmonary trunk.

A

Inter-arterial course of right coronary artery
- aberrant origin from left coronary sinus.
Again passes between ascending aorta and pulmonary trunk.

45
Q

Coronary fistula
- connection coronary artery and cardiac chamber or great vessels.
- results in large coronary artery aneurysms

A

Myocardial bridging of left anterior descending artery
- left anterior descending artery dives into myocardium.

Anomalous left coronary artery arising from pulmonary artery
- left coronary artery arises from pulmonary artery and get flow reversal in the left coronary artery - steal syndrome

46
Q

Left coronary artery (arises ABOVE left cusp) + supplies
- left atrium
-left ventricle
-intraventricular septum
- left branch bundle of His

A

Right coronary artery (arises ABOVE right cusp)
+ supplies
- right atrium
- SA and AV nodes
- posterior intraventricular septum

47
Q

Black blood T2 is NOT useful for amyloidosis

A

Why?
amyloid deposition leads to fibrosis, therefore little water
- also gad washes out faster of myocardium than what normally occurs.
THEREFORE heart is very dark.

48
Q

Cardiac CT artefacts

A
49
Q

Truncus arteriosis
- single trunk rather than aorta and pulmonary trunk separately

A

Associated with DiGeorge syndrome
Chromosome 22 - elongated face and cleft palate
Also associated with tetralogy of Fallot

Truncus also associated with
CHARGE
C (coloboma) - posterior eye defect
H - congential heart disease
A - Choanal atresia
R - Retardation
G - genital hypoplasia
E - ear abnormality

Also associated with VSD, and right sided arch

50
Q

Loeffler endocarditis (Eosinophilic cardiomyopathy)

A

Biventricular thrombus with endocardial fibrosis is classical

51
Q

Physics - MRI artefacts

A

My FRCR2A (7 decks)

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