Imaging in Cardiology: Heart Failure

Question 1

What is pulmonary capillary wedge pressure (PCWP)? [1]

Answer 1

measurement that provides an indirect estimate of left atrial pressure (LAP)

Question 2

What are the features of stage 1 congestive heart failure? [3]

Answer 2

1. PCWP = 13-18mmHg
2. redistribution of pulmonary vessels
   
   • due to distention of the vessels
3. cardiomegaly (usually the heart is BIG)
   
   • ​​greater than half of the chest wall width

Question 3

What is cardiomegaly? [1]

Answer 3

abnormal enlargement of the heart

Question 4

What are the features of stage 2 congestive heart failure? [6]

Answer 4

1. interstitial oedema
2. PCWP = 18-25mmHg
3. kerley B lines
4. peribronchial cuffing
5. hazy contours of vessels
6. thickened interlobular fissures

Question 5

What are Kerley B lines? [2]

Answer 5

Fine horizontal lines seen in the angle between the diaphragm and chest wall on an AP chest x-ray

Sign of early interstital oedema and therefore heart failure

Question 6

What is peribronchial cuffing? [2]

Answer 6

Also referred to as peribronchial thickening or bronchial wall thickening

Radiological sign which occurs when excess fluid or mucus build-up in the small airway passages of the lung causes localized patches of atelectasis (lung collapse)

Question 7

What are the features of stage 3 congestive heart failure? [6]

Answer 7

1. alveolar oedema
2. PCWP >25mmHg
3. consolidation
4. air bronchogram
5. cotton wool appearance
6. pleural effusions

Question 8

What is consolidation? [1]

Answer 8

State of the lung in which the alveoli are filled with fluid produced by inflamed tissue, as in pneumonia

Question 9

What is an air bronchogram? [1]

Answer 9

Tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates

Question 10

What is the cause of the cotton wool appearance?

Answer 10

Caused by alveolar infiltrates

Question 11

What are pleural effusions? [3]

Answer 11

Build up of excess fluid between the parietal and visceral pleura of the lungs

Divided into transudates and exudates

Measurements consistent with exudates:

• Protein levels >30g/l
• LDH (lactate dehydrogenase) >200lU
• pH < 7.1

Question 12

How much fluid must be present to be seen on:

1. PA chest X-ray? [1]
2. supine examination? [1]

Answer 12

1. At least 175ml of fluid must be present to be seen on PA chest x-ray
2. At least 500ml of fluid must be present to be seen on supine examination

Question 13

What is the key sign of pleural effusion on X-ray? [1]

Answer 13

blunted costophrenic angles