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Cardiac > Coronary artery anomalies and disease > Flashcards

Coronary artery anomalies and disease Flashcards

1
Q

Coronary arteries arise from 3 anatomic outpouchings called

A

Sinuses of valsalva

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2
Q

True or false: no coronary artery should arise from the noncoronary sinus, which is directed posteriorly toward the interatrial septum

A

True

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3
Q

Largest coronary artery

A

Left main coronary artery

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4
Q

In approximately 20 to 30% of patients, the left main coronary artery trifurcates with what branch, in between the LAD and LCx

A

Ramus intermedius

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5
Q

Large vessel that runs along the anterior surface of the left ventricle

A

Left anterior descending artery

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6
Q

Gives rise to both septal branches and diagonal coronary artery branches

A

Left anterior descending artery

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7
Q

Supplies oxygenated blood to anterolateral and anteroseptal LV myocardium

A

Diagonal and septal branches of LAD

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8
Q

Supply oxygenated blood to the inferolateral aspect of LV

A

Obtuse marginal vessels from LCx

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9
Q

Gives rise to posterior descending artery and posterior left ventricular branches

A

Right coronary artery

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10
Q

Defined as the ostium of RCA to 1/2 the distance to the acute margin of heart

A

Proximal RCA

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11
Q

Defined as the end of the proximal RCA to the acute margin of the heart

A

Mid RCA

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12
Q

Defined as the end of the mid RCA to the origin of PDA

A

Distal RCA

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13
Q

Vessel that courses in the posterkor interventricular sulcus to supply the inferior wall of LV

A

Posterior descending artery

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14
Q

Usually the first branch of RCA; it supply blood to the right ventricular outflow tract or conus

A

Conus branch

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15
Q

Sometimes acts as a collateral pathway for blood flow to the LAD and this circuit is often referred to as the arterial circle of Vieussens

A

Conus branch

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16
Q

Small vessel that most often originates from RCA, but arises from LCx in about 1/3 of patients

A

Sinoatrial nodal branch

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17
Q

SA nodal branch courses posteriorly, if its from what artery

A

RCA

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18
Q

SA node courses medially if its from

A

LCx

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19
Q

SA node is located where

A

Posterior aspect of where the SVC enters the RA

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20
Q

In most patients, AV nodal branch arises from

A

Very distal “U-shaped” aspect of the distal RCA as it courses superior to PDA

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21
Q

Small vessel that courses superiorly toward the posterior annulus of mitral valve

A

AV nodal branch

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22
Q

Benign variant of left main coronary artery in which LAD and LCx have independent origins from the left sinus of Valsalva

A

Absence of the left main coronary artery

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23
Q

High origin of a coronary artery occurs when its ostium is located __ cm or greater above the sinotubular junction

A

1 cm

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24
Q

Anomalous origin of coronary arteries outside of aortic root most commonly affects what artery

A

RCA

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25
Q

Retroaortic course of coronary artery arises from the opposite sinus and courses posteriorly between the aorta and left atrium. It most commonly occurs in

A

LCx or left main coronary artery that arises from right sinus of valsalva

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26
Q

Occurs when an anomalous coronary artery courses anterior to RVOT

A

Prepulmonic course

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27
Q

Prepulmonic vessel often arises directly from _______ in the setting of a single coronary artery

A

Proximal RCA

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28
Q

Septal course of coronary artery usually involves what artery

A

Left anterior descending artery

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29
Q

Origin from the noncoronary sinus is an extremely rare anomaly that can occur with

A

RCA or LCA

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30
Q

Course of coronary artery where it arises from the opposite sinus and courses medially between the aorta and pulmonary artery

A

Interarterial course

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31
Q

Interarterial course of coronary artery, especially if this artery is involved, can lead to myocardial ischemia, infarction and sudden cardiac death

A

Left main or LAD

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32
Q

In interarterial course of RCA, a higher incidence of symptoms and adverse cardiac events has bern reported in those with a

A

More superior course of the interarterial vessel (between the aprta and pulmonary artery) as compared to those with a more inferior course (between the aorta and rvot)

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33
Q

A rare congenital anomaly wherein there anomalous origin of the left main coronary artery from the pulmonary artery

A

Bland-Garland-White syndrome

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34
Q

Single coronary artery is common in what side

A

Right

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35
Q

Ostial atresia is more common on what side

A

Left main coronary artery ostium

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36
Q

This anomaly us often associated with sudden cardiac death in newborns but patients can survive into adulthood if collateral pathways between the opposite coronary circulation exist

A

Ostial atresia

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37
Q

True or false: in ostial atresia, just distal to the atretic segment is a normal coronary anatomy

A

True

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38
Q

Common incidental finding and has been reported in up to 58% of patients undergoing coronary CTA and in up to 86% of autopsies

A

Intramyocardial course of a coronary artery/ myocardial bridging

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39
Q

Bridging most often involves the ____ where a band of myocardial tissue extends around the vessel

A

Mid-LAD

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40
Q

in myocardial bridging, patient may be asymptomatic because

A

even tho the vessel is compressed during systole, the arteries fill during diastole

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41
Q

altho myocardial bridging can be asymptomatic, angina and ischemia can occur through what various mechanisms

A

phasic systolic vessel compression, persistent diastolic lumen diameter reduction, increased blood flow velocities, retrograde systolic flow and reduced coronary flow reserve

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42
Q

there is increased incidence of coronary artery atherosclerotic disease at what part or segment of the myocardial bridged segment

A

proximal to the bridge; the bridged segment is typically free of disease

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43
Q

intracavitary course of coronary artery usually involves what artery

A

RCA extending into the RA

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44
Q

in most instances, a split or double coronary artery presents as

A

one coronary artery arising from the sinus of Valsalva, which then divides in its proximal portion into two parallel coronary arteries that mirror their courses

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45
Q

Coronary fistula are most often

A

Congenital

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46
Q

Drainage in coronary fistula is most commonly on what side

A

Right side (coronary sinus to pulmonary artery) physiologically acts like a left to right shunt

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47
Q

In coronary fistula, patients often present with

A

Congestive heart failure due to long standing shunt, ischemia due to a steal phenomenon (preferential flow of blood thru lower-pressure fistula instead of through higher-pressure capillary bed), or endocarditis

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48
Q

Leading cause of mortality of both men and women in the western world

A

Coronary artery disease

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49
Q

One of the main uses of coronary cta is

A

In patients with nonacute chest pain and a low to intermediate pretest probability of having severe obstructive coronary disease

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50
Q

True or false: coronary cta should not be performed in patients having acute coronary syndrome with ST elevation or elevated troponin level so

A

True

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51
Q

Currently, coronary artery calcification scoring is performed using

A

Prospective ECG gating with data reconstructed at a 2.5 mm slice thickness

52
Q

Tube potential recommended for CACS

A

120 kV

53
Q

Calcifications related to atherosclerotic disease

A

Intimal calcifications

54
Q

Calcifications that occur due to an osteoblastic-like factor released from intimal vascular smooth muscle cells

A

Intimal calcifications

55
Q

Refers to outward growth or expansion of both the coronary artery and associated plaque. It is primarily caused by medial and adventitial inflammation which weakens the underlying framework of the coronary artery and causes its outward expansion

A

Positive remodeling complex

56
Q

Inward growth of calcification, causing stenosis

A

Negative remodeling

57
Q

True or false: positive and negative remodeling usually occur together

A

True

58
Q

Caused by medial and adventitial inflammation which weakens the underlying framework of the coronary artery and causes its outward expansion

A

Positive remodeling

59
Q

Low attenuation plaque is defined as a plaque with attenuation value of ____, corresponds to a plaque with a larger lipid-rich necrotic core and thus has a higher propensity to rupture

A

<30 HU

60
Q

An additional coronary CTA Finding that may be indicative of a thin-cap atheromatous vulnerable plaque is termed the

A

Napkin ring sign

61
Q

A rim of high attenuation surrounding an area of low attenuation representing the inflamed fibrous cap surrounding the necrotic lipid core, and its presence can be an independent predictor of a future acute coronary event

A

Napkin ring sign

62
Q

In the left main coronary artery, a stenosis of ____ % is considered severe

A

> 50%

63
Q

Coronary stenosis is classified as absent, minimal, mild, moderate, severe and occlusive by how many %?

A 
Absent 0%
Minimal 1-24 %
Mild 25-49%
Moderate 50-69%
Severe 70-99%
Occlussive 100%
64
Q

In myocardial perfusion CT, images of the heart and coronary arteries are obtained during ____, when the iodinated contrast is predominantly intravascular

A

Early portion of first-pass circulation

65
Q

In myocardial perfusion imaging, infarcted tissue should show

A

Persistent perfusion defecrs during rest imaging

66
Q

In myocardial perfusion ct, iodinated contrast will concentrate in infarcted tissue and can be visualized by obtaininh a third scan _____ minutes after the last contrast administration

A

5-10 minutes

67
Q

It is derived from invasive coronary angiography where the differences in pressure across a stenosis are directly measured

A

CTa derived fractional flow reserve testing

68
Q

An FFR measurement of 1 means

A

No change in pressure across a stenosis

69
Q

FFR of 0.7 means

A

Pressure distal to the stenosis is only 70% of that proximal to the stenosis

70
Q

In general,FFR of 0.8 or lower is considered

A

Hemodynamically significant

71
Q

In patients with acute chest pain and ECG changes or elevated cardiac troponin levels, the first line of therapy is

A

Thrombolysis and revascularization

72
Q

This is an excellent tool to assess patients presenting to the ED with acute chest pain, a low to intermediate risk of CAD, and a negative troponin level

A

Coronary CTA

73
Q

Primary noninvasive technique for evaluatinh the coronary arteries

A

Coronary CTA

74
Q

True or false: coronary MRA can be done without contrast

A

True

75
Q

Coronary MRA is accepted as a tool to assess

A

for anomalous coronary arteries and coronary artery aneurysms, especially in the pediatric population, or those with severe contrasr allergies

76
Q

At 1.5 T,cMRA is performed using a whole heart, free-breathing, _____ sequence

A

3D steady-state free precession (SSFP)

77
Q

True or false: in cMRA using 3T, gadolinium contrast agents are recommended due to the different sequences used

A

True

78
Q

Gold standard for evaluating cardiac function and can differentiate between ischemic and nonischemic etiologies of myocardial injury and dysfunction

A

MRI

79
Q

When a patient undergoes a cardiac MRI with a known or suspected ischemic cardiomyopathy, the radiologist has four main goals, namely

A

Confirm or refute the suspected diagnosis, evaluate cardiac function and morphology, assess for myocardial viability and look for any complications

80
Q

Functional cardiac evaluation in 3T MRI uses what sequences

A

GRE or SSFP

81
Q

To acquire a single slice along a prespecified cardiac plane, what technique is done

A

Expiratory breath-held, retrospectively gated, segmented sequence is obtained over multiple heart beats

82
Q

Mainstay slide thickness and gap used in cardiac MRI

A

6-8 mm slice thickness, sometimes with a 2mm gap between slices, a short axis stack of cine SSFP or GRE, throigh the entire cardiac axis from the mitral valve plane to cardiac apex

83
Q

Cardiac wall motion can be described as

A

Hypokinetic (reduced contractility), akinetic (no contractility) or dyskinetic (paradoxical movement)

84
Q

Anterior and anteroseptal segments at the base and mid cavity levels are supplied by

A

LAD and its branches

85
Q

Anteroseptal segments can be supplied by

A

Diagonal branches from LAD

86
Q

Often supplies the inferolateral segment but can also supply portions of the anterolateral and/or inferior segments depending on size and dominance

A

LCx and OM

87
Q

At the apical level, in many patients, the anterior, lateral and septal segments are supplied by

A

LAD distribution

88
Q

Inferior segment is supplied by the

A

PDA

89
Q

The cardiac apex (segment 17)is usually supplied by

A

LAD

90
Q

In the setting of recent MI, there may be increased subendocardial signal intensity at what sequence, due to edema

A

T2

91
Q

The T2 Sequences in recent MI are usually performed using

A

Doube inversiom recovery “black blood”, or triple inversion recovery to null both blood and fat

92
Q

As the myocardium remodels after an infarct, the affected segments can become _____. This is often associated with worsening function as the affected segments may become akinetic or dyskinetic

A

Thinned

93
Q

True or false: while myocardial thinning often suggests scarring, it does not necessarily indicate nonviable myocardium, which is assessed using delayed enhancement imaging

A

True

94
Q

Contrast enhanced cardiac mri shows enhancement or nonenhancement in areas where there has been acute myocyte injury or subacute infarct

A

Enhancement, secondary to cell membrane disruption, causing pooling of contrast

95
Q

Aside from gadolinium enhancement of acute or subacute myocardial infarct, chronic infarcts can also show enhancement due to its accumulation in the interstitial space due to scarring. Therefore, these sequence techniques are done to differentiate regions affected

A

Inversion time (double or triple)

96
Q

A myocardial injury from an infarct starts in the

A

Subendocardial region of the ventricle and extends outward

97
Q

Subendocardial enhancement measuring ____ of the regional myocardial thickness is associated with functional recovery after revascularization

A

<50%

98
Q

If the infarct involves the entire thickness of the myocardium, it is called

A

Transmural infarct

99
Q

Large transmural infarcts, especially those in LAD distribution are more likely to cause

A

Left ventricular aneurysms

100
Q

Due to alterations of blood flow, anterior left ventricular aneuryms have a propensity to develop _____ which can subsequentlu embolize

A

Thrombus

101
Q

Specific form of myocardial reperfusion injuru that occurs after therapy for an acute MI

A

Microvascular obstruction

102
Q

Microvascular obstruction occurs when after reperfusion, and when can it increase in size after injury

A

Nearly immediately after reperfusion, can increase in size up to 48 hours after injury, and can be seen up to 1 month after reperfusion

103
Q

True or false: gadolinium cannot diffuse into areas of microvascular obstruction

A

True

104
Q

On LGE imaging, microvascular obstruction appears as

A

Dark, nonenhanced areas surrounded by enhancing infarct

105
Q

When present, it is an indicator of severe myocardial injury that often leads to adverse left ventricular remodeling and is an independent predictor of worse patient outcomes

A

Microvascular obstruction

106
Q

Imaging that can be used to distinguish ischemia from prior myocardial infarction

A

Stress MR imaging using SSFP and perfusion imaging

107
Q

Rest followed by stress MR imaging is often performed using pharmacologic agents such as ______ because of the challenges of introducing MR compatible equipment into the MR imaging suite to perform physiologic stress testing

A

Adenosine

108
Q

Stents ___ mm in diameter are more likely to be evaluable

A

> |= to 3 mm

109
Q

Definitive treatment for advanced CAD

A

Coronary artery bypass grafting

110
Q

Artery that has a patency pf 85% after 10 years

A

Internal mammary

111
Q

Commonly used side of internal mamary artery for grafting

A

Left; due to its proximity to the lefr ventricular apex

112
Q

When a saphenous vein graft thrombose, all that may be visivle is a small, vascular outpouching from the ascending aorta, a finding that is sometimes referred to as the

A

Nubbin sign

113
Q

Aneurysms froM SVG graft occurs commonly at what distibution side

A

RCA distribution grafts

114
Q

In contrast to SVGAs, which occurs after 5 to 10 years after, pseudoaneurysms can occur when

A

First weeks to months after surgery, due to graft breakdown and dehiscence

115
Q

Defined as segment of the coronary artery that measures more than 1.5 times the adjacent normal coronary artery

A

Coronary artery aneurysm

116
Q

Most common cause of coronary artery aneurysm in pediatric population is

A

kawasaki disease; systemic small and medium vessel vasculitis

117
Q

True or false: smaller coronary attery aneurysms may decrease in size or resolve in patients with kawasaki disease

A

True

118
Q

Most common cause of coronary artery dissection

A

Percutaneous interventions

119
Q

Type of aortic dissection involving the ascending aorta and can extend into the aortic root

A

Type A

120
Q

Cause of coronary artery dissection in young women and was the cause of MI in 24% of women less than 50 y.o udergoing cadiac catheterization

A

Spontaneous coronary artery dissection

121
Q

3 catastrophic mechanical complications after acute myocardial infarction

A

Left ventricular free wall rupture, ventricular septal rupture, papillary muscle rupture

122
Q

Occurs when there is a tear thru the myocardium which is contained by adjacent pericardium or scar tissue

A

Left ventricular aneuryms aka left ventricular free wall rupture

123
Q

Most cardiac pseudoaneurysms invole the

A

Inferior and inferolateral walls

124
Q

In general, true cardiac aneurysms have

A

Broad neck

125
Q

Septal rupture can develop after transmural infract and leads to

A

Left to right shunt

126
Q

Papillary muscle that is 6 to 13 times more likely to rupture after MI

A

Posteromedial papullar muscle of LV

127
Q

Posteromedial papillary muscle is supplied by

A

PDA

Cardiac (8 decks)

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