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AJT CORE > CORE - Cardiac > Flashcards

CORE - Cardiac Flashcards

1
Q

Coronary artery aneurysm size threshold

A

1.5x normal luminal diameter

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2
Q

Mitral stenosis

A

rheumatic heart disease

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3
Q

PA draped over the aorta

A

appearance of the PA after the LeCompte Maneuver to correct D-transposition (Jatene procedure)

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4
Q

Dilated cardiomyopathy measurement

A

end-diastolic diameter >5.5 cm + decreased EF; need cardiac cath to exclude an ischemic cause

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5
Q

Restrictive cardiomyopathy

A

anything interfering with diastolic function

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6
Q

Most common cause of restrictive cardiomyopathy

A

amyloidosis

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7
Q

Difficult to null/suppress myocardium

A

amyloidosis

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8
Q

Bi-ventricular thrombus

A

eosinophilic cardiomyopathy

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9
Q

Upper limit of normal pericardial thickness

A

4 mm; if >4 mm => pericarditis

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10
Q

Diastolic bounce (sigmoidization)

A

constrictive pericarditis - ventricular septum moves toward the left ventricle in a wavy pattern during early diastole

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11
Q

Systolic anterior motion of the mitral valve

A

HOCM

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12
Q

Non-compaction ratio

A

2.3:1, non-compacted to compacted myocardium measurd at end-diastole; medical management typically

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13
Q

Water bottle heart

A

pericardial effusion

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14
Q

Oreo cookie or sandwich sign

A

pericardial effusion; outlined by the relatively lucencies of the epicardial and mediastinal fat

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15
Q

Cardiac tamponade can occur with as little as ___ cc of fluid

A

100 cc; rate of accumulation is an important factor

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16
Q

Flattening or inversion of septum towards LV

A

cardiac tamponade; due to augmented RV fillling from pressure

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17
Q

Kid with dilated heart and mid myocardial enhancement

A

muscular dystrophy

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18
Q

Most common ASD

A

ostium secundum (mid) > ostium primum (anterior) > sinus venosus (posterior)

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19
Q

Giant coronary artery aneurysm

A

>8 mm; associated with MI’s

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20
Q

Wet beri beri (thiamine deficiency)

A

dilated cardiomyopathy

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21
Q

Unroofed coronary sinus

A

persistent left SVC

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22
Q

Most common cardiac metastasis

A

lung cancer > lymphoma

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23
Q

Most common cause of tricuspid insufficiency

A

RV hypertrophy from pulmonary HTN or cor pulmonale

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24
Q

VENC

A

velocity encoding gradient - upper limit of velocities for velocity mapping. blood flow velocities over this value will result in aliasing

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25
Q

Restrictive cardiomyopathy DDx

A

sarcoidosis, amyloidosis, hemochromatosis, endocardial fibroelastosis, scleroderma, Fabry disease, Loeffler’s

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26
Q

Constrictive pericarditis DDx

A

uremia, TB, prior hemorrhage, prior cardiac surgery

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27
Q

Pericardial thickening

A

constrictive pericarditis

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28
Q

Septal bounce

A

constrictive pericarditis; RV fills first pushes septum to the LV => LV then fills and pushes septum back => bouncing appearance in diastole

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29
Q

LBBB

A

systolic irregularity of septal movement due to discordant ventricular contraction

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30
Q

Pericardial malignancy DDx

A

mets, hemangioma, lymphangioma, teratoma

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31
Q

Pericardial effusion DDx

A

uremia, SLE, Dressler syndrome

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32
Q

Crista terminalis

A

normal structure in the RA that may mimic tumor or thrombus

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33
Q

Eustachian valve

A

at inferior cavoatrial junction (IVC)

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34
Q

Chiari network

A

trabeculated appearance off the Eustachian valve

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35
Q

Dominance refers to which artery gives off PDA and PLA

A

80% are right dominant

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36
Q

Co-dominance

A

right gives off the PDA and the LCx gives off the PLA

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37
Q

Great cardiac vein

A

accompanies LAD

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38
Q

Middle cardiac vein

A

accompanies PDA (in posterior interventricular groove)

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39
Q

Delayed myocardial enhancement (DME)

A

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.

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40
Q

Rhabdomyoma

A

Most common cardiac tumor in peds. Most regress by themselves.

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41
Q

Fibroma

A

Second most common cardiac tumor in peds. Assoc. with basal cell nevus syndrome. LV free wall or septum most commonly.

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42
Q

Retrospective gating

A

Scan during entire cardiac cycle. Higher dose. Functional imaging. Necessary if patient has high heart rate.

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43
Q

Prospective gating

A

Scan only during specific time of R-R interval. Reduced dose. No functional imaging. Axial/step-and-shoot.

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44
Q

Goal HR for cardiac CTA and MRI

A

60 bpm or less

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45
Q

Beta-blocker is given for CTA/MRI to…

A

slow heart rate

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46
Q

Nitroglycerin is given for CTA/MRI to…

A

dilate the coronary arteries for better visualization

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47
Q

Contraindications to beta-blockers

A

severe asthma, acute chest pain, 2nd/3rd degree heart block, recent cocaine use

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48
Q

Contraindications to nitroglycerine

A

hypotension (SBP <100), severe aortic stenosis, HOCM, phosphodiesterase use (e.g. Viagra)

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49
Q

How long to hold Viagra before nitroglycerin?

A

24 hours

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50
Q

How long to hold Cialis before nitroglycerin?

A

48 hours

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51
Q

No caffeine within __ hours before the exam

A

12 hours

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52
Q

Transmural infarct thickness <25%

A

likely to improve with PCI

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53
Q

Transmural infarct thickness 25-50%

A

may improve with PCI

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54
Q

Transmural infarct thickness 50-100%

A

unlikely to recover function with PCI

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55
Q

Myocardial rupture (post-MI)

A

<3 days

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56
Q

Papillary muscle rupture (post-MI)

A

3-7 days

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57
Q

Ventricular pseudoaneurysm (post-MI)

A

3-7 days

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58
Q

Dressler syndrome (post-MI)

A

4-6 weeks

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59
Q

Ventricular aneurysm (post-MI)

A

months; requires remodeling and thinning

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60
Q

Crista supraventricularis

A

infundibulum separating the pulmonic and tricuspid valves

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61
Q

Double density sign

A

LA enlargement

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62
Q

Splaying of carina

A

LA enlargement (>90 degrees)

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63
Q

Walking man sign

A

LA enlargement

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64
Q

Chordae tendinae

A

connection between MV/TV leaflets and papillary muscles

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65
Q

Echogenic focus in LV

A

calcified papillary muscle; assoc. with increased incidence of Down syndrome

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66
Q

SA nodal branch origin

A

RCA

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67
Q

AV nodal branch origin

A

RCA

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68
Q

Acute marginal branch origin

A

RCA

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69
Q

Obtuse marginal branch origin

A

LCx

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70
Q

First branch off of RCA

A

conus branch

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71
Q

Posterior descending artery (PDA) origin

A

RCA, less commonly from the LCx

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72
Q

Posterolateral artery (PLA) origin

A

RCA, less commonly from the LCx

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73
Q

Coronary sinus location on 2-chamber view

A

below LA

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74
Q

3-chamber view

A

visualize LA, LV, and RV; for evaluation of LVOT (aortic valve)

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75
Q

2-chamber view

A

visualize LA and LV; for evaluation of LV wall motion and mitral valve

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76
Q

Steal syndrome

A

in ALCAPA; reversal of flow in the LCA as pressure decreases in the pulmonary circulation

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77
Q

Decreased coronary artery diameter in systole

A

myocardial bridging; Tx beta blockers, unroofing (if needed)

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78
Q

Coronary artery aneurysm causes

A

atherosclerosis, Kawasaki, iatrogenic

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79
Q

Coronary CTA indications

A

low risk for MI, atypical chest pain, coronary anatomy evaluation

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80
Q

Coronary CTA without beta-blocker

A

must be retrospective gated

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81
Q

Supravalvular aortic stenosis

A

Williams syndrome; may also be pulmonic

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82
Q

Valvular pulmonic stenosis

A

Noonan syndrome

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83
Q

Causes of aortic regurgitation

A

bicuspid aortic valve, endocarditis, Marfan’s, aortic root dilation from HTN, aortic dissection

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84
Q

Peripheral pulmonary arterial stenosis

A

Alagille syndrome (with absence of intrahepatic bile ducts)

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85
Q

Causes of mitral regurgitation

A

endocarditis, papillary muscle rupture post-MI, myxomatous degeneration, dilated CM => mitral annular dilation

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86
Q

2nd most common valve involved in rheumatic heart disease

A

aortic valve

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87
Q

Causes of tricuspid regurgitation

A

endocarditis, carcinoid syndrome, pulmonary HTN

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88
Q

Ebstein anomaly

A

hypoplastic TV, apically displaced posterior leaflet, enlarged RA, small “atrialized” RV; tricuspid regurgitation; due to maternal lithium

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89
Q

Tricuspid atresia

A

occurs with RV hypoplasia; assoc. with asplenia

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90
Q

Left-sided valvular degradation

A

primary bronchial carcinoid or right-to-left shunt

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91
Q

Calcified and dilated LA

A

mitral stenosis

92
Q

Dilated LA and LV

A

mitral regurgitation

93
Q

Mitral valve prolapse

A

bowing of 1 or both mitral valve leaflets >2 mm below in the annulus into the left atrium

94
Q

Left subclavian origin in mirror branching

A

front of arch (vs. back of arch with an aberrant origin)

95
Q

Causes of subclavian steal syndrome

A

atherosclerosis, Takayasu arteritis, radiation, preductal aortic coarctation, Blalock-Taussig shunt

96
Q

Most common congenital heart disease

A

Bicuspid aortic valve or VSD (depends on wording)

97
Q

Cyanotic with increased pulmonary blood flow

A

TAPVR, D-TGA, truncus arteriosus, tingle ventricle

98
Q

Cyanotic with decreased pulmonary blood flow

A

ToF, tricuspid atresia, Ebstein anomaly

99
Q

Aortic coarctation associations

A

assoc. with Turners, bicuspid aortic valve

100
Q

Extra-cardiac shunts

A

hepatic hemangioendothelioma, vein of galen malformation, sacrococcygeal teratoma

101
Q

Small heart DDx

A

adrenal insufficiency (Addison’s), cachectic state, constrictive pericarditis

102
Q

CHF in a newborn DDx

A

type 3 TAPVR, congenital aortic or mitral stenosis, hypoplastic left heart, cor triatriatum, pre-ductal coarctation

103
Q

Survival dependent on admixture DDx

A

TAPVR, D-TGA, hypoplastic left heart; ToF and TA also, but VSD is implicit

104
Q

type 1 TAPVR

A

Supracardiac (50%) - snowman sign

105
Q

type 2 TAPVR

A

Cardiac (30%)

106
Q

type 3 TAPVR

A

Infracardiac (20%) - veins drain below the diaphragm (hepatic or IVC); often causes pulmonary edema in newborns

107
Q

Tetralogy of Fallot

A

VSD, overriding aorta, RV hypertrophy, RVOT obstruction; pentalogy = ToF + ASD

108
Q

Double aortic arch

A

right arch is classically higher and larger compared to the left arch

109
Q

Double density

A

double density of the enlarged LA and right heart contour

110
Q

Walking man sign

A

posterior displacement of left mainstem bronchus on the lateral view from LA enlargement

111
Q

Egg-on-a-string heart

A

D-TGA

112
Q

Boot-shaped heart

A

Tetralogy of Fallot

113
Q

Snowman heart

A

TAPVR (supracardiac type)

114
Q

3 sign

A

aortic coarctation

115
Q

Scimitar sign

A

PAPVR with pulmonary hypoplasia

116
Q

Massive box-shaped heart

A

Ebstein anomaly, pulmonary atresia without a VSD, extra-cardiac shunt

117
Q

How much pericardial fluid is visible on plain film?

A

>200 cc

118
Q

Most anterior heart valve?

A

tricuspid valve

119
Q

Most superior heart valve?

A

pulmonary valve

120
Q

Supravalvar pulmonary stenosis

A

Williams syndrome, Ehlers-Danlos, post-rubella syndromes

121
Q

Supravalvular aortic stenosis

A

Williams syndrome

122
Q

Most prevalent cardiac valvular abnormality

A

mitral valve prolapse (Barlow syndrome)

123
Q

Isolated RUL pulmonary edema

A

mitral regurgitation

124
Q

Normal aortic valve area (ultrasound) + other grades

A

>2 cm²; mild = >1.5 cm²; moderate = 1.0-1.5 cm²; severe = <1.0 cm²; critical = <0.6 cm²

125
Q

Diverticulum of Kommerel

A

dilated origin of an aberrant left SCA

126
Q

Pulmonary hypertension

A

pulmonary artery pressure >25 mmHg and >30 mmHg with exercise; PA diameter ≥2.9 cm

127
Q

VSD subtype that must be repaired

A

outlet (infundibulum) subtype

128
Q

VSD causes enlargement of which chamber

A

classically the LA (may also affect LV or RV)

129
Q

PDA associations

A

prematurity, congenital rubella, cyanotic heart disease

130
Q

ASD with hand/thumb defects

A

Holt-Oram

131
Q

Congenital heart disease assoc. with Down syndrome

A

ostium primum ASD, endocardial cushion defects

132
Q

Unroofed coronary sinus

A

assoc. with left SVC; paradoxical emboli, chronic right heart volume overload

133
Q

Congenital heart disease assoc. with asplenia

A

TAPVR > endocardial cushion defects

134
Q

L-TGA

A

inversion of the ventricles; RV (with moderator band) is on the left

135
Q

Most common cyanotic heart disease

A

Tetralogy of Fallot

136
Q

Most common cause of cyanosis in the first 24 hours

A

D-TGA

137
Q

Most common complication of ToF repair

A

pulmonic regurgitation

138
Q

Microvascular obstruction - acute, subacute, or chronic?

A

acute or subacute

139
Q

Salvageable tissue (acute post-MI setting)

A

T2 bright tissue minus LGE tissue

140
Q

Causes of dilated cardiomyopathy

A

idiopathic, ischemic, alcohol, doxorubicin, cyclosporin, Chagas

141
Q

Bloodpool darker than myocardium

A

amyloidosis

142
Q

Causes of constrictive pericarditis

A

iatrogenic (CABG), radiation, TB, viral

143
Q

Calcified pericardium

A

constrictive pericarditis

144
Q

Dilated RV with abnormal wall motion

A

ARVD; fat signal within RV wall +/- thinning

145
Q

Dilated LV with mid-myocardial enhancement (peds)

A

muscular dystrophy

146
Q

Most common met to the heart

A

lung cancer (to pericardium)

147
Q

Most common primary malignant tumor (adults)

A

angiosarcoma

148
Q

Left atrial myxoma association

A

Carney complex

149
Q

Norwood procedure

A

stage 1 of HLH repair; first days of life; RV=>aorta, BT (or Sano) shunt, atrial septal excision, PDA ligated

150
Q

Blalock-Taussig (BT) shunt

A

connects right SCA to right PA

151
Q

Sano shunt

A

connects RV to pulmonary artery stump (from Norwood procedure); alternative to BT shunt

152
Q

Bi-directional Glenn (BDG) shunt

A

stage 2 of HLH repair; 3-6 months after stage 1 repair; connects SVC to right PA (replaces BT shunt)

153
Q

Fontan procedure

A

stage 3 of HLH repair; 1.5-5 y/o; connects IVC to PA (works in conjunction with BDG shunt)

154
Q

Hypoplastic left heart repair

A

Norwood procedure (includes BT shunt) => Bi-directional Glenn shunt => Fontan procedure

155
Q

Pulmonary artery banding

A

for tingle ventricle most commonly; reduces PA pressure (goal is 1/3 of systemic pressure)

156
Q

Atrial switch procedures

A

Senning or Mustard; utilize a baffle

157
Q

Jatene procedure

A

D-TGA repair; swap aorta and PA + relocation of coronary arteries

158
Q

Truncus arteriosus associations

A

DiGeorge syndrome (CATCH-22), right arch

159
Q

Structures arising from the primitive endocardial cushion

A

posterior/membranous ventricular septum, anterior leaflet of MV, septal leaflet of TV, ostium primum closure

160
Q

Rastelli procedure

A

for D-TGA, RVOT obstruction, VSD; alternative to Jatene procedure; utilizes baffles and grafts to create RV=>PA and LV=>aorta

161
Q

Ross procedure

A

for diseased aortic valves; the pulmonic valve is switched to the aortic position and a prosthetic valve is placed in the pulmonic position

162
Q

Bentall procedure

A

for combined AV and ascending aortic disease (e.g. annuloaortic ectasia); graft replacement of AV, aortic root, and ascending aorta; ‘B’ for both

163
Q

Complications of BDG shunt

A

SVC syndrome, pulmonary artery aneurysms

164
Q

Complications of BT shunt

A

pulmonary stenosis at shunt insertion site

165
Q

Complications of Fontan procedure

A

plastic bronchitis, enlarged RA => arrhythmia

166
Q

ToF associations

A

DiGeorge syndrome (CATCH-22), right arch, VACTERL, trisomy 21; TA is just the first two

167
Q

Treatment of PDA

A

indomethacin or surgical clip

168
Q

Malignant coronary artery anomalies

A

arising from PA, interarterial course (especially an intramural course with a “slit-like” configuration)

169
Q

Mid-myocardial enhancement

A

myocarditis, sarcoidosis, Chagas, dilated CM, hypertrophic CM (fibrosis), RV overload

170
Q

Subepicardial enhancement

A

myocarditis, sarcoidosis, Chagas, post-chemotherapy CM

171
Q

Circumferential enhancement

A

amyloidosis (subendocardial), post-cardiac transplant, hypereosinophilic CM, scleroderma

172
Q

Qp/Qs ratio >1.5

A

signifcant shunting that may benefit from intervention

173
Q

LA enlargement + big heart

A

mitral regurgitation

174
Q

Aorta enlargement + big heart

A

aortic regurgitation

175
Q

LA enlargement + normal-sized heart

A

mitral stenosis

176
Q

Aorta enlargement + normal-sized heart

A

aortic stenosis

177
Q

True cardiac aneurysms

A

occur months after MI, may calcify, rarely rupture; management is medical

178
Q

False cardiac aneurysms

A

occur days after MI, may rupture at any time; treatment is surgical

179
Q

Dilateral cardiomyopathy

A

impaired systolic function; next step is catheter angio to exclude CAD as a cause

180
Q

Truncal valve

A

most commonly tricuspid; may also be bicuspid or quadricuspid (latter assoc. with aortic insufficiency)

181
Q

Situs solitus

A

normal thoracic and abdominal anatomy

182
Q

Situs inversus

A

inverted position of chest and/or abdominal organs; totalis = complete chest and abdominal inversion

183
Q

Situs ambiguus

A

polysplenia or asplenia; disturbance of normal distribution of thoracic and/or abdominal organs

184
Q

Normal relationship of bronchi and PAs

A

right is eparterial (bronchus above artery), left is hyparterial (artery above bronchus); switched in situs inversus; bilateral hyparterial is seen in asplenia/polysplenia

185
Q

Young person with LBBB pattern on EKG

A

ARVD

186
Q

Thebesian valve

A

at the ostium of the coronary sinus

187
Q

Aliasing on phase contrast MRI

A

repeat study with higher VENC (above maximum expected velocity)

188
Q

Hemodynamically-significant % coronary artery stenosis

A

70%, except in the left main which is 50%; indication for CABG

189
Q

% coronary stenosis for perfusion defect (nucs)

A

50% stenosis during stress, 90% stenosis at rest

190
Q

Bernoulli equation

A

pressure gradient (mmHg) = 4 * Vmax^2, where Vmax is maximum velocity in m/s

191
Q

Normal mitral valve area (ultrasound) + other grades

A

4-6 cm²; mild = >1.5 cm²; moderate = 1.0-1.5 cm²; severe = <1.0 cm²

192
Q

Most common cardiac mass

A

thrombus > mets > myxoma

193
Q

ARVD (major criteria)

A

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
Q

Triad of symptoms associated with cardiac myxoma

A

embolic phenomenon (TIA/stroke), CHF (obstructive), constitutional symptoms

195
Q

Definition of transmural infarct

A

involves >50% of wall thickness

196
Q

Mitral annular calcification associations

A

coronary artery calcification, heart block, mild mitral regurgitation, Afib, increased stroke risk; NOT mitral stenosis

197
Q

Most posterior ASD

A

sinus venosus; assoc. with PAPVR

198
Q

Carcinoid syndrome effect on heart valves

A

causes Tricuspid Insufficiency and Pulmonic Stenosis (TIPS)

199
Q

Treatment for Kawasaki disease

A

aspirin + gammaglobulin

200
Q

Criteria for giant coronary artery aneurysm in Kawasaki’s

A

>8 mm

201
Q

SSFP

A

bright blood sequence (GRE); T2-weighted with some T1-weighting; used for cine imaging

202
Q

Black blood MRI sequence

A

spin echo-based; longer acquisition time but high spatial resolution

203
Q

VENC

A

velocity encoded cine; phase contrast sequence used for quantification of blood flow

204
Q

Domed appearance of the aortic valve (MRI)

A

bicuspid aortic valve; ‘raphe’ is the structure between the fused valves

205
Q

Papillary muscle attachment in LV and RV

A

LV = attach to free wall only; RV = attach to free wall and septum

206
Q

Papillary muscle distribution

A

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
Q

RCA branches

A

conus => SA nodal => acute marginal => AV nodal => PDA + PLA

208
Q

Plane of short axis view (MR)

A

parallel to MV and perpendicular to septum

209
Q

MR sequence used to assess for LGE

A

T1-weighted IR GRE (bright blood)

210
Q

LGE pattern of hibernating myocardium

A

NONE (hibernating myocardium does not have LGE), just hypokinetic; will regain function with revascularization

211
Q

View used for quantification of chamber volumes and myocardial mass

A

short axis view

212
Q

Position of aortic valve relative to pulmonic valve

A

posterior, right, and inferior

213
Q

Opacification of retrosternal clear space

A

RV enlargement

214
Q

Cardiac silhouette-to-inner diameter of thorax ratio >0.55 (x-ray)

A

cardiac enlargement

215
Q

Chambers not seen on frontal and lateral views of x-ray

A

RV not seen on frontal; RA not seen on lateral

216
Q

Most common valve for fibroelastoma

A

aortic valve

217
Q

Postpartum female with coronary abnormality

A

coronary dissection

218
Q

LGE at the insertion points

A

HCM, pulmonary hypertension

219
Q

Libman-Sacks endocarditis

A

Sterile endocarditis assoc. with SLE. Small sterile deposits on both sides of the mitral valve.

220
Q

LGE involving both ventricles

A

sarcoidosis or myocarditis

221
Q

Left main (LCA) branches

A

LAD, LCx, ramus branch

222
Q

Pulmonary atresia association

A

right aortic arch

223
Q

Null point for normal myocardium

A

300 msec

224
Q

Takotsubo cardiomyopathy

A

chest, abnormal ECG, elevated enzymes; normal cardiac cath; self-limited

225
Q

Hypereosinophilic cardiomyopathy

A

subendocardial enhancement (may be circumferential); often assoc. with thrombus

AJT CORE (12 decks)

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