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79 Cards in this Set
- Front
- Back
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Order of cardiac electrical conduction
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SA node, anterior/middle/posterior internodal tracts, AV node, His bundle, bundle branches, Purkinje network, ventricular myocardium
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Two divisions of left bundle branch…
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Anterosuperior and posteroinferior
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Complication of large left atrial myxomas
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Mitral valve obstruction (60%)
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Are myxomas typically sporadic or syndromic?
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Typically sporadic; Assoc. with Carney complex 7%
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Most common valvular neoplasm
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Papillary fibroelastoma, usually small (<2mm), mobile, on a stalk, attached to commissure
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Most common congenital heart defect
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VSD; most common symptomatic in neonates
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What are the classifications of VSD?
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Muscular
Membranous Doubly committed, subarterial (combined) Inlet – near mitral valve Outlet – below aortic valve Supracristal – below pulmonic valve |
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At what Qp/Qs ratio should a VSD be closed?
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2.0; quantification possible with MRI
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What is ALCAPA? Is it symptomatic? What determines the age at which it is diagnosed?
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Anomalous origin of the left coronary artery from the pulmonary artery resulting in steal from the myocardium towards the pulmonary artery. This causes ischemia, with mortality near 90% in first year of life. If minimal steal, this may be diagnosed in adulthood.
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Which is more common, ARCAPA or ALCAPA? Is ARCAPA symptomatic?
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ARCAPA is extremely rare and can be asymptomatic, but can also present with ischemia. ALCAPA usually presents with ischemia is infancy.
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Where is the most common place for fibrous/calcific pericarditis?
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Atrioventricular groove
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What findings suggest Constrictive pericarditis as opposed to pericarditis without constriction?
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RA, coronary sinus dilation, IVC dilation, hepatosplenomegaly, ascites…pericardial effusion suggests effusive constrictive pericarditis
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Two types of subaortic stenosis…
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Discrete/membranous (90%) and muscular/tunnel-type
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What side are coronary artery fistulas more common? Where do they usually drain?
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More commonly RCA (60%), more commonly drains to right side of heart (70%), most commonly drains to right ventricle, then right atrium
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What is positive remodeling for coronary arteries?
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Initial increase in size of CA with progressive atherosclerotic plaque, maintaining luminal diameter
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What is a septal bounce? DDx? Affected by breathing?
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Paradoxical motion of interventricular septum towards then away from LV during diastole. Accentuated by inspiration (increased with inspiration).
Seen with restricted cardiac dz, constrictive pericarditis, cardiac tamponade…distinguishing from restrictive cardiomyopathy (tx is different for each…surgery for pericarditis, medical for restrictive CM) |
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What are the types of ASD?
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In order of decreasing frequency
Ostium secundum: central defect of the fossa ovalis, PFO Sinus venosus: superior, adjacent to the SVC or IVC Ostium primum: medial, adj to AV junction (endocardial cushing defects) Coronary sinus: inv coronary sinus (will be near IVC sinus venosus) Mixed defects do occur |
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What are the phases of Takaysu’s arteritis
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Acute phase – inflammatory
Late phase (pulseless) – divided into areas of involvement (aortic arch vs. branch vessels) |
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What are MR findings of Acute infarction? Chronic infarction?
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Myocardial thickening and edema; Myocardial thinning, aneurysm, enhancement
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What is considered nonviable myocardium?
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Involvement of greater than 50% of the myocardium
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Causes of coronary artery aneurysms? Definition? Most common?
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Kawasaki dz, Ehler-Danlos, Marfans
Greater than 150% of expected diameter RCA (50%), LCX/LAD (50%)…these will commonly thrombose |
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What abnormalities is supravalvular aortic stenosis associated with?
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Williams syndrome, bicuspid aortic valve, coarctation, TOF, VSD
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What is the MR appearance of cardiac amyloid? Is this primary or secondary amyloidosis?
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Myocardial thickening, patchy heterogenous myocardial enhancement, which makes it very difficult to suppress the myocardium resulting in long TI values (250ms)
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Anomalous origin of the LCA from right coronary sinus, what are the four courses? Which type is malignant? What is the most common?
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Interarterial course (75% for LCA), malignant type, high risk for sudden cardiac death, due to acute angles, small orfice. RCA - may do nothing.
Septal path may be malignant also Prepulmonic and retroaortic are benign LCX from right coronary sinus is of no clinical significance |
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Most common cause of sudden cardiac death?
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Cardiac sarcoid, most commonly causes arrhythmia
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What is the MR appearance of cardiac sarcoid?
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Middle and epicardial delayed enhancement, typically involving septum, LV wall. Usually spares RV and papillary muscle.
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What is an L-TGA?
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Atrioventricular and ventriculoarterial discordance…associated with cong. heart anomalies
R-TGA represents soley ventriculoarterial discordance |
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What are the two types of procedure performed for TGA?
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Atrial switch and arterial switch
Atrial switch (Mustard or Senning) creates a Baffle by resecting the atrial septum Arterial switch (Jatene) occurs by transecting and reanastamosing the PA and aorta with reimplantation of the coronary arteries |
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What is the MR appearance of ARVD?
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Fatty and fibrous replacement of the RV, less often LV. Fatty components will be bright of spin echo and PD images, hypointense with fat sat. Fibrous tissue will enhance with gad. Myocardial thinning.
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What are the MR features of HOCM?
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Myocardial thickening >30mm measure on short axis images at end diastole, most frequently involves anteroseptal wall
Patchy mid-myocardial enhancement Hypertrophy of one or both papillary muscles |
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What disorder is associated with aortic valve cusp avulsion?
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Pseudoxanthoma elasticum – inherited connective tissue disease
Avulsed cusps will prolapse into LVOT during diastole |
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What are gradient echo sequences used for?
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White blood images, fast scan times, used to assess flow of blood e.g. LVEF, valvular stenosis/insufficiency, enhancement, perfusion
Susceptible to metal artifact |
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What are spin echo sequences used for?
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Black blood, high resolution, slower scan times, anatomy scans, look at vessels and mediastinum
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What is SSFP?
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Family of gradient echo images that produced good contrast between blood pool and myocardium…these sequences are what make our cines to assess function
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What is microvascular obstruction? What does it signify?
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In severe acute infarct, the subendocardium will not enhance due to MO...different than typical infarct related DHE which affects the subendocardium. This portends a poor prognosis
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Subendocardial non enhancement DDx
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Thrombus
Necrotic tissue due to microvascular obstruction Compare with myocardial thickness on SSFP to differentiate |
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What is the enhancement part of HOCM?
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Anteroseptal enhancement representing fibrosis
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How do you differentiate dilated cardiomyopathy from end stage ischemic cardiomyopathy?
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DCM enhancement will be absent OR in a non coronary distribution that is subepithelial or mid myocardial
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Abnormal trabeculations and myocardial thinning...
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Ventricular noncompaction
Unorganized myocardium Myocardium can look thick at end-systole Multiple forms of heritable transmission |
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What is more likely to rupture, true or false LV aneurysm...
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False aneurysms
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What is the clinical significance of false cords of the myocardium?
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May displace papillary muscles and lead to chordae or valve dysfucntion
Usually clinically silent |
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IASA...
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Interatrial septal aneurysm
Congenital Assoc with stroke, embolism |
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Causes of restrictive cardiomyopathy...
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Primary
Amyloid Sarcoid Hemochromatosis Scleroderma |
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In sinus of Valsalva aneurysms, which is most commonly involved?
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RCA sinus
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What is IAA and what is it associated with?
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Interruption of the aortic arch
Classified by location of interruption Associated with VSD, PDA |
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What is Noonan syndrome?
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Short stature, pectus excavatum, VSD and #pulmonary artery stenoses
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What does valsalva maneuver do to mitral valve prolapse?
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Induces/increases it
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What ASD is associated with PAPVR?
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Sinus venosus (>90%)
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Double aortic arch is associated with...
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CATCH 22
Chrom 22q11 ~20% double AA DiGeorge Conotruncal facial abn Velocardiofacial synderomes Surgical release of vascular ring resolves compression on Esophagus and Trachea Right arch typically higher and dominant |
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What is a circumflex right arch?
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Right arch that descends on the left after travelling retroesophageal
DDx double arch with atretic left |
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Significance of pulmonary artery sling...
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Hypoplasia of distal trachea
Complete cartilaginous rings CV anomalies common: left SVC, ASD, VSD, PDA, TOF, Arch anomalies |
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FIndings of Ebstein anomaly...
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Displacement of septal tricuspid valve leaflet towards RV
RV atrialized |
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How can you prove interartrial lipoma?
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They contain Kupffer cells, so they take up sulfur colloid
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Ectopia cordis...
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Failure of sternal cleft to fuse, heart can be external to thoracic cavity
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What findings on CT suggest absence of left pericardium?
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Lung b/w aorta and MPA
Posterior rotation of cardiac apex |
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What is the primary cause of ascending aortic aneurysms (pathologically)?
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Cystic medial degeneration
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What images should you look for microvascular obstrunction?
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First pass images
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What is the most common appearance of amyloid with myocardial delayed enhancement?
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Diffuse subendocardial - that is what makes selecting the proper TI difficult
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What does MDE portend for hypertrophic cardiomyopathy?
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MDE correlates with fibrosis
Increases risk for SCD Increased risk of NVTach |
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Most common location/distribution of LV noncompaction?
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Apex, you will see increased trabeculation
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Does Dilated CM have MDE?
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Yes, mid-myocardial, typically seen best in septum
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Which coronary cusp points anteriorly? Which points between the atria?
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RCC; Non CC
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What are the two most common anatomic variants of the left main coronary artery?
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Ramus intermedius (30%)
Separate ostia (2%) |
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What are the branches of the LAD?
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Medial - Septal perforators, these divide LAD into prox/mid/distal segments
Lateral - Diagonals, huge blood supply to Anterolateral LV |
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What is the typical branching anatomy of the RCA?
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Conus branch - supplies RVOT
SA nodal branch - 60% from RCA Divides to PDA and Post. LV Post. LV gives off AV PDA gives off acute marginals |
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Interarterial course LCA vs. RCA, which requires surgery?
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LCA; less common, but if anomalous origin there is a high likelihood it is interarterial
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What causes mitral annular calcification?
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ESRD
Rarely leads to mitral stenosis |
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What is a cause of acute mitral insufficiency?
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Papillary muscle rupture, can be due to infarct
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What valve does carcinoid affect?
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Tricuspid
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Where are the majority of cardiac myxomas found?
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LA 75% fossa ovalis
RA 20% |
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DDx papillary fibroelastoma...
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Vegetations
Myxoma |
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Where do cardiac angiosarcomas arise?
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Right atrium
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Where does cardiac lymphoma typically arise?
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RA or RV
Causes IVC or SVC obstruction Common pericardial effusion |
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What determines the morphologic right ventricle?
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Moderator band
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Myocardial tagging is used to identify...
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Myocardial strain
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Left atrial calcifications suggests...
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Rheumatic heart disease, mitral stenosis
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Complication of Jatene procedure...
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Pulm valve stenosis
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What is the most sensitive sign of ARVD?
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Diffuse or focal RV wall motion abn
RV aneurysm is most specific (most severe manifestation of wall motion abn) |
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When does the septal bounce occur?
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Early diastole
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