Cardio Flashcards by mkb drs

Shone complex

P arachute mitral valve/supramitral ring
A ortic valve stenosis
C oarctation of aorta
S ubvalvular aortic stenosis

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MC cause of severe non ischemic mitral regurgitation

Mitral valve prolapse

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Rupture of pappilary muscle occurring during the acute phase of MI

Acute ischemic Mitral Regurgitation

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MC cause of congenital tricuspid regurgitation

Ebstein anomaly

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Radiograph:
Box shape or globular heart
Normal or decreased vascularity

Ebstein anomaly

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In cardiac MRI, apical displacement of septal leaflet of ____mm/m2 is cutoff for Ebstein anomaly

More than 8

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Kind of pulmonary stenosis in TOF?

Subvalvular

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Obstruction at the level of the main pulmonary artey at its bifurcation will cause what kind of pulmonic stenosis?

Supravalvular

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Detection of small vegetations and small perforations?

TEE

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Most common involved valve in rheumatic heart disease

Mitral valve

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Classic hazy midmyocardial enhancement in LGE MRI?

Hypertrophic cardiomyopathy

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MC form of HCM?

Assymetric septal HCM

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SPADE-LIKE configuration of the left ventricle on vertical long axis view of the heart?

Apical hypertrophic cardiomyopathy (HCM)

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Radiographic Appearance of TAPVR Type 1

Snowman or Figure of 8

*only occurs when vertical vein empties into the brachiocephalic vein

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Congenital heart anomaly wherein Pulmonary veins empty into a common confluence separated from the left atrium by a partial membrane

Cor triatriatum

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Normla amount of fluid within the pericardial sac

25-5 ml

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REQUISITES:
Normal thickness of teh percarddium b/w the sternum and free wall of the RV

< 3mm

most reliable @ the midventricular level

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(REQUISITES)
Allows for detection of freely moving fluid within the pericardial space

Phase contrast images

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(REQUISITES)
Amount of fluid that can acutely distend the normal adult pericardial space before cardiac tamponade results

150-250 cc

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Low cardiac-output state wherein the cardiac size in CXR is slightly to markedly enlarged w/ the classic “WATER-BOTTLE” appearance

Cardiac tamponade

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Differential diagnoses for WATER-BOTTLE appearance

Cardiomegaly
Large mediastinal mass
Pericardial effusion (massive)

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(REQUISITES)
Infectious agents that cause pericarditis with epricardial effusion

Coxsackievirus grp B
Echovirus type 8

*TB pericarditis, common in patients w/ AIDS

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(REQUISITES)
MC organisms to cause pericarditis

Staph
H. influenzae
N. meningitidis

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(REQUISITES)
MCC of pericardial effusion

MI w/ left ventricular failure

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(REQUISITES) This is the development of PERICARDIAL and PLEURAL effusions 2-10 weeks post-MI

Dressler Syndrome

(REQUISITES) Modality of Choice in evaluating cardiac masses

CARDIAC MRI

(REQUISITES) Mediastinal dose that will cause *radiation pericarditis*

40 Gy

(REQUISITES) MC of constrictive pericarditis

1. Viral and tuberculous pericarditis 2. Uremia w/ pericardial effusion 3. Surgery

Most reliable sign indicating constriction in contstrictive pericarditis

Presence of adhesion Constrictive pericarditis: wall thickness > 4mm

Pericardium in Restrictive cariomyopathy does NOT calcify, but the absence of calcification does not rule out constriction

True

Most common BENIGN PRIMARY CARDIAC TUMOR in infants and children

Rhabdomyoma

Most common BENIGN PRIMARY CARDIAC TUMOR overall

MYXOMA

SECOND Most common BENIGN PRIMARY CARDIAC TUMOR in infants and children

FIBROMA

MC location of congenital absence of the pericardium

Left Atrial Appendage adjacent PA

MC locations of Fibroma

Left Ventricular wall INTRAventricular septum

Gorlin Syndrome is also called as

basal cell nevus syndrome

MC location of cardiac hemangioma

intraMURAL (75%)

MC location of Cardiac Paraganglioma

LEFT ATRIUM (left atrial ROOF or POSTERIOR WALL)

Carney Triad

Extra adrenal pheochromocytoma GIST Pulmonary chordoma

MC cardiac mass in ADULT POPULATION

Metastasis

MC Primary MALIGNANT CARDIAC tumor

Sarcoma

MC DIFFERENTIATED CARDIAC tumor

Angiosarcoma

SECOND MC Sarcoma involving the heart

UNdifferentiated Sarcoma

MC Primary CARDIAC malignancy/tumor in CHILDHOOD

Rhabdomyosarcoma

only cardiac sarcoma that predominantly arises in the right atrium in the region of the atrioventricular groove

Cardiac Angiosarcoma

Anolmalous origin of the Left Main Coronary artery from Pulmonary artery (ALCAPA) is also known as

Bland-Garland- White Syndrome

MC indication for coronary CTA

coronary artery disease

(REQUISITES) MC tumors to metastasize to the heart

M elanoma L eukemia M alignant lymphoma

(REQUISITES) MC primary tumors to metastasize to the PERICARDIUM

Breast Lung

(REQUISITES) MC primary malignancy of the PERICARDIUM

Pericardial Mesothelioma

Rare variant of mitral annular calcification seen in the POSTERIOR ATRIOVENTRICULAR GROOVE which appears as mass-like calcification and usually misdiagnosed as abscess, infection or tumor

CASEOUS CALCIFICATION of the mitral valve

(REQUISITES) MC location of pericardial cysts

Right Cardiophrenic Angle (70%)

Gold standard for evaluating CARDIAC VALVES esp. pulmonary and tricuspid valves

CARDIAC MRI

PRIMARY modality for evaluation of suspected VALVE DISEASE

Echocardiography

Clinical GOLD STANDARD for non-invasive measurement of blood flow. It is also used to quantify the severity of valvular stenosis or regurgitation.

Phase contrast MRI

(REQUISITES) Cardiac mass that has grown through the fossa ovalis and extends into both the right and left atrium

DUMBBELL Myxoma

(REQUISITES) Differential dx for dumbbell myxoma involving the interatrial septum with sparing of the fossa ovalis

Lipomatous hypertrophy of the interatrial septum *can produce supraventricular arrythmia

(REQUISITES) MC tumor of the cardiac VALVES w/ sea-anemone-like appearance

Papillary Fibroelastoma *usually small (<1.5 cm)

(REQUISITES) MC location of cardiac papillary fibroelastoma

Aortic Valve (aortic side) 2nd MC: Mitral Valve (atrial side of leaflets)

(REQUISITES) MC PRIMARY MALIGNANT tumor of the heart in ADULT

Angiosarcoma *typically right side, often right atrium

(REQUISITES) MRI demonstrates "CAULIFLOWER-LIKE" heterogeneous appearance on T1, w/ hyperintense foci corresponding to hge, hypointense areas of necrosis, and heterogeneous lesions on T2.

Angiosarcoma

Most common type of SUBAORTIC STENOSIS which results in murmur. It occurs in isolation or part of SHONE COMPLEX

Subaortic Membrane

(REQUISITES) MC location of sarcomas that originate from the heart, other than angiosarcoma

Left atrium predominance

(REQUISITES) Differential diagnosis of lesions arising from the heart valves

Thrombi Vegetations Papillary Fibroelastoma

(REQUISITES) Larger, pedunculated masses attached to the valve leaflets are characteristic of

Vegetation

(REQUISITES) Non Bacterial vs Infective endocarditis: Has vegetation that are considerably smaller and frequently occurs BENEATH the CUSPS.

Non thrombotic Endocarditis (Libman-Sacks endocarditis)

(REQUISITES) Non Bacterial vs Infective endocarditis: Has vegetation that frequently occurs on LINE of CLOSURE of the leaflets.

Infective endocarditis

(REQUISITES) Calssic clinical triad of cardiac vegetation

Fever Heart murmur Positive blood cultures

(REQUISITES) BEST imaging TECHNIQUE to CONFIRM the presence of left vetricular THROMBUS

MRI Perfusion study followed by Delayed enhancement sequence *thrombus lasck enhancement *Bright enhancement of the underlying aneurysmal myocardial scar on the delayed enhancement images

(REQUISITES) MCC of DILATED cardiomyopathy

ISCHEMIC Disease

(REQUISITES) Criteria for the diagnosis of hypertrophic cardiomyopathy

Thickness of 15 mm or more, measured in END DIASTOLE

(REQUISITES) Criteria for the diagnosis of hypertrophic cardiomyopathy

Thickness of 15 mm or more, measured in END DIASTOLE

(REQUISITES) MC phenotype of Hypertrophic Cardiomyopathy

Asymmetric fetal type -hypertrophy of the septal wall of the left ventricle

MC valve disease

aortic disease

(REQUISITES) Most superior coronary sinus

Left aortic sinus

(REQUISITES) Most superior coronary sinus

Left aortic sinus

(REQUISITES) Non-coronay sinus and inferior most sinus

Posterior right aortic snus

Conditions associated with Mitral Valve Prolapse

MARFAN SYNDROME ostium secundum and atrial septal defect Aortic Coarctation

Common cardiac manifestation of Patients with SLE

Libman-Sacks Nonbacterial endocarditis *VEGETATIONS are seen the atrial and ventricular side of the MITRAL VALVE

Infection of the valve leaflets and prosthetic valves. Increased risk in patients with history of IV DRUG ABUSE

Infective endocarditis

an acquired cardiac disease that results to SCARRING AND FIBROSIS of cardiac valves

Rheumatic heart disease *autoimmune reaction to infection with GROUP A strep

MC Cardiac valve involved in RHEUMATIC HEART DISEASE

MITRAL VALVE **Mitral Valve > Aortic > Tricuspid > Pulmonary

Characterized by development of plaque-like, fibrous endocardial thickening involving the heart valves (esp tricuspid and pulmonary)

CARCINOID VALVE DISEASE *first line imaging is TTE * associated with carcinoid syndrome (midgut carcinoid) and chronic serotonin exposure

Imaging Feature of Carcinoid valve disease in TTE

- Thickened valve leaflets/cusps and subvalvular apparatus - Retraction and altered motion of the leaflets/cusps - Valve regurgitation

BRANT: Combination of Dextrocardia, Bronchiectasis, Sinusitis

Kartagener Syndrome

BRANT: Symmetrical mirror image of each other

Isomerism

BRANT: Left isomerism is associated with increased incidnec of

ASD Anomalous pulmonary venous return

BRANT: MC forrm of PAPVR,

one in w/c a right upper pulmonary vein connects to the RA of SVC.

BRANT: Stress induced cardiomyopathy or aka BROKEN HEART SYNDROME which as usually seen in POSTmenopausal women

TAKOTSUBO CARDIOMYOPATHY

Brant: genetically Heterogenous disease in both PEDIA AND ADULT in which normal morphogenesis of myocardial tissue into compact myocardium is DISRUPTED

Left Ventricular Non-Compaction

HYPERTRABECULATION of the Left ventricular myocardium and SPARES THE SEPTUM in cardiac MRI

left ventricular non- compaction

Systemic Inflammatory of the heart that shows presence of NONCASEATING GRANULOMA on endomyocardial biopsy

CARDIAC SARCOIDOSIS

Brant: Focal inflammation of the myocardium triggered by VIRAL INFECTION. Acute inflammation of this disease shows T2 hyperintense signal (global or regional) 2x from the skeletal muscle

MYOCARDITIS

DIAGNOSTIC OF ACUTE MYOCARDITIS

Myocardial edema ratio >3.2:1 Global relative enhancement Delayed pattern enhancement (Patchy nodular and/or linear in subepicardial and midmyocardial *2out of 3 reliable for the diagnosis

BRANT: MC form of PAPVR associated with sinus venosus ASD

Right Upper Pulmonary Vein (darining the irght upper and middle lobes) drains into the RA or SVC

BRANT: Ductus Arteriosum closes functionally

First 24H of life

BRANT: Ductus Arteriosum closes anatomically

by 10 Days of life

BRANT: Implulse delay in the AV node

0.7 sec

BRANT: Time b/w CLOSING of AV valves and OPENING of aortic and pulmonic valves

Period of Isovolumetric Contraction

BRANT: Period immediately after ventricular CONTRACTION when aortic and pulmonic valves have CLOSED, BUT the AV valves have NOT yet OPENED

Isovolumetric Relaxation

BRANT: INDIRECT signs of LA enlargement

1. Splaying of the carina (>90 deg) 2. Post displacement of LMB (lat view) 3. Sup displacement of LMB (AP)

BRANT: Measured @ 2cm above the intersection of the diaphragm and IVC (Lateral view); POSITIVE if the distance from the LA border and post border of IVC is >1.8 cm

Hoffman-Rigler Sign

BRANT: Standard view on ECHO useful to evaluate VENTRICULAR size and contractility, as well as assess morhology and function of the mitral and aortic valves

Long-axis view, Parasternal Window

BRANT: Useful for vsualization of the 4 cardica chambers including the Apex, EF assessment thru Simpson method, and assessment of mitral valve INFLOW

4-Chamber View

BRANT: Useful in assessment of Aortic Stenosis

5- Chamber View

Focal outpouching in the aortic contour at the ligamentum arteriosum

Physiologic Ductus Bump *difference with traumatic aneurysm - no history of trauma - no mediastinal hematoma

Acute hemorrhage WITHIN the aortic wall that resulted from rupture of the vasa vasorum within the media, forming a HEMATOMA WITHOUT COMMUNICATION to the aortic lumen

INTRAMURAL HEMATOMA

Brant: It is characterized by continous often crescentic hyperdense thickening of the aortic wall seen on NCCT. It may also demonstrate an INWARD DISPLACEMENT of atherosclerotic calcifications

INTRAMURAL HEMATOMA Standford classification TypeA- surgical treatment; higher risk; may extent into the mediastinum or pericardium TypeB - medical treatment

Brant: Indicative of thin cap atheroma; seen as RIM OF HIGH attenuation SURROUNDING AN AREA OF LOW attenuation, representing an inflamed cap surrounding a necrotic core. Presence is an INDEPENDENT PREDICTOR of future acute coronary event

Napkin-ring sign

Brant: Hemodynamically significant Fractional Flow Reserve (FFR)

0.8 or lower

Indirect sign of Plaque rupture which consist of severe atherosclerotic disease, composed of thick layers diffuse predominantly non calcified atheromatous plaque

Complex atheroma

Indirect sign of plaque rupture wherein contrast is seen extending between areas of complex plaque. This lesion DO NOT EXTEND BEYOND the lumen of the Aorta into the intima and DELINEATED BY LINEAR WALL CALCIFICATIONS

Plaque Ulceration DDX PAU: EXTEND BEYOND the intima of the aorta; sign of intimal disruption

Brant: Commonly seen in the left ventricular wall or interventricular septum that is T1 iso, T2 HYPO w/ intense late gad enhancement and central coarse calcification A. Rhabdomyoma B. Fibroma C. Papillay Fibroelastoma D. Hemangioma

Fibroma (Iso, hypo, intense LGE w/ central coarse calci)

Brant: MC primary cardiac tumor in infant & children associated w/ TS; shows T1 iso, T2 hyper w/ minimal to no enhancement A. Rhabdomyoma B. Fibroma C. Papillay Fibroelastoma D. Hemangioma

Rhabdomyoma (Iso, hyper, no enhancement) *assoc w/ TS

Brant: Most often valvular in location (aortic or mitral) showing T1 intermediate, T2 hyper w/ intense LGE; sea anemone appearance A. Rhabdomyoma B. Fibroma C. Papillay Fibroelastoma D. Hemangioma

Papillary Fibroelastoma (Intermediate, hyper, intense LGE) *best eval w/ 2D echo *DDx: vegetation (w/o enhancement within; septic clinically, destruction of valves)

Brant: Associated w/ Kasabach-Merritt syndrome; T1 and T2 hyper w/ intense enhancement A. Rhabdomyoma B. Fibroma C. Papillay Fibroelastoma D. Hemangioma

Hemangioma *intramural

Brant: Associated w/ Carney triad; MC in the LEFT ATRIAL wall (roof or posterior wall); T1 hypo- iso, T2 EXTREMELY hyper, intense enhancement A. Rhabdomyoma B. Paraganglioma C. Papillay Fibroelastoma D. Hemangioma

Paraganglioma (Iso/hypo, EXTREMELY hyper, intense enhancement)

Brant: MC in infants and children; within pericardial sac; MC RIGHT side; complex, multilocular cystic mass w/ attachment to aorta via a pedicle

Teratoma

Aortic arch variant that demonstrates a COMMON ORIGIN of the RIGHT BRACHIOCEPHALIC AND LEFT COMMON CAROTID ARTERY.

TWO vessel arch

A aortic arch variant in which the LEFT VERTEBRAL ARTERY has an INDEPENDENT ORIGIN from the aortic arch, BETWEEN the left common carotid and left subclavian arteries

FOUR VESSEL ARCH

Aortic arch variant in which the RIGHT subclavian artery arises distal to the left subclavian artery from the distal aortic arch and travels through the mediastinum behind the esophagus to supply the right upper extremity

ABERRANT RIGHT SUBCLAVIAN ARTERY * associated with KOMMERELL DIVERTICULUM * associated with Vascular ring, only if there is Right ligamentum arteriosum

If large, this embryologic remnant of the dorsal aortic arch can cause compressive symptoms of the esophagus

DIVERTICULUM OF KOMMERELL

Brant: Fical prominence of the aorta at the ligamentum arteriosum, a normal variant

Ductus Diverticulum a.k.a "Ductus Bump"

Brant: Aneurysm @ tye origin of the aberrant right subclavian artery

Diverticulum of Kommerell *may cause compressive sx on thr esophagus

Brant: Dysphagia secondary to extrinsic compression of the esophagus, may occur due to a vascular ring or diverticulum of Kommerell

Dysphagia Lusoria

Brant: MC vascular RINGS

1. Right Aortic Arch w/ aberrant Left SA 2. Double Aortic Arch

Brant: AAA size with increased risk of rupture of about 14%

> 6 cm

Brant: Continuous, often crescentic, hyperdense thickening of the aortic wall; hematoma w/o communication w/ the aortic lumen.

Intramural Hematoma