Module 1: Cardiothoracics Flashcards
right atrium is defined by
the IVC
what is the crista terminalis
muscular ridge from superior to inferior vena cava.
right ventricle is defined by the
moderator band
tricuspide papillary muiscles inert on the
septum
crista supraventricularis is what
thick muscle sperating AV and tricuspid valve
aortic and mitral realtion
side by side, no muscle between them
chest xr double density sign is
direct sign of left atrium enlargement
other signs of dilated left atrium
splaying of the carina (over 90 degrees)
mitral valve connected to papillary muscles via
chordae tendinae
papillary uscles of the left ventricle insert on to l
lateral and posteiror walls
NOT septum like the right side
echogenic focus in left ventricle on prenatal scanning is ax with
increase risk of downs
dumbell appearance of fat desnity in atrial septum
lipomatous hypertrophy of the intra atrial septum
Lipomatous hypertrophy of intra atrial septum spares the
fossa ovalis
why is lipomatous hypertrophy hot on PET
made of brown fat
RCA perfuses the SA node by
60%
RCA perfuses the AV node by
90%
most common and most serious malignant origin of coronary artery
LCA form the right coronary sinus coursing between aorta and pulmonary artery
What to do if anomolous left off the right cusp
always repair
what does ALCAPA stand for
Anomalous left coronary from the pulmonary artery
two types of ALCAPA are
infantile
- steal syndrome.
adult
what is steal syndrome in ALCAPA-
reversal of flow in LCA as pressure decreases in the pulmonary circulation
what is myocardial bridging?
intramyocardial course of a coronary artery.
definition of coronary artery aneurysm
diamter of 1.5x normal
common cause of coronary aneurysm
atherosclerosis
Coronary fistula defined
connection between coronary artery and cardiac chamber
contraindications to beta block in cardiac CT
severe asthma
heart block
acute chest pain
recent cocaine
which types of heart block are contraindicated to beta blockers
2nd and 3rd.
1st is not
contraindications to GTN
hypotensive
severe aortic stenosis
hypertrophic obstructive cardiomyopathy
Viagra use
how to quantiy velocity of blood in MRI
Velocity mapping also called phase-contrastr imaging
also called velocity encoded cine MR imaging
cause of congenital aortic stenosis
bicuspid
dilatation of the ascending aorta from stenotic valve due to
Jet phenomenon
- valvular (most common)
- subvalvular
- supravalvular
Williams syndrome is which stenosis
supravalvular stenosis of aorta
Bicuspid aortic valve and coarctation think
turners syndrome
most common congential heart disease
bicuspid valve
then VSD
associations of biscupid aortc valve
Turners and coarctation
Cystic medial necorsis
PKD
aortic regurg is seen in which conditions
bicuspid valve
bac endo
marfans
HTN dilated aortic root
aortic dissection
commonest cause of mitral stenosis
rheumatic heart disease
common cuae of mitral regurgitation
endocarditis or papillary muscle/chordal rupture post MI
isolated right upper lobe pulmonary oedema is ax with
mitral regurgitation
pulmonary stenosis is ax with
Noonan syndrome
Peripheral pulmonary stenosis is seen in
Alagille syndrome
which is a disease where kids wijh absent bile ducts
diverse disease, rare
what is rheumatic heart disease
immune modulated response to Group A beta haemolytic stre
Tricupsid regurg is common form of tricuspid disease due to
weak annulus
How does tricuspid regurg happen in carcinoid
serotonin degrades the calve
Triscupsid Regurg causes what in the right ventricle
RV dilatation
What is Ebsteins anomaly
kids whose mums were on lithium
tricuspid valve is hypoplastic and psoterior lead is displaced apically.
enalrged RA, decreased RV and TR
Tricuspid atresia - occurs in what congenital anomaly
RV hypoplasia
Tricuspid atresia will also have
an ASD or PFO
asplenia
carcinoid induced valve disease only happens after what
mets to the liver
why does carcinoid valve disease affect on the right side
lungs get rid of vasoactive substance
if left sided disease either shunt or lung mets
most common great vesell anomaly
bovine arch
brachiocephalic and left common carotid common origin
right arhc with aberrant LEFT …
Subclavian artery
vascular ring via the liagment arterisoum on the left, copletes the ring
mirror image right arch is ax with
TOF
congential heart disease
LEFT arch, aberrant right subclavian passes posterior to the oesophagus
dysphagia lusoria
if the origin of the aberrant right subclavian artery is dilated
divertiuculum of Kommerell
most common vascular ring
double aortic arch.
what is subclavian steal syndrome / phenomenon
Phneomenon: Stenosis and or occlusion of the proximal subclavian with retrograde flow in the ipsilateral vertebral artery
Syndrome:
Stenosis and/or occlusion of the proximal subclavian artery with retrograde flow in the ipsilateral vertebral artery AND cerebral ischaemic symptoms
causes of subclavian steal
always athersclerosis
Takayasu arteritis
radiation
preductal aortic coarctation
blalock-taussig shunt
CXR egg on string
Transpostion
CXR
Snowman
TAPVR
Supracardiac
CXR
bootshaped
TOF
Figure 3
CXR sign
3
coarctation
CXR
box shaped mediastinum
Ebsteins
CXR
scimitar sword
PAPVR with hypoplasia
the causes of Cyanotic heart
6T
TOF
TAPVR
Transposition
Truncus
Tricupsid atresia
not cyanotic disorders
ASD
VSD
PDA
PAPVR
Aortic coarctation
Cyanotic, left arch, massive heart
Ebsteins
or pulmonary atresia
Cyanotic, left arch, increased pulmonary blood flow
TAPVR
D-transpotion
Truncus
Tingle Ventricle
cyanotic, left arch
decrease pulmonary blood flow
TOF
Ebsteins
Tricupid atresia
cyanotic, RIGHT arch
Increase pulmonary vasculature
Truncus
Cyanotic, RIGHT arch
Decreased pulmonary vasculature
TOF
TAPVR, survival depends on
TOF, survival depends on
VSD
Tricuspid atresia depends on
VSD
PDA consider
prematurity
maternal rubella
cyanotic heart disease
most common type of ASD
secundum
largest subtype of ASD by size of defect is
Primum
Which ASD will close on its own
Secundums
why can ASD primums not be closed by device?
too close to the AV valve rtissue
Downs get which ASD
Ostium primum / endocardial cushion defect
When I say sinus venosus ASD
you say PAPVR
define PAPVR
one one of the four pulmonary veins into the right atrium.
PAPVR is ax with
venosus ASD
Toal APVR survival depends on
Large PFO or ASD required for survival
types of TAPVR
supracaridac - snowman
cardiac
infracardiac - pulmonary oedema
commonest cause of cyanosis in first 24 horus
TGA
who gets TGA
infatns of diabetic mothers
survival of TGA
ASD, VSD or PDA
normally a VSD
types of TGA
D and L
L - lucky
D - only PDA
D type TGA
what to do
intra-atrial baffle
(mustard or Senning)
L type TGA
what to do
double discordance so is compatible
LeCompte Maneuver
operation to fix a D type TGA.
moustache over the aorta.
tetrology of fallot is what four things
VSD
RVOT obstruction
overiding aorta
RV hypertrophy
Truncus Arteriosus ax with
CATCH22 genese like DiGeorge
coarctation of aorta ax with
TURNERS SYNDROME
why does rib notching not exist in the 1st and 2nd in coarc
1st and 2nd are fed by costocervical trunk
hypoplastic heart must have
ASD or large PFO
typically large PDA to get blood into the arch
associations of hypoplastic left heart
aortic coarctation
endocardial fibroelastosis
Cor Triatratium Sinistrum
left atrium gets pulmonary vein WITH a muscle layer
looks like three atriums
in MI
what does stunned myocardium mean?
after acute injury
dysfunction of myocardium persists even after restoration of blood flow
oerfusion study will be normal but contractility is bad
Hibernating myocardium
chronic process from severe CAD. Chronic hypoperfusion.
but takes up more tracer on PET
what does scar mean in MI
dead tissue
why is microsvascular obstruciton a poor prognostic indicator in MI
lack of funcitonal recovery
true ventricular aneurysm vs flase ventricular aneurysm
true
- mouth wider than body. Myocardium intact. anterolateral wall.
False
- Mouth is nrrow. Myocardium not intact.
Posterior-lateral wall. Higher risk of rupture
Viability post MI based on wal thickness
<25% - improve with PCI
25 - 50% may improve with PCI
5o% < unlikely to recover
post MI sequelae timeframes
4 weeks
dresslers
2-7 days
post MI sequelae timeframes
papillary uscle rupture
post MI sequelae timeframes
7 days
ventriuclar pseudoaneurysm
Months
post MI sequelae timeframes
Ventricular aneurysm
needs remodelling time
post MI sequelae timeframes
myocardial rupture
within 3 days
causes of dilated cardiomyopathy
idopathic
ischaemic
aEtoh
doxorubicin
cyclosporine
chages
ltos
ischaemic dilated cardiomyopathy will show enhancement where
subendocardial enhancement
idiopathic dilated cardiomyopathy will show what enhacnement
linear mid-myocardial enhacnement
commonest cause of restritice cardiomyopathy
amyloid
difficult to supress the myocardium think
amyloid
needs a longer T1.
Loeffler syndrome is
Eosinophilic cardiomyopathy
what is eosinophilic cardiomyopathy
bilateral ventricular thrombus is the classic phrase / buzzword.
long t1 to show the thormbus
left ventricular apical obliteration by laminar thrombosis
causes of constrictive pericarditis
used to be viral / TB
now radiotherapy or CABG
myocarditis - type of Gf enhacnement
late
non vascular distribution
lateral free wall
eipcardial or midwall
Sarcoid on cardiac MR
T2 increased and early Gd increase
Gd pattern - middle and epicardial, non vascular
focal wall thickening from edema can mimic hypertrophic cardiomyopathy.
involves septum
