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69 Cards in this Set
- Front
- Back
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Group 1
Inc pulm flow Non-cyanotic |
L-R shunts
ASD / VSD PDA PAPVR |
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Group 2
Nl or dec pulm flow Cyanotic Normal size heart |
TOF
(Right aortic arch seen in 25%) |
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Group 3
Nl or dec pulm flow Cyanotic Big heart |
Ebstein's
DDx: Tricuspid atresia with retricted ASD Pulmonary stenosis with intact ventricular septum Tricuspid Regurgitation in the Newbord |
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Group 4
Inc pulm flow Cyanotic |
T-lesion
Truncus TGA - narrow heart base Tricuspid atresia Tingle ventricle (double outlet LV or RV) TAPVC supracardiac - wide mediastinum |
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Group 5
Pulm edema Cyanotic |
Infradiaphragmatic TAPVR
Heart stress |
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Inc pulm flow
Non-cyanotic Left atrial enlargement |
VSD
PDA (aortic arch enlargement) |
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Inc pulm flow
Non-cyanotic NO left atrial enlargement |
ASD
PAPVR |
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S/p TOF repair evaluation
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Pulmonary regurgitation
Residual stenosis RV volumes and function |
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Occult L-R shunts
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Supracristal VSD
-dicontinuous right ventricular outflow tract with protrusion of the coronary sinus Sinus venosus ASD -communication b/w SVC and left atrium -95% have PAPVR PAPVR (RUL vein to SVC or RA) Hypogenetic lung syndrome (scimitar syndrome) -PAPVR usually below diaphragm -Hypoplastic lung, PA, bronchus |
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Transposition of Great Arteries
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Complete - D-TGA
-aorta anterior and to the right of the MPA -LV to PA -RV to aorta Post-surgical complications -Arterial switch - PA stenosis -Atrial switch (Baffle) - decreased RV, shunt stenosis, clot |
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Corrected TGA
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Congenitally corrected
Aorta anterior and to the Left of the PA - L-transposition -Right atrium connected to left ventricle -Left atrium connected to right ventricle |
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Morphology of RV and LV
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-RV has a muscular infundibulum
-Irregular contour of septum -LV has a fibrous continuity between the aortic and mitral valves -Smooth septum |
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Anomalous origin and course of coronary arteries
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-Main Pulm Artery ectopic origin (Anomalous Left CA arising from LPA) (ALCAPA)
-Aortic ectopic origin (R or L sinus of valsalva) Course: -anterior to RVOT -in between MPA and aorta (malignant) -retroaortic (e.g. left circuflex from RCA) |
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Small heart
Left atrial enlargement |
Mitral stenosis
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Small Heart
Aortic enlargement |
Aortic stenosis
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Small heart
No chamber enlargement |
Acute MI
Reduced LV compliance -Restrictive CM -Hypertrophic CM -Constrictive pericarditis |
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Big heart
Left atrial enlargement |
Mitral regurgitation
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Big heart
Aortic Enlargement |
Aortic regurgitation
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Big heart
No chamber enlargement |
Idiopathic dilated CM
Ischemic CM Tricuspid regurgitation Right ventricular failure Pericardial effusion |
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Constrictive pericarditis
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1. >4mm pericardial thickening
2. Pericardial calcifications 3. Septal bounce (temporary bulging of the septum towards the LV in early diastole) 4. Tubular RV 5. Dilated RA or IVC Sxs: worsening LE edema + JVD Etiology: TB XRT Cardiac surgery Viral pericarditis |
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True vs False LV aneurysm
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True - anteroseptal, broad based
False - inferoposterior, narrow neck |
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Annuloaortic ectasia - ascending aorta aneurysm
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-Marfan's and Ehler's Danlos
-Cystic medial necrosis -Increased risk of dissection/rupture -Intervention >5cm with annuloaortic ectasia (lower) |
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TOF - 4 things
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VSD
Pulmonary infundibular stenosis Overriding aorta RV hypertrophy Right aortic arch - 25% R - L shunt (cyanotic) due to pulmonary stenosis and VSD Pulmonary atresia with VSD is a severe variant of TOF -Pulmonary artery collaterals arise from descending aorta |
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Mitral annular vs mitral valve calcification
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annular
-c and o shapes -degenerative (related to aging) -women with CRF -causes mitral regurg mitral valve leaflets -mitral stenosis -RA |
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Most common cardiac mass
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thrombus
no enhancement |
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Secondary cardiac tumors
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40 times more common than primary
-lymphoma -mets (lung, breast, melanoma) |
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Benign primary cardiac tumors
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-myxoma (most common) - intense enhancement
-lipoma -rhabdomyoma (tuberous sclerosis) |
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Life threatening complications of ascending aortic dissection
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-dissection of coronary arteries
-dissection of carotid arteries -pericardial hemorrhage causing tamponade -aortic valve rupture causing aortic regurg |
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"wall-to-wall" heart
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tricuspid regurgitation
(or pericardial effusion) RA and RV dilated congentical cause - Ebstein's |
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SVC syndrome
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Severely compressed SVC due to
-metastatic lung ca (US) -mediastinal fibrosis from TB or histo Presents with facial fullness and flushing Acutely treat with XRT SVC can be stented after XRT relieves acute symptoms |
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Persistent left SVC
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-arises from left brachiocephalic vein
-drains into coronary sinus Vertical vein in PAPVC -arises from confluence of pulm veins -drains into left brachocephalic vein Bridging vein connects right and left SVCs |
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Eisenmenger Syndrome
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ASD
-longstanding pulmonary arterial hypertension from a L-R shunt causes reversal of the shunt to right-to-left flow |
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Hypertrophic cardiomyopathy
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No cause for the hypertrophy (no pressure overload lesion)
90% are asymmetric septal hypertophy seen on echo Indications for MRI: Unusual distribution Measure LV mass Distinguish HCM from tumor Interrogate subvalvular stenosis Dx.: Septal / Lateral wall ratio >1.5 80% subendocardial enhancement |
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Obstructive HCM
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Three chamber plane
-Hypertrophic septum narrows LVOT -Generates a flow jet of subaortic stenosis -Some have anomolous anterior motion of the septal mitral valve leaflet |
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Restrictive cardiomyopathy
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Diastolic dysfunction
Mild systolic dysfunction RAE, LAE Small ventricles Wall thickening GLOBAL subendocardial enhancement (does not respect coronary territory) |
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Amyloidosis
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Usually restrictive CM
Global subendocardial enhancement - 70% Right atrial involvement |
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Sarcoidosis
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Usually restrictive CM
Subendo enhancement - anterolateral or anteroseptal 11% of pts with pulm sarcoid have cardiac sarcoid |
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Arrythmogenic right ventricular dysplasia (ARVD)
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Recurrent VT or PVCs of RV origin
Syncope/sudden death during exercise Fatty/fibrous degeneration of RV Dx: 1. Fatty infiltration (non-specific/sensitive) - inc T1 2. Wall tinning 3. Diffuse or focal wall motion abnormalities (most sensitive) 4. Aneurysm (most specific) 5. RV dilation + decreased EF - |
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Thombus vs Tumor on MR
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Thrombus:
Dark of Cine MR Intermediate on Black Blood (T1) No enhancement Tumor Intermediate on cine MR (except myxoma which may be dark) Enhancement |
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Valvular disease - role of MRI
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Quantitative - velocity-encoded cine MRI is highly accurate
Pressure gradient: Modified bernoulli equation =4*velocity squared |
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Mercedes benz sign
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Calcified aortic valve causing aortic stenosis
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Mediastinal widening
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Hemorrhage - trauma, iatrogenic, acute aortic syndromes
Tumor - lymphoma Pus - mediastinitis Fluid - left or right heart failure Fat - mediastinal lipomatosis |
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Traumatic aortic injury
Direct signs |
Extravasation of contrast
-pseudoaneurysm -intimal flap -wall irregularity |
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Nromal thoracic aorta sizes
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<4 nl
>4 dilated or ectatic >5 aneurysmal >6 surgery |
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Coarctation
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Stenosis at level of ductus arteriosum
-inverted 3 -rib notching Identify dilated internal mammary and intercostal arteries Determine velocity -Velocity encoded cine image just distal to the coarctation -Velocity encoded cine image at the level of the diaphragm -In nl pt, flow should should slightly decrease (blood going to intercostals) -In coarct, equal or more flow distally than there is proximally (flow is coming into the aorta from the collaterals) |
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Large vessel vasculitides
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Takayasu
Giant cell Radiation Rare: Williams Neurofibromatosis |
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Mediastinal widening
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Hemorrhage - trauma, iatrogenic, acute aortic syndromes
Tumor - lymphoma Pus - mediastinitis Fluid - left or right heart failure Fat - mediastinal lipomatosis |
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Traumatic aortic injury
Direct signs |
Extravasation of contrast
-pseudoaneurysm -intimal flap -wall irregularity |
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Nromal thoracic aorta sizes
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<4 nl
>4 dilated or ectatic >5 aneurysmal >6 surgery |
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Coarctation
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Stenosis at level of ductus arteriosum
-inverted 3 -rib notching Identify dilated internal mammary and intercostal arteries Determine velocity -Velocity encoded cine image just distal to the coarctation -Velocity encoded cine image at the level of the diaphragm -In nl pt, flow should should slightly decrease (blood going to intercostals) -In coarct, equal or more flow distally than there is proximally (flow is coming into the aorta from the collaterals) - hemodynamically significant |
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Large vessel vasculitides
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Takayasu
Giant cell Radiation Rare: Williams Neurofibromatosis |
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Coronary CT
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Curved multiplanar reformat
Reconstruction is always through the middle of a vessel of interest See entire vessel within one image |
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Indications for CTA
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-Coronary artery disease
-Grafts -Stents -Anomalous coronary arteries |
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Stenosis of coronary arteries
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->50 significant - Recommend cardiac cath
-luman at the maximum stensosis compared to normal vessel -high NEGATIVE predictive value -Problem with CT - blooming articfact from calcium - why PPV is not as good as NPV |
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Cardiac MRI
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Short axis - round left ventricle
Black myocardium - inversion recovery If vessel leading to infarct is open, will myocardium regain fxn? -Residual myocardium (non-enhancing) >5.5mm -Ratio of viable myocardium:total wall thickness >50% |
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Hibernating myocardium
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Wall thinning
Diastolic / systolic dysfxn No enhancement Will recover with revascularization |
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Type A dissection complications
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Aortic valve rupture
Pericardial hemorrhage Coronary artery dissection Carotid / vertebral artery dissection |
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LAD
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-runs in interventricular groove
-diagonal branches - anterior wall -septal perforators - septum |
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Left circumflex
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-runs posteriorly in atrioventricular groove
-obtuse marginals - lateral wall |
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Right coronary artery
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-runs anteriorly in atrioventricular groove
-acute marginals - RV free wall -in right dominant, branches into PDA and posterolateral branches -PDA runs along inferior heart in interventricular groove -PDA + posterolateral supply inferior wall of LV |
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MI complications
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Aneurysm
-focal dyskinesis at the apex -wide neck -low risk rupture Pseudoaneurysm -posterior/diaphragmatic -focal outpouching with narrow neck -high risk rupture - surgical tx |
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Viability MRI
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-Residual myocardium (non-enhancing) >5.5mm
-Ratio of viable myocardium:total wall thickness >50% |
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Non-ischemic delayed enhancement ddx
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Patchy supepicardial, intramyocardial enhancement
-Myocarditis -Amyloiditis -Sarcoidosis -Cardiomyopathies (but other findings predominate) |
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Hypertrophic cardiomyopathy
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Asymmetric (95%)
-septal -apical Wall thickness ->12mm (end-diastole) -Septum : posterolateral wall ratio >1.3 Subvalvular aortic stenosis |
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Malignant primary cardiac tumor
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Can't distinguish
-angiosarcoma (most common)* Other malignant mesenchymal tumors: -malignant fibrous histiocytoma -leiyomyosarcoma -rhabdomyosarcoma -fibrosarcoma -chondrosarcoma -osteosarcoma -liposarcoma -lymphoma |
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Causes of sudden death in young patient
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1. Hypertrophic cardiomyopathy
2. Anomamous coronary artery - malgnant course (LCA between aorta and RVOT) 3. ARVD 4. Myocarditis |
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Anomalous coronary surgical options
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Unroofing
Reimplantation Bypass graft |
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Pulmonary arterial HTN causes
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-Left-sided heart disease (mitral stenosis)
-Pulmonary veno-occlusive disease (rare) -Parenchymal lung disease (IPF, emphysema) -Chronic pulmonary embolism -Shunts (ASD, VSD) -Primary |
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Pulmonary arterial HTN - CT manifestions
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RA and RV dilation
Septum is bowed towards the left Reflux of contrast into IVC |
