1
Q
most common congenital heart anomaly
A
bicuspid aortic valve
ASD #2
2
Q
most common cause enlarged coronary sinus
A
persistent left SVC
3
Q
most common primary cardiac tumor in adults
A
cardiac myxoma
left atrium, attached to septum, +/- Ca2+
4
Q
“aortic root”
A
aortic annulus (basal ring) + sinuses of Valsalva + sinotubular junction
5
Q
“annuloaortic ectasia”
A
dilatation of annulus and sinuses of Valsalva with effacement of the sinuotubular junction
tulip bulb sign
6
Q
anomalous course of coronary arteries
A
- interarterial (malignant)
- retroaortic
- prepulmonic
- subpulmonic/transseptal
7
Q
dilated cardiomyopathy causes
A
- ischemia
- infection
- toxic: alcohol, cocaine
- chemotherapy (doxorubicin)
- idiopathic
- familial
(- peripartum)
(- muscular dystrophies)
8
Q
valve cusps (aortic, tricuspid, pulmonary, mitral)
A
- aortic: “learn” - L, R, Noncoronary
- tricuspid: “traps” - Ant, Post, Septal
- pulmonary: “pallor” PALR - Ant, Left, Right
- mitral: MAP - Ant, Post
9
Q
myocarditis findings
A
- midmyocardium & epicardium
- wall motion abN
- myocardial edema
10
Q
LV aneurysm vs pseudoaneurysm
A
aneurysm: bounded by thin myocardium
- wide neck
- anterior or apical
- less rupture risk
pseudoaneurysm: contained rupture by pericardium
- narrow neck (ratio <1)
- posterolateral or inferior
- risk of rupture
both complic of MI, assoc w thrombus
11
Q
tamponade
A
- large or rapidly accumulating
- RA/RV compression
- dilated IVC
- reflux of contrast
- septal flattening
12
Q
second most common benign heart tumor
A
lipoma
13
Q
most common embryologic abnormality of aortic arch
A
aberrant right subclavian - usually incidental
14
Q
Glenn shunt
A
SVC to right pulmonary artery
- classic: end-to-end + prox RPA closed (to reduce RV work)
- bidirectional: end-to-side (RPA left open, blood flow to both lungs)
15
Q
Blalock Taussig shunt
A
subclavian artery to pulmonary artery
- classic: opposite side of arch
- modified: gortex shunt, same side as arch
purpose: increase pulm blood flow
16
Q
Fontan procedure
A
total cavopulmonary connection to bypass RV & direct systemic circulation into PAs
- for single ventricle physiology (HLH, Ebstein, tricuspid atresia, double inlet ventricle)
Glenn shunt: SVC to right PA
Fontan pathway: IVC to right or left PA
- lateral tunnel or extracardiac
17
Q
Fontan procedure complications
A
conduit related: thrombosis, stenosis, calc’n
cardiac: RA enlargement, ventric failure, arrhythmias
vascular: pulm AVM, PE, pHTN, aortopulmonary collaterals (hemoptysis)
liver: congestion, cirrhosis, regen nodules, HCC
lymphatic: chylous effusions, protein losing enteropathy, plastic bronchitis
18
Q
Blalock Taussig shunt complication
A
stenosis at shunt’s pulm insertion site
19
Q
LV papillary muscles: name & blood supply
A
- anterolateral: shared LAD and LCX
- posteromedial: RCA (in right dominant patients) –> more prone to rupture 2/2 single vascular supply
20
Q
microvascular obstruction
A
- infarcted myocardium where obstructed microvasculature doesn’t allow contrast to perfuse the tissue (contrast does not reach interstitium)
- area without reflow → less favourable prognosis, marker of adverse LV remodeling
Imaging: dark signal tissue surrounded by enhancing scar on both sides
21
Q
vulnerable plaque - 4 main features on CTA
A
- positive remodeling
- outer vessel diameter at plaque ≥ 1.1x adj uninvolved vessel (on long & short axis) - low attenuation plaque <30 HU
- napkin-ring sign
- peripheral higher attenuation of the noncalcified portion of the plaque - spotty calcium
- small calcified plaque (>130 HU separately visualized from the lumen, diameter <3 mm in any direction, length <1.5x vessel diameter & width <2/3x vessel diameter)
22
Q
hypertrophic cardiomyopathy - types
A
- asymmetric
- symmetrical (or concentric)
- apical (spade shape ventricular lumen)
- mid ventricular
- mass-like
23
Q
hypoplastic left heart
A
- cyanotic, ↑ pulm vascularity & pulm edema
- hypoplasia of asc aorta, aortic & mitral valves, LV
- PDA dependent (R→L shunt for survival)
- dilated right-sided cardiac chambers & PA
- most severe CHD: CHF, cardiogenic shock, cyanosis
- assoc w coarctation, endocardial fibroelastosis
- palliative repair: Norwood, bidirectional Glenn, Fontan
24
Q
right aortic arch branching patterns and associations
A
- right arch w/ aberrant left subclavian - no association
2. right arch w/ mirror image branching - cyanotic heart disease (truncus arteriosus, tetralogy of fallot)
25
tetralogy of fallot - components
"PROV"
- pulmonic stenosis
- RV hypertrophy
- overriding aorta
- VSD
26
rib notching patterns
1. Bilateral = Past L subclavian (post ductal)
2. Right sided = Before L subclavian (pre ductal/infantile)
3. Left sided = Proximal to anomalous R subclavian
27
most common vessel with myocardial bridging
LAD
| then LCx and RCA
28
most common partial anomalous pulmonary venous return (PAPVR)
- right superior pulmonary vein into IVC
| - associated w/ sinus venosus ASD
29
more common side of absent pulmonary artery
| which is associated w/ CHD
R > L
2:1
L w/ CHD - Tet of Fallot
30
embryologic arch to form the pulmonary arteries
6th arch
31
significant shunt (Qp/Qs - pulmonic/aortic)
>1.5
32
artifact resulting from regurgitant flow
dephasing artifact
33
Ebstein anomaly
- atrialized RV
- apically displaced septal tricuspid leaflet
- tricuspid regurg
34
def'n of severe stenosis on coronary CT angio
def'n of obstructive CAD
diameter narrowing >70%
except in left main coronary artery where a severe stenosis is >50%
obstructive >50%
35
enlargement of main and left pulmonary artery with a small right pulmonary artery
pulmonary stenosis
36
cutoff on CT for pericardial thickening
4 mm
37
beta blocker contraindications (CT angiography)
```
sinus bradycardia
hypotension
asthma, COPD
sick sinus syndrome
2nd- & 3rd-degree AV nodal block
critical aortic stenosis
decompensated heart failure
```
38
mid-myocardial delayed gadolinium enhancement
```
myocarditis
sarcoidosis (linear or nodular, RV side of septum is classic)
dilated cardiomyopathy (septal)
hypertrophic cardiomyopathy (at hinge points)
RV pressure overload (at hinge points)
```
39
subepicardial delayed gadolinium enhancement
myocarditis
| sarcoidosis
40
diffuse subendocardial delayed gadolinium enhancement
amyloidosis
Loeffler endocarditis
endomyocardial fibrosis
41
myocardium nulls before blood pool on TI scout sequence
amyloidosis
| buzzwords: "difficult to suppress myocardium"
42
which kind of ASD is most highly associated with partial anomalous draining of the right superior pulmonary vein?
sinus venosus
43
mitral valve prolapse def'n & associations
2mm displacement of mitral valve leaflets posterior to mitral valve plane during systole
- often assoc w mitral regurg
- can be assoc w papillary muscle or chordae tendineae rupture
- connective tissue disorders, adult PCKD
44
transposition of the great arteries: types
D-transposition: ventriculoarterial discordance (RV➡aorta, LV➡PA)
- PDA connects 2 systems
- CXR: egg on a string
L-transposition: ventriculoarterial & atrioventricular discordance (SVC/IVC➡RA➡LV➡PA➡pulm veins➡LA➡RV➡aorta)
- congenitally corrected; no PDA required
* Two wrongs (atrioventricular & ventriculoarterial discordance) make a right and L= life
45
surgical options for D-transposition of the great arteries
- Jatene arterial switch
- atrial inversion using intra-artrial baffle: Senning (uses atrium) or Mustard (pericardium or synthetic material)
- Rastelli procedure (if concomitant VSD & LVOT obstruction)
46
surgical options for L-transposition of the great arteries
double switch procedure:
- atrial inversion surgery (Senning or Mustard) + Jatene arterial switch OR Rastelli procedure
- to remove systemic pressure load from morphologic RV & prevent tricusp valve dysf'n
- may 1st need pulmonary artery banding to train morphologic LV to receive higher systemic load
- modified BT shunt if severe pulmonary stenosis or atresia
47
most common type of TAPVR
type 1: supracardiac
48
types of coarctation
infantile: preductal
adult: juxta-ductal, post-ductal or middle aortic
49
coarctation associations
```
bicuspid aortic valve
PDA
VSD
transposition of great vessels
truncus arteriosus
intracranial berry aneurysms
spinal scoliosis
PHACE & Turner syndromes
```
50
pseudocoarctation
- elongation, kinking or buckling of descending aorta at level of ligamentum arteriosum
- no pressure gradient across lesion
- benign entity with no specific intervention
51
complications of Senning & Mustard procedures
```
Stenosis of the baffle
Arrhythmias
- sinoatrial node may be injured in Senning
- intra-atrial conduction delays
Right heart failure
- d/t RV supplying system circulation
```
52
pulmonary sling: course of LPA
left PA courses between esophagus and trachea
53
Ortner's syndrome
cardiovocal hoarseness
| 2/2 compression of left recurrent laryngeal nerve by enlarged left atrium
54
CXR appearance of mitral stenosis
left atrial enlargement:
- right double density sign
- splaying of carina (superior displacement of left mainstem bronchus)
- posterior esophageal displacement
- walking man sign on lateral
55
heterotaxy associated with polysplenia
LEFT pulmonary isomerism
- polysplenia
- bilateral left lung lobation
- azygos or hemiazygos continuation of the inferior vena cava
56
pathognomonic for pulmonary sling
anterior indentation on esophagus
57
high risk plaque features
positive remodeling
low attenuation plaque
spotty Ca2+
napkin ring
58
ECG finding in ARVD
epsilon waves
59
other name for apical HoCM
Yamaguchi
60
T1 black blood phase
spin echo sequence
61
LV myocardial thickening cutoff
diastolic LV wall ≥ 15 mm
| echo: ≥ 12 mm
62
dilated cardiomyopathy cutoff
LV end diastolic dimension of 60 mm
measured from anteroseptal wall to inferolateral wall at mid chamber of LV
63
Loeffler endocarditis
aka eosinophilic endocarditis, cardiac manifestation of hypereosinophilic syndrome
- eosinophils deposit in the subendocardium with necrosis & fibrosis of endocardium, thrombus formation
- over time, thrombus epithelializes into subendocardium -> reduced chamber -> restrictive CM
Crack: biventricular thrombus
64
Most common valve neoplasm
Fibroelastoma
65
MR features of noncompaction
hypertrabeculated LV myocardium
| noncompacted end-diastolic myocardium to compacted end-diastolic myocardium ratio of >2.3:1
66
cyanotic heart disease (5) & non cyanotic (5)
cyanotic (5 T's): TOF, TAPVR, transposition, truncus, tricuspid atresia
noncyanotic: ASD, VSD, PSA, PAPVR, aortic coarctation (adult, post ductal)
67
what defines the RV
moderator band (important for congenital heart)
68
congenital heart disease relying on admixture (5)
- TAPVR (has PFO)
- transposition
- TOF (has VSD)
- tricuspid atresia (has VSD)
- hypoplastic left
69
microvascular obstruction independent predictor of:
- death
| - adverse LV remodeling
70
causes restrictive cardiomyopathy
things decreasing diastolic function
- amyloidosis
- loeffler/eosinophilic cardiomyopathy
- endocardial fibroelastosis
- hemochromatosis
71
systolic anterior motion in hypertrophic cardiomyopathy independent risk factor for...
sudden death
72
ratio for LV noncompaction
≥ 2.3 : 1
telediastolic noncompated myocardium: compacted
73
most common primary malignant tumor of heart
angiosarcoma
| right atrium
74
What perfusés SA and AV nodes?
RCA SA node 60%
| RCA AV node 90%
75
Cardiac CT drugs and contraindications
Beta blocker - 2nd/3rd degree heart block, asthma, acute chest pain, cocaine
Nitroglycérine - hypotension SBP<100, severe aortic stenosis, hypertrophic obstructive cardiomyopathy, phosphodiesterase
76
most common cause malignant pericardial effusion
lung cancer
77
critical aortic stenosis valve area
1 cm^2
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