Webb Cardiac Flashcards by Sai Vishal

Aortic stenosis features on radiograph

-Enlarged post stenotic ascending aorta
- small heart ; secondary to chronic compensation
- calcification of cardiac valve

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Ct ratio normal value

Site of measure

0.55

Trans thoracic diameter at right hemi diaphragm
Maximum cardiac diameter

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Sign posts corresponding to what ?

left atrial enlargement
Ascending aorta enlargement
Right atrial enlargement

Mitral valve
Aortic valve
Tricuspid valve

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Hoffman riggler sign

At 2 cm above the entry of the IVC at the level of diaphragm the distance between the posterior border of IVC and the left ventricle is more than 1.8 cm then the sign is positive

Suggestive of left ventricular enlargement feature

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Mitral stenosis classical radiograph’s features

Pulmonary venous hypertension
Pulmonary edema
Enlargement of left atrium classical
Left arterial appendage enlargement Rheumatic ecology

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Pulmonary venous hypertension grading

Grade 1 upper lobe veins prominent
Grade two interstitial oedema
Grade three alveolar oedema

Pressure variant
12-19
20-25
>_ 25

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Caused n of restrictive cardiomyopathy

Sarcoidosis
Lymphoma
Hemochromatosis
Amyloidosis

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Restrictive cardiomyopathy classical features 1

Pulmonary venous hypertension

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Left ventricular aneurysm most common site

Antero lateral wall of apical wall of LV

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False aneurysm of lv is seen most commonly at

Posterolateral wall of LV

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Points of difference from true anyersym for a false aneurysm

False :
Posterior wall of LV
Sequential increase in growth in studies
Formed by occlusion of circumflex/ right coronary artery

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Left Av Aneurysm is formed by

Occlusion of left anterior descending artery

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Signs of complication of acyte MI on radiograph

Intractable pulmonary edema : papillary muscle rupture

Enlarged cardiac silhouette :pericardial effusion

Abnormal evagination of any one wall of the left ventricle : suggestive of aneurysm

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Constrictive pericarditis most common cause

Iatrogenic; post operative bleeding secondary to cardiac revascularisation procedure

2nd most common : mediastinal irradiation

3rd most common : secondary t0 pericardial diseases

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What happens to the right heart border in case of constrictive pericarditis

It becomes flattened

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Mitral regurgitation secondary to rheumatic etiology shows classically ———————-

Left atrial appendage enlargement ; rare in non rheumatic aetiologies

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Causes of main pulmonary artery enlargement : 6 causes

PAH
excess blood flow —- shunts / high output states
Valvular pulmonic stenosis
Pulmonary regurgitation
Absence of left pericardium
Aneurysm of pulmonary artery

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Pulmonary arterial hypertension categories 5

1 : PAH resulting from PVH

2 PAH from left to right shunts resulting in pulmonary arteriolar disease

3 PAH from obliteration of vascular bed secondary to chronic lung disease

4 PAH from obliteration of vascular bed secondary to pulmonary embolism or schistosomiasis

5 primary pulmonary arterial hypertension

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Enlargement of right heart 6 in numbers

Pericardial fat pad
Eventration of diaphragmatic
Pericardial cyst
Cardiac tumours
Diaphragmatic tumours
Mediastinal tumours

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LV mitral calcification indicates

Previous MI or ventricular aneurism

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What is the unique feature of loeffler eosinophilic fibroplasia

Calcification of LV wall entirely

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Classification of congenital heart diseases
Five groups name them

ACyanosis’// pulmonary arterial over circulation

Cyanotic// reduced pulmonary vascularity //
no cardiomeglay

Cyanotic// reduced pulmonary vascularity // cardiomeglay

Cyanotic with pulmonary arterial overcirculation

Patients with primary pulmonary venous congestion

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Group 1 : —————

Examples 6

Acyantoic with pulmonary arterial over-circulation

ASD
Partial anomalous pulmonary venous connection
Atrioventricular septal defect
VSD
PATENT DUCTUS ARTERIOSUS
SHUNTS AT AORTIC VALVE LEVEL : aortic pulmonary window , ruptured sinus of valsalva

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Group II : ——————

Number

Cyanotic , decreased pulmonary vascularity , no cardiomegaly

Tetralogy of fallot
Any syndromes with pulmonic stenosis or atresia
Hypoplastic right ventricle syndrome

Group III ————————— Examples 4

Cyanotic with decreased pulmonary vascularity , cardiomegaly ++++++ Ebsteins anomaly Pulmonary stenosis with ASD Restrictive ASD Pulmonary atresia with intact ventricular septum type II

Group IV Examples 4

Cyanotic with pulmonary arterial hypercirculation TGA TRUNCUS ARTERIOSUS TAPVC TA AVSd complete form Hypoplastic eft heart syndrome

Group V subdivision 2 Examples in each 2

Pulmonary venous congestion Structural heart diseases in new born No structural heart disease in new born Structural : Hypoplastic left heart ; coarctation of aorta ; critical aortic stenosis; ALCAPA/ARCAPA Non Structral : asphyxia ; overhydration ; twin to twin transfusion ; hydrops fetalis

Radiographic appearances : Group 1 : pulmonary arterial over circulation // Left to right shunts

Congested lung fields No cardiomegaly

Group 2 appearance : right to left with little or no cardiomegaly

Cyanosis clinically Decrease or normal vascularity Little or no cardiomegaly

Group 3 : cyanosis // pulmonary vascularity decreased with cardiomegaly Radiograph appearance

Cyanosis Right to left shunt Normal or decreased blood flow Cardiomegaly Eg ebsteins anomaly

Group 4 : cyanotic with pulmonary over circulation Both right to left and left to right

TA TRICUSPID ATRESIA TAPVC TGA CYANOSIS PULMONARY FIELDS CONGESTION MILD CARDIOMEGALY

In a congenital heart syndrome radiograph barium esophagus shows indentation Interpret site of blood shunt

Atrial level

Impression on barium esophagus die to cardiomegaly is secondary to —————

Ventricular enlargement

Cardiac masses : most common cardiac mass is

Thrombus > tumour

First sequence in a cardiac mri

ECG gated transaxial T1 weighted spin echo

Sequence to enhance the contrast between the myocardium and tumour tissue

Trans axial T2, weighted spin echo images.

Two. Causes for increased contrast enhancement in any cardiac tumour.

Increase in extra cellular spaces between the cells Increase in vascularity of the tumour

What is the appearance of flowing blood on spin echo sequences

Appears as low signal intensity or flow void

Appearance of flowing blood on gradient, echo or steady-state, free precession sequences

Blood pool indicated with high signal intensity

What are the four common locations of cardiac tumours?

Intra cavitary Paracardiac Intramural Intra pericardial

Benign, primary cardiac tumours Examples seven in number

Lipoma MYXOMA Papillary fibro ELASTOMA Rhabdomyoma Fibroma PHEOCHROMOCOTOMA HEMANGIOMA

Most common Left atrium, tumour AORTIC valve Myocardium Right ventricular wall and ventricular septum PERI left atrium retro AORTic Right atrium Ventricular myocardium

MYXOMA Papillary fibro ELASTOMA RHABDOMYOMA FIBROMA PHEOCHROMOCYTOMA ANGIOSArCOMA/lymphoma Rado myosarcoma

Walking man sign of left atrial enlargement

Normal individuals have left AMA right main bronchus overlapping with each other on lateral chest x ray In left atrial enlargement due to the left bronchus being pushed posterior there is inverted V configuration

Contrast dose cardiac MRI

Gadolinium based agents 0.05-0.2mmol/ kg body weight

Best agent in renal dysfunction patients

FERUMOXYTOL

Use of SE sequence

Anatomy High resolution sequence Slow sequence

GRE sequence

Fast acquisition sequence Used for angiography Quantitative measurement Perfusion

SSFP USE ?

Single state free precession Bright blood sequence High temporal resolution Excellent contrast between myocardium and blood pool For valve lesion wall motion Volume quantification

In inversion recovery sequence how does normal myocardium appear ?

Black

Time for normal myocardial inversion

300-400 milliseconds after RF pulse

Factors on which inversion recovery depends ?

Volume contrast relaxiviity Excretion rates Field strength

Triple IR sequence

Fat black Blood black Myocardium black

What is VENC ? What’s is it used How’s does blood appear in it

Phase contrast imaging is otherwise called VENC measures blood flows perpendicular to imaging plane bases on differences in phase shift of moving tissue relative to stationary tissue Appears as as cine image throughout a cardiac cycle Blood flowing towards is white /// away is black // stationary tissue is gray Is used to interrogate specific velocities ; anything outside it is aliasing

Webcast is myocardial tagging How are RF pulses applied in this study

Assessment’ of wall motion and strain Line grids Lines deform as heat contracts and relaxes Helps to identify contractile myocardium versus non contractile myocardial mass

Name advanced sequences Ford cardiac MRI

Mr elastography Mr fingerprinting Diffusion tensor imaging Pet MRI Interventional MRI

Mr elastography is used where

For determination of cardiac stiffness

Mr spectroscopy uses in cardiac imaging

Using H proton spectroscopy determination of triglyceride content is an independent predictor of diastolic dysfunction For valvular diseases Cardiomyopathies

3 Teslas scanning used for

Better imaging quality