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Harrisons Cardio Part 2 > Chapter 232 - Basic Biology; 236 - Imaging > Flashcards

Chapter 232 - Basic Biology; 236 - Imaging Flashcards

1
Q

Normal ef
Normal end diastolic volume
Normal end systolic volume

A

Normal ef 67 +/-8%
Normal end diastolic volume 75 +/- 20cc
Normal end systolic volume 25 +/- 7

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2
Q

O2 requirement of heart

A

15% of that of entire organism

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3
Q

Heart source of energy

A

Ffa - plasma (ffa metab = 70% in resting/fed state)

Glucose - plasma, glycogenolysis

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4
Q

Shifts between heart preference for glycolysis vs beta oxidation

A

Gluc - increase cardiac work, inotropes, hypoxia, ischemia

Ffa - beta adrenergic stimulation

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5
Q

Bernoulli equation

A

P=4v^2

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6
Q

Coronary artery calcium ct scoring

A

Agatson score

  • minimal 0-10
  • mild 10-100
  • moderate 100-400
  • severe >400
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7
Q

Radiation dose per imaging

A 
Cac measurement in ct: 1-2mSv
Typical mp spect scan: 4- 11
Mp pet scan: 2.5-4
Coronary cta: 5-15
Coronary angio: 7

**1 yr equivalent background radiation: 3msv

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8
Q

Pathognomonic findings of infarct and and microvascular obstruction on cmr

A

Infarct: Late gadolinium enhancement in areas or ccoronary artery distribution; sensitivity acute -99% chronic -94%

Microvascular obstruction: dense hypoenhanced areas within the core of a birght region of infarction

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9
Q

Assessment of lv systolic and diastolic fxn

A

Systolic = normal ef >55%; low normal ef 50-55%
Diastolic = mitral relaxation velocity - prognostic significance
Mitral deceleration time <150ms - restrictive physiology and severe diastolic dysfunction

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10
Q

Assessment of rv fxn

A

Fractional area chabge: correlate with outcomes

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11
Q

Contrast induced nephropathy return to baseline of renal function

A

7-10 days

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12
Q

Gadolinium nephropathy

A

Nephrogenic systemic fibrosis - unchelated form of gadolinium

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13
Q

Hallmark of myocardial ischemia on 2d echo

A
  • Wall motion abnormalities

- reduced systolic wall thickening

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14
Q

Rate of major adverse cardiac event annually if PET/SPECT is normal

A

<1% annnually

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15
Q

Normal coronary flow reserve

A

> 2.0

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16
Q

Fractional flow reserve

A

Pressure differential between a coronary segment distal to a stenosis and the aortaPressure differential between a coronary segment distal to a stenosis and the aorta

Normal=1

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17
Q

Low risk ett

A

> 10 mets without chest pain or ecg changes

= managed medically

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18
Q

High risk ett

A
  • Typical angina with >2mm st dep
  • ste
  • sustained arrhythmia
  • drop in bp

Management: refer for coronary angio

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19
Q

Aortic valve estimation of area most accurate technique

A
  • continuity principle
    <1.0cm2 severe
    <0.6cm2 critical
20
Q

Aortic regurg estimation

Mitral regurg estimation

A

Aortic - vena contracta

Mitral - proximal isovelocity surface area (pisa)

21
Q

Rheumatic mitral stenosis distinct appearance

A
  • hockey stick type deformity: tethering at the leaflet tips with relative pliabikity of the leaflets themselves
22
Q

Ff up imaging post myocardial infarct timing

A

1-6mos

23
Q

Pet vs dobu echo sensi vs speci comparison

A

Sensitive - pet

Specific - dobu echo

24
Q

Cardiac mri findings

A

Cardiac mri findings

  • infarct or ischemia: lge of subendocardium following coronary distribution
  • infiltrative: lge subepicardium and intramuscular not following coronary distribution
  • t2 enhancement: edema - myocarditis
  • t2 flair: iron deposition - hemochromatosis

**PET FDG: sarcoidosis

25
Q

Clinical diagnosis of chemotx associated cardiotoxicity

A
  • > 10% reduction in lvef to <55% in those without symptoms

- >5% reduction in lvef to <55% in those with symptoms

26
Q

2d echo findings of pericardial effusion

A
  • distance between parietal and visceral peritoneum >1cm
  • rv free wall diastolic collapse
  • respiratory flow variation: echo equivalent of pulsus paradoxus
27
Q

Atrial myxomas most common chamber in heart

A

75% la
20% ra
5% mixed or ventricular

28
Q

Initial test of choice for px with mechanical aortic or mitral valve and suspicion of IE
TRANSESOPHAGEAL echo

A
  • vegetation size should be measured because has prognostic significance
29
Q

Gorlin syndrome

A
  • cardiac fibromas
  • bifid ribs
  • gingival hyperplasia
30
Q

Patent foramen ovale test

A 
Bubble test (agitated saline test)
- manuevers to increase ra pressure >la: sniff maneuver, valsalva maneuver
31
Q

Iron toxicity cardiomyopathy cmr finding

A

t2 value (rate of signal reduction/decay in the myocardium) <20ms

32
Q

Elective cardiac catheterization risk

A 
Allergic rxn <5%
Access Bleeding 1.5-2%
Death 0.1%
Mi <0.1%
Stroke 0.01%
Ciaki 2-7%
Ci aki in high risk 20-30%
Dialysis 0.3-0.7%
33
Q

Ci aki definition and prevention

A

Increase by >0.5mg/dl or >25% crea within 48-72hrs
Prevention
1. Nss x 1-1.5cc/kg/hr 3-12hrs pre and 6-24hrs post contrast
2. Metformin hold 24hrs pre and 48hrs post
3. Nahco3 3cc/kg 1hr pre and 6hrs post
4. Limit contrast volume <50cc

34
Q

Coranary angio antiplatelets and anticoag

A
  • ok with antiplatelets, load if with planmed pci
  • hold warfarin 2-3days target inr <1.7
  • hold noacs 24-48hrs
35
Q

Test to assess palmar arch patency prior to catheterization

A
  • allen test and barbeau test
36
Q

Normal hemodynamic values: ra, rv-pa, la, lv-ao

A 
Ra: 0-5
La: 4-12
Rv/pa: 17-32/1-7
Lv: 90-130/5-12
Ao: 90-130/60-85
37
Q

Systemic vascular resistance

Pulmo vascular resistance

A

S: 900-1400
P: 40-120

38
Q

Cardiac index

A

CI 2.8-4.2 Lmin/m2

39
Q

AV O2 difference

A

AV O2 difference 3.5-4.8%

40
Q

Hocm hemodynamic sign on cardiac catheterization

A

Brockenbrough-Braunwald sign: after pvc, increase in lv pressure but decrease aortic pressure

41
Q

Hemodynamic measurements
Tamponade vs
constrictive pericarditis vs
Restrictive cm

A

Tamponade
- ra: increased
- y descent: decreased or absent
- diastole pressures: equalization in all chambers
constrictive pericarditis
- ra: increased
- y descent: prominent, square root sign
- diastole pressures (most specific sign of constriction): rv increase, lv decrease** chapter 235
**chapter 265 equalization of all pressures
Restrictive cm
- ra: increased (>60mmhg)
- y descent: prominent, square rt sign
- diastole pressures: both rv and lv increase but separation by >5mmhg

42
Q

Intracardiac shunt hemodynamic assessment

Significant shunt ratio and indication for surgery

A
  • step up: left to right shunt
  • step down: right to left shunt
    Shunt ratio for asd
  • > 1.5: significant
  • > 2.0 + lv overload: indication for sx
43
Q

Circulation dominance

A
  • depends on origin of av nodal branch, posterior descending artery, posterior lateral vessels
  • right 85% - rca
  • left 5% - lcx
  • codominant 10%
  • *sa nodal artery source
  • rca: 55-60%
  • lcx: 40-45%
44
Q

Stenosis of how much is considered significant

A

50%

45
Q

Most common coronary artery anomaly

A
  • separare ostia for lad and lcx
46
Q

Timi flow

A

0 - no flow
1 - no distal perfusion
2 - delayed distal perfusion
3 - normal flow

47
Q

Hemodynamically sig stenosis by fractional flow reserve

A

<0.80

- ratio of pressure of distal to stenosis vs proximal to stenosis

Harrisons Cardio Part 2 (4 decks)

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