Page 27 Flashcards
MC affected leaflet in Congenital cleft mitral valve
Anterior leaflet
Type of mitral valve where All chordae tendineae are attached to a single papillary muscle
Parachute mitral valve
Anomaly demonstrating apical displacement of septal tricupid valve leaflet in relation to tricuspid annulus plane w/ resultant dilation of RA and RV and tricuspid regurgitation
Ebstein anomaly
Globular or box shape heart (frontal cxr)
Ebstein anomaly
MCC of congenital tricuspid regurgitation
Ebstein anomaly
Associated conditions of tricuspid atresia
Right-sided aortic arch and TGA
What is the cutoff measurement of apical displacement of septal leaflet for Ebstein anomaly?
> 8 mm/m2 (normal heart = septal and posterior leaflets are slightly apically displace relative to anterior MV leaflet of <8 mm/m2)
Dynamic or fixed anatomic obstruction to blood flow from RV to pulm varterial vasculatures
Congenital Pulmonary stenosis - valvular, subvalvular, supravalvular
Cardiac CT or MR depict fatty or muscular separation of RA from RV
Tricuspid atresia
Cyanotic type of CHD with small and hypoplastic RV, while RA is dilated and hypertrophied
Tricuspid atresia
Type of PS in double-chambered RV
Subvalvular PS
Refers to infection of valve leaflets as wel las prosthetic valves
Valve infective endocarditis
In the setting of RIGHT heart dse, break off of fragments of vegetation will result to?
Pulmonary septic emboli
Nonbacterial heart manifestation in px with SLE
Libman-Sacks nonbacterial endocarditis (rarely embolize unlike IE)
In the setting of LEFT heart dse, break off of fragments of vegetation will result to?
TIA or stroke
Plaque-like fibrous endocardial thickening involving heart valves (tricuspid and pulmonary)
Carcinoid heart disease
Chronic exposure to excessive circulating serotonin is an imoortant contributing factor
Carcinoid heart disease
Heart disaese associated withmetastatic neuroendocrine tumors
Carcinoid heart disease
Refers to valve fibrosis and scarring caused by autoimmune rxn to infection (group A strep) resulting to stemosis/regurgitation
RHD (majority with hx of rheumatic fever)
Postoperative complications ff valve surgery
Infection, dehiscence, and perivalvular leak
Late complications ff valve surgery
Valve regurgitation, IE, anastomotic dehiscence, pseudoaneurysm, and thromboembolic events
This imaging technique is now the reference standard for assessing chamber size, LV fxn, and ventricular mass in cardiomyopathies
Cardiac MRI
Leading case of sudden cardiac death in young adults and athletes
Hypertrophic cardiomyopathy (HCM) -AD genetic cardiomyopathy
Imaging hallmark of HCM
focal, regional, or diffuse LVH measuring >20mm at end-diastole (w/ classic hazy midmyocardial enhancement)
HCM variant with characteristic “spade-like” configuration of LV on vertical long axis
Apical HCM variant
MC location of asymmetric septal HCM
Anteroseptal segments (base of LV)
Ejection fraction in cardiac amyloidosis
Mildly reduced (cardiac amyloidosis is a restrictive cardiomyopathy)
MC form of HCM
Asymmetric septal involvement (other variants =apical, symmetric, midventricular, mass-like and noncontiguous)
Ejection fraction in HCM
Normal or increased
Ejection fraction in dilated cardiomyopathy
Decreased
Fabry disease vs HCM
In Fabry disease, hazy midmyocardial delayed enhancement is siolated to inferolateral segments of LV despite relative diffuse hypertrophy
Mimicker of HCM, an x-linked disorder with accumulation of glycosphingolipid in diff tissues including the heart
Fabry disease
Imaging hallmark of cardiac amyloidosis
Diffuse concentric LVH (also, diffuse subendocardial hypoperfusion and delayed enhancement), biatrial enlargement
Restrictive CM involvingg 1 or both ventricles with classic circumferentialRestrictive CM involvingg 1 or both ventricles with classic circumferential subendocardial patternl of delayed enhancement (same with cardiac amyloidosis)
Loeffler endocarditis
Classic Cardiac manifestation of hypereosinophilic syndrome (HES)
Loeffler endocarditis
MCC of cardiac amyloidosis
AL (Amyloid light chain) or primary amyloidosis -deposition of amyloid fibrils within heart
Loeffler endocarditis vs cardiac amyloidosis
Both have same circumferential subendocardial delayed enhancement. Loeffler -presence of adherent ventricular thrombi (low signal on LGE). Overtime, subendocardial fibrosis leads to obliteration of LV cavity and result in restrictive CM)
Cardiac chamber dilation with impaired contractility of LV
Dilated CM
AD, RV predominant disease including RV dilatation, reduced RV ejection fraction, and focal areas of RV dyskinesia leading to small aneurysms
Arrhythmogenic RV cardiomyopathy (ARCV) or arrhythmogenic RV dysplasia (ARVD)
Imaging findings of dilated CM
Normal to mildly thinned LV myocardium with absent delayed dnhancement. (If present - linear midmyocardial distribution)
Imaging findings of Acute myocarditis
Global or regional areas of T2 hyperintensities (myocardial edema) with relative diffuse linear midmyocardial and subelicardial delayed enhancement
Myocardial fibrosis vs repaired myocardium in myocarditis
Ff up imaging - Delayed enhancement that persists (fibrosis), delayed enhancement that resolves (repaired injured myocardium)
Systemic inflammatory disorder characterized by deposition of noncaseating nonnecrotic granulomas including the heart
Cardiac sarcoidosis
MC involvement of LVNC
Anterolateral and inferolateral segments at the base and mid-cavity levels and much of cardiac apex (sparing the septum)
Imaging findings of cardiac sarcoidosis
Nonspecific mild LV dilatation w/ corresponding nodular midmyocardial LGE (involving inferolateral segment at midcavity level). FDG-PET =Patchy/focal areas of myocardial uptake along anterior and inferior LV wall. (In the background of bilateral mediastinal and hilar lymphadenopathies)
Hypertrabeculation of LV myocardium with relative thinning of adjacent compacted myocardium
Left ventricular noncompaction (LVNC)
Takatsubo vs STEMI and myocarditis
Signal abnormality/edema on T2 in regions of wall motion extending across vascular teritories w/o corresponding delayed enhancement. However edema resolves w/n 2 weeks in contrast to STEMI/myocarditis where it persists 2-3months after
Hallmark of Takatsubo CM
Transient hypokinesis or akinesis of mid and apical segments of LV w/ hypercontractility of basilar segments (leading to hallmark configuration of LV -resembling Takatsubo = japanese octopus pot)
Stress-induced CM frequently seen in postmenopausal women after severe emotional/physical event
Takotsubo CM/Apical ballooning syndrome/Broken heart syndrome
Findings of cardiac MR T2* shortening
Iron overload cardiomyopathy
Potential space where visceral and parietal serous layers are not attached
Pericardial cavity
2 layers of pericardium
1) visceral pericardium - innermost layer that lines the epicardial surface of heart separated from the outermost myocardium by epicardial fat, 2) parietal pericardium -has 2 layers (inner and outer=fibrous)
Staging of Iron overload CM (thru MR T2* mapping)
Normal >20ms (mean 40ms); MILD-MODERATE =10-20ms; SEVERE <10ms (stratify px at risk for heart failire and arrhythmia)
What forms the serous pericardium?
Visceral pericardium and inner layer parietal pericardium =adherent
Normal pericardial thickness on CT
Thin 1-2mm. >4mm is abnormal
Blood supply to pericardium
Branches from thoracic aorta and pericardiophrenic arteries
Cardiac recess: superior to LA, posterior to aorta and MPA, but anterior to oblique sinus
Transverse sinus
Cardiac recess: posterior and superior to the LA
Oblique sinus
MRI Appearance of pericardium
Hypointense to adjacent myocardium on all sequences
Normal volume of pericardial fluid
15-35 ml
T or F. Fibrous (outer) parietal layer is continues over aortic arch and blends w/ deep cervical fascia.
TRUE
Divisions of visceral pericardium
Arterial mesocardium = Portion of visceral pericardium covering the AA and pulmonary trunk; Venous mesocardium = covering the SVC, IVC, and 4 PV
Venous drainage
Thru venae pericardiales draining to azygos v, SVC, or brachiocephalic v.
Innervation
Predom thru branches of phrenic n (sime of posterior pericardium -vagal innervation from esophageal plexus)
Lymphatic drainage
Toward tracheobronchial nodes (and less frequently prepericardial LV and nodes)
Congenital lesion appearing as Smooth, ovoid mass along the hemidiaphragm, (x section) homogeneous thinned-wall without septations and no internal enhancement
Pericardial cyst
Pericardial cyst vs pericardial diverticulum
Diverticula often cannot be distinguished from cyst. Though diverticulum can change can change over time (may disappear)
Pericardial cyst vs cystic tumor
Internal enhancement, heterogeneous signal, thick wall, numerous septations, or invasion into surrounding structures raise rhe possibility of cystic tumors
MC location of congenital pericardial defect
Left side
MCC of pericardial defect or absence of pericardium
Postsurgical
Types of pericardial effusion
Transudative, exudative, hemorrhagic, or pyogenic
Causes of transudative pericardial effusion
CHF, pulm HPN
Associated congenital anomalies of congenital pericardial defect
ASD, PDA, bicuspid aortic valve, or pulmonary abnormalities