CORE - Cardiac Flashcards
1
Q
Coronary artery aneurysm size threshold
A
1.5x normal luminal diameter
2
Q
Mitral stenosis
A
rheumatic heart disease
3
Q
PA draped over the aorta
A
appearance of the PA after the LeCompte Maneuver to correct D-transposition (Jatene procedure)
4
Q
Dilated cardiomyopathy measurement
A
end-diastolic diameter >5.5 cm + decreased EF; need cardiac cath to exclude an ischemic cause
5
Q
Restrictive cardiomyopathy
A
anything interfering with diastolic function
6
Q
Most common cause of restrictive cardiomyopathy
A
amyloidosis
7
Q
Difficult to null/suppress myocardium
A
amyloidosis
8
Q
Bi-ventricular thrombus
A
eosinophilic cardiomyopathy
9
Q
Upper limit of normal pericardial thickness
A
4 mm; if >4 mm => pericarditis
10
Q
Diastolic bounce (sigmoidization)
A
constrictive pericarditis - ventricular septum moves toward the left ventricle in a wavy pattern during early diastole
11
Q
Systolic anterior motion of the mitral valve
A
HOCM
12
Q
Non-compaction ratio
A
2.3:1, non-compacted to compacted myocardium measurd at end-diastole; medical management typically
13
Q
Water bottle heart
A
pericardial effusion
14
Q
Oreo cookie or sandwich sign
A
pericardial effusion; outlined by the relatively lucencies of the epicardial and mediastinal fat
15
Q
Cardiac tamponade can occur with as little as ___ cc of fluid
A
100 cc; rate of accumulation is an important factor
16
Q
Flattening or inversion of septum towards LV
A
cardiac tamponade; due to augmented RV fillling from pressure
17
Q
Kid with dilated heart and mid myocardial enhancement
A
muscular dystrophy
18
Q
Most common ASD
A
ostium secundum (mid) > ostium primum (anterior) > sinus venosus (posterior)
19
Q
Giant coronary artery aneurysm
A
>8 mm; associated with MI’s
20
Q
Wet beri beri (thiamine deficiency)
A
dilated cardiomyopathy
21
Q
Unroofed coronary sinus
A
persistent left SVC
22
Q
Most common cardiac metastasis
A
lung cancer > lymphoma
23
Q
Most common cause of tricuspid insufficiency
A
RV hypertrophy from pulmonary HTN or cor pulmonale
24
Q
VENC
A
velocity encoding gradient - upper limit of velocities for velocity mapping. blood flow velocities over this value will result in aliasing
25
Restrictive cardiomyopathy DDx
sarcoidosis, amyloidosis, hemochromatosis, endocardial fibroelastosis, scleroderma, Fabry disease, Loeffler's
26
Constrictive pericarditis DDx
uremia, TB, prior hemorrhage, prior cardiac surgery
27
Pericardial thickening
constrictive pericarditis
28
Septal bounce
constrictive pericarditis; RV fills first pushes septum to the LV =\> LV then fills and pushes septum back =\> bouncing appearance in diastole
29
LBBB
systolic irregularity of septal movement due to discordant ventricular contraction
30
Pericardial malignancy DDx
mets, hemangioma, lymphangioma, teratoma
31
Pericardial effusion DDx
uremia, SLE, Dressler syndrome
32
Crista terminalis
normal structure in the RA that may mimic tumor or thrombus
33
Eustachian valve
at inferior cavoatrial junction (IVC)
34
Chiari network
trabeculated appearance off the Eustachian valve
35
Dominance refers to which artery gives off PDA and PLA
80% are right dominant
36
Co-dominance
right gives off the PDA and the LCx gives off the PLA
37
Great cardiac vein
accompanies LAD
38
Middle cardiac vein
accompanies PDA (in posterior interventricular groove)
39
Delayed myocardial enhancement (DME)
Normal myocadium null point is usually around 300 msec. Abnormal myocardium will null and recover signal faster, so by 300msec abnormal myocardium should be bright already.
40
Rhabdomyoma
Most common cardiac tumor in peds. Most regress by themselves.
41
Fibroma
Second most common cardiac tumor in peds. Assoc. with basal cell nevus syndrome. LV free wall or septum most commonly.
42
Retrospective gating
Scan during entire cardiac cycle. Higher dose. Functional imaging. Necessary if patient has high heart rate.
43
Prospective gating
Scan only during specific time of R-R interval. Reduced dose. No functional imaging. Axial/step-and-shoot.
44
Goal HR for cardiac CTA and MRI
60 bpm or less
45
Beta-blocker is given for CTA/MRI to...
slow heart rate
46
Nitroglycerin is given for CTA/MRI to...
dilate the coronary arteries for better visualization
47
Contraindications to beta-blockers
severe asthma, acute chest pain, 2nd/3rd degree heart block, recent cocaine use
48
Contraindications to nitroglycerine
hypotension (SBP \<100), severe aortic stenosis, HOCM, phosphodiesterase use (e.g. Viagra)
49
How long to hold Viagra before nitroglycerin?
24 hours
50
How long to hold Cialis before nitroglycerin?
48 hours
51
No caffeine within __ hours before the exam
12 hours
52
Transmural infarct thickness \<25%
likely to improve with PCI
53
Transmural infarct thickness 25-50%
may improve with PCI
54
Transmural infarct thickness 50-100%
unlikely to recover function with PCI
55
Myocardial rupture (post-MI)
\<3 days
56
Papillary muscle rupture (post-MI)
3-7 days
57
Ventricular pseudoaneurysm (post-MI)
3-7 days
58
Dressler syndrome (post-MI)
4-6 weeks
59
Ventricular aneurysm (post-MI)
months; requires remodeling and thinning
60
Crista supraventricularis
infundibulum separating the pulmonic and tricuspid valves
61
Double density sign
LA enlargement
62
Splaying of carina
LA enlargement (\>90 degrees)
63
Walking man sign
LA enlargement
64
Chordae tendinae
connection between MV/TV leaflets and papillary muscles
65
Echogenic focus in LV
calcified papillary muscle; assoc. with increased incidence of Down syndrome
66
SA nodal branch origin
RCA
67
AV nodal branch origin
RCA
68
Acute marginal branch origin
RCA
69
Obtuse marginal branch origin
LCx
70
First branch off of RCA
conus branch
71
Posterior descending artery (PDA) origin
RCA, less commonly from the LCx
72
Posterolateral artery (PLA) origin
RCA, less commonly from the LCx
73
Coronary sinus location on 2-chamber view
below LA
74
3-chamber view
visualize LA, LV, and RV; for evaluation of LVOT (aortic valve)
75
2-chamber view
visualize LA and LV; for evaluation of LV wall motion and mitral valve
76
Steal syndrome
in ALCAPA; reversal of flow in the LCA as pressure decreases in the pulmonary circulation
77
Decreased coronary artery diameter in systole
myocardial bridging; Tx beta blockers, unroofing (if needed)
78
Coronary artery aneurysm causes
atherosclerosis, Kawasaki, iatrogenic
79
Coronary CTA indications
low risk for MI, atypical chest pain, coronary anatomy evaluation
80
Coronary CTA without beta-blocker
must be retrospective gated
81
Supravalvular aortic stenosis
Williams syndrome; may also be pulmonic
82
Valvular pulmonic stenosis
Noonan syndrome
83
Causes of aortic regurgitation
bicuspid aortic valve, endocarditis, Marfan's, aortic root dilation from HTN, aortic dissection
84
Peripheral pulmonary arterial stenosis
Alagille syndrome (with absence of intrahepatic bile ducts)
85
Causes of mitral regurgitation
endocarditis, papillary muscle rupture post-MI, myxomatous degeneration, dilated CM =\> mitral annular dilation
86
2nd most common valve involved in rheumatic heart disease
aortic valve
87
Causes of tricuspid regurgitation
endocarditis, carcinoid syndrome, pulmonary HTN
88
Ebstein anomaly
hypoplastic TV, apically displaced posterior leaflet, enlarged RA, small "atrialized" RV; tricuspid regurgitation; due to maternal lithium
89
Tricuspid atresia
occurs with RV hypoplasia; assoc. with asplenia
90
Left-sided valvular degradation
primary bronchial carcinoid or right-to-left shunt
91
Calcified and dilated LA
mitral stenosis
92
Dilated LA and LV
mitral regurgitation
93
Mitral valve prolapse
bowing of 1 or both mitral valve leaflets \>2 mm below in the annulus into the left atrium
94
Left subclavian origin in mirror branching
front of arch (vs. back of arch with an aberrant origin)
95
Causes of subclavian steal syndrome
atherosclerosis, Takayasu arteritis, radiation, preductal aortic coarctation, Blalock-Taussig shunt
96
Most common congenital heart disease
Bicuspid aortic valve or VSD (depends on wording)
97
Cyanotic with increased pulmonary blood flow
TAPVR, D-TGA, truncus arteriosus, tingle ventricle
98
Cyanotic with decreased pulmonary blood flow
ToF, tricuspid atresia, Ebstein anomaly
99
Aortic coarctation associations
assoc. with Turners, bicuspid aortic valve
100
Extra-cardiac shunts
hepatic hemangioendothelioma, vein of galen malformation, sacrococcygeal teratoma
101
Small heart DDx
adrenal insufficiency (Addison's), cachectic state, constrictive pericarditis
102
CHF in a newborn DDx
type 3 TAPVR, congenital aortic or mitral stenosis, hypoplastic left heart, cor triatriatum, pre-ductal coarctation
103
Survival dependent on admixture DDx
TAPVR, D-TGA, hypoplastic left heart; ToF and TA also, but VSD is implicit
104
type 1 TAPVR
Supracardiac (50%) - snowman sign
105
type 2 TAPVR
Cardiac (30%)
106
type 3 TAPVR
Infracardiac (20%) - veins drain below the diaphragm (hepatic or IVC); often causes pulmonary edema in newborns
107
Tetralogy of Fallot
VSD, overriding aorta, RV hypertrophy, RVOT obstruction; pentalogy = ToF + ASD
108
Double aortic arch
right arch is classically higher and larger compared to the left arch
109
Double density
double density of the enlarged LA and right heart contour
110
Walking man sign
posterior displacement of left mainstem bronchus on the lateral view from LA enlargement
111
Egg-on-a-string heart
D-TGA
112
Boot-shaped heart
Tetralogy of Fallot
113
Snowman heart
TAPVR (supracardiac type)
114
3 sign
aortic coarctation
115
Scimitar sign
PAPVR with pulmonary hypoplasia
116
Massive box-shaped heart
Ebstein anomaly, pulmonary atresia without a VSD, extra-cardiac shunt
117
How much pericardial fluid is visible on plain film?
\>200 cc
118
Most anterior heart valve?
tricuspid valve
119
Most superior heart valve?
pulmonary valve
120
Supravalvar pulmonary stenosis
Williams syndrome, Ehlers-Danlos, post-rubella syndromes
121
Supravalvular aortic stenosis
Williams syndrome
122
Most prevalent cardiac valvular abnormality
mitral valve prolapse (Barlow syndrome)
123
Isolated RUL pulmonary edema
mitral regurgitation
124
Normal aortic valve area (ultrasound) + other grades
\>2 cm²; mild = \>1.5 cm²; moderate = 1.0-1.5 cm²; severe = \<1.0 cm²; critical = \<0.6 cm²
125
Diverticulum of Kommerel
dilated origin of an aberrant left SCA
126
Pulmonary hypertension
pulmonary artery pressure \>25 mmHg and \>30 mmHg with exercise; PA diameter ≥2.9 cm
127
VSD subtype that must be repaired
outlet (infundibulum) subtype
128
VSD causes enlargement of which chamber
classically the LA (may also affect LV or RV)
129
PDA associations
prematurity, congenital rubella, cyanotic heart disease
130
ASD with hand/thumb defects
Holt-Oram
131
Congenital heart disease assoc. with Down syndrome
ostium primum ASD, endocardial cushion defects
132
Unroofed coronary sinus
assoc. with left SVC; paradoxical emboli, chronic right heart volume overload
133
Congenital heart disease assoc. with asplenia
TAPVR \> endocardial cushion defects
134
L-TGA
inversion of the ventricles; RV (with moderator band) is on the left
135
Most common cyanotic heart disease
Tetralogy of Fallot
136
Most common cause of cyanosis in the first 24 hours
D-TGA
137
Most common complication of ToF repair
pulmonic regurgitation
138
Microvascular obstruction - acute, subacute, or chronic?
acute or subacute
139
Salvageable tissue (acute post-MI setting)
T2 bright tissue minus LGE tissue
140
Causes of dilated cardiomyopathy
idiopathic, ischemic, alcohol, doxorubicin, cyclosporin, Chagas
141
Bloodpool darker than myocardium
amyloidosis
142
Causes of constrictive pericarditis
iatrogenic (CABG), radiation, TB, viral
143
Calcified pericardium
constrictive pericarditis
144
Dilated RV with abnormal wall motion
ARVD; fat signal within RV wall +/- thinning
145
Dilated LV with mid-myocardial enhancement (peds)
muscular dystrophy
146
Most common met to the heart
lung cancer (to pericardium)
147
Most common primary malignant tumor (adults)
angiosarcoma
148
Left atrial myxoma association
Carney complex
149
Norwood procedure
stage 1 of HLH repair; first days of life; RV=\>aorta, BT (or Sano) shunt, atrial septal excision, PDA ligated
150
Blalock-Taussig (BT) shunt
connects right SCA to right PA
151
Sano shunt
connects RV to pulmonary artery stump (from Norwood procedure); alternative to BT shunt
152
Bi-directional Glenn (BDG) shunt
stage 2 of HLH repair; 3-6 months after stage 1 repair; connects SVC to right PA (replaces BT shunt)
153
Fontan procedure
stage 3 of HLH repair; 1.5-5 y/o; connects IVC to PA (works in conjunction with BDG shunt)
154
Hypoplastic left heart repair
Norwood procedure (includes BT shunt) =\> Bi-directional Glenn shunt =\> Fontan procedure
155
Pulmonary artery banding
for tingle ventricle most commonly; reduces PA pressure (goal is 1/3 of systemic pressure)
156
Atrial switch procedures
Senning or Mustard; utilize a baffle
157
Jatene procedure
D-TGA repair; swap aorta and PA + relocation of coronary arteries
158
Truncus arteriosus associations
DiGeorge syndrome (CATCH-22), right arch
159
Structures arising from the primitive endocardial cushion
posterior/membranous ventricular septum, anterior leaflet of MV, septal leaflet of TV, ostium primum closure
160
Rastelli procedure
for D-TGA, RVOT obstruction, VSD; alternative to Jatene procedure; utilizes baffles and grafts to create RV=\>PA and LV=\>aorta
161
Ross procedure
for diseased aortic valves; the pulmonic valve is switched to the aortic position and a prosthetic valve is placed in the pulmonic position
162
Bentall procedure
for combined AV and ascending aortic disease (e.g. annuloaortic ectasia); graft replacement of AV, aortic root, and ascending aorta; 'B' for both
163
Complications of BDG shunt
SVC syndrome, pulmonary artery aneurysms
164
Complications of BT shunt
pulmonary stenosis at shunt insertion site
165
Complications of Fontan procedure
plastic bronchitis, enlarged RA =\> arrhythmia
166
ToF associations
DiGeorge syndrome (CATCH-22), right arch, VACTERL, trisomy 21; TA is just the first two
167
Treatment of PDA
indomethacin or surgical clip
168
Malignant coronary artery anomalies
arising from PA, interarterial course (especially an intramural course with a "slit-like" configuration)
169
Mid-myocardial enhancement
myocarditis, sarcoidosis, Chagas, dilated CM, hypertrophic CM (fibrosis), RV overload
170
Subepicardial enhancement
myocarditis, sarcoidosis, Chagas, post-chemotherapy CM
171
Circumferential enhancement
amyloidosis (subendocardial), post-cardiac transplant, hypereosinophilic CM, scleroderma
172
Qp/Qs ratio \>1.5
signifcant shunting that may benefit from intervention
173
LA enlargement + big heart
mitral regurgitation
174
Aorta enlargement + big heart
aortic regurgitation
175
LA enlargement + normal-sized heart
mitral stenosis
176
Aorta enlargement + normal-sized heart
aortic stenosis
177
True cardiac aneurysms
occur months after MI, may calcify, rarely rupture; management is medical
178
False cardiac aneurysms
occur days after MI, may rupture at any time; treatment is surgical
179
Dilateral cardiomyopathy
impaired systolic function; next step is catheter angio to exclude CAD as a cause
180
Truncal valve
most commonly tricuspid; may also be bicuspid or quadricuspid (latter assoc. with aortic insufficiency)
181
Situs solitus
normal thoracic and abdominal anatomy
182
Situs inversus
inverted position of chest and/or abdominal organs; totalis = complete chest and abdominal inversion
183
Situs ambiguus
polysplenia or asplenia; disturbance of normal distribution of thoracic and/or abdominal organs
184
Normal relationship of bronchi and PAs
right is eparterial (bronchus above artery), left is hyparterial (artery above bronchus); switched in situs inversus; bilateral hyparterial is seen in asplenia/polysplenia
185
Young person with LBBB pattern on EKG
ARVD
186
Thebesian valve
at the ostium of the coronary sinus
187
Aliasing on phase contrast MRI
repeat study with higher VENC (above maximum expected velocity)
188
Hemodynamically-significant % coronary artery stenosis
70%, except in the left main which is 50%; indication for CABG
189
% coronary stenosis for perfusion defect (nucs)
50% stenosis during stress, 90% stenosis at rest
190
Bernoulli equation
pressure gradient (mmHg) = 4 \* Vmax^2, where Vmax is maximum velocity in m/s
191
Normal mitral valve area (ultrasound) + other grades
4-6 cm²; mild = \>1.5 cm²; moderate = 1.0-1.5 cm²; severe = \<1.0 cm²
192
Most common cardiac mass
thrombus \> mets \> myxoma
193
ARVD (major criteria)
imaging may only supply 1 major or minor criteria; include abnormal wall motion, RV aneurysm, decreased RVEF, and RV dilatation; LV involvement in 75%; Tx AICD
194
Triad of symptoms associated with cardiac myxoma
embolic phenomenon (TIA/stroke), CHF (obstructive), constitutional symptoms
195
Definition of transmural infarct
involves \>50% of wall thickness
196
Mitral annular calcification associations
coronary artery calcification, heart block, mild mitral regurgitation, Afib, increased stroke risk; NOT mitral stenosis
197
Most posterior ASD
sinus venosus; assoc. with PAPVR
198
Carcinoid syndrome effect on heart valves
causes Tricuspid Insufficiency and Pulmonic Stenosis (TIPS)
199
Treatment for Kawasaki disease
aspirin + gammaglobulin
200
Criteria for giant coronary artery aneurysm in Kawasaki's
\>8 mm
201
SSFP
bright blood sequence (GRE); T2-weighted with some T1-weighting; used for cine imaging
202
Black blood MRI sequence
spin echo-based; longer acquisition time but high spatial resolution
203
VENC
velocity encoded cine; phase contrast sequence used for quantification of blood flow
204
Domed appearance of the aortic valve (MRI)
bicuspid aortic valve; 'raphe' is the structure between the fused valves
205
Papillary muscle attachment in LV and RV
LV = attach to free wall only; RV = attach to free wall and septum
206
Papillary muscle distribution
RV = anterior, posterior, septal; LV = anterolateral (supplied by LAD+LCx), posteromedial (supplied by RCA); posteromedial muscle ruptures most often because of single blood supply
207
RCA branches
conus =\> SA nodal =\> acute marginal =\> AV nodal =\> PDA + PLA
208
Plane of short axis view (MR)
parallel to MV and perpendicular to septum
209
MR sequence used to assess for LGE
T1-weighted IR GRE (bright blood)
210
LGE pattern of hibernating myocardium
NONE (hibernating myocardium does not have LGE), just hypokinetic; will regain function with revascularization
211
View used for quantification of chamber volumes and myocardial mass
short axis view
212
Position of aortic valve relative to pulmonic valve
posterior, right, and inferior
213
Opacification of retrosternal clear space
RV enlargement
214
Cardiac silhouette-to-inner diameter of thorax ratio \>0.55 (x-ray)
cardiac enlargement
215
Chambers not seen on frontal and lateral views of x-ray
RV not seen on frontal; RA not seen on lateral
216
Most common valve for fibroelastoma
aortic valve
217
Postpartum female with coronary abnormality
coronary dissection
218
LGE at the insertion points
HCM, pulmonary hypertension
219
Libman-Sacks endocarditis
Sterile endocarditis assoc. with SLE. Small sterile deposits on both sides of the mitral valve.
220
LGE involving both ventricles
sarcoidosis or myocarditis
221
Left main (LCA) branches
LAD, LCx, ramus branch
222
Pulmonary atresia association
right aortic arch
223
Null point for normal myocardium
300 msec
224
Takotsubo cardiomyopathy
chest, abnormal ECG, elevated enzymes; normal cardiac cath; self-limited
225
Hypereosinophilic cardiomyopathy
subendocardial enhancement (may be circumferential); often assoc. with thrombus
