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153 Cards in this Set
- Front
- Back
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Where is the AV node located?
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The crux cordis
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In a left atrial thromus, what aspect of the atrium is it usually attached to? How about a myxoma?
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thrombus - posterior or lateral
myxoma -interatrial septum |
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What % of myxomas calcify?
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50%
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Most common valvular neoplasm?
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papillary fibroelastoma
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Top three benign tumors of the heart?
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myxoma, lipoma, papillary fibroelastoma
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Most common locations for papillary fibroelastoma?
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45%aortic, 36% mitral
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6 subtypes of VSD?
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muscular - surrounded by muscle
membranous - just below aortic valve doubly-committed/subarterial - bordered by fibrous tissue b/w aortic and pulm valves inlet - near mitral outlet - below aortic valve supracristal - below pulm valve |
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Qp = pulmonary resistance
Qs = systemic resistance Describe Qp:Qs ratio? When should a vsd definitely be repaired? |
<1.5/1.0 = restrictive
1.5-2.5/1.0 = moderate >2.5/1.0 = nonrestrictive repair when >2.0/1.0 |
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Prospective gating is (higher/lower) dose?
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lower
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Bland-Garland-White?
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ALCAPA - anomalous origin of LCA from PA
ARCAPA is extremely rare |
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Describe the flow in the anomalous vessel in ALCAPA?
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Reversed toward PA
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DDx dilated coronary arteries?
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Ehrlos-Danlos, scleroderma, Kawasaki, PAN, Coronary artery fistula, ALCAPA
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Where are the most prominent calcifications in pericarditis?
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along av groove
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Causes of constrictive pericarditis
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radiation
surgery tb viral cvd uremia |
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How thick of a pericardium is too thick
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>4mm
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Two types of subaortic stenosis? Which is more common?
Associations? |
discrete membranous-type
muscular - diffuse - cone-shaped membranous more common, assoc with bicuspid aortic valve, VSD, usually autosomal recessive, M>F 7:1 |
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Shone's complex?
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MV stenosis
bicuspid AV coarctation of aorta |
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Locations of myocardial bridging in decreasing order?
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Mid LAD>diagonal>RCA>LCx
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In myocardial bridging, where is the risk of plaque development?
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just proximal to the bridging portion
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Which artery does a coronary artery fistula usually involve?
what can they communicate with? Most common sites of drainage |
Right (60%), left (40%)
coronary sinus, cardiac chamber, pulmonary artey, SVC RA>RV |
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When a cardiac mass shows invasion of pulmonary vein, what is the likely etiology?
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extension of lung Ca
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Effusive constrictive pericarditis?
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Atrial enlargement, myocardial thinning, tubelike configuration of ventricle, calcification
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What is the hallmark of effusive constrictive pericarditis?
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Involvement of the visceral pericardium
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Most widely used calcium scoring method?
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Agatson
Calcified area x CTHU 1-100 = 2.1 x risk, >400 = 10x risk |
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four kinds of ASD?
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primum - medial, adjacent to av jxn
secendum - central, within fossa ovalis sinus venosus - adjacent to SVC or IVC coronary sinus - involves coronary sinus |
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what is sinus venosus asd associated with?
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PAPVR
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4 types of Takayasu
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I - arch branches only
II - combination of I and atypical coarctation - most common III - atypical coarctation IV - dilation of aorta and branches |
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Where do most coronary artery aneurysms occur?
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Right>LAD and LCx
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What is the significance of bicuspid valve in association with coarctation of aorta?
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early CAD
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What % of bicuspid aortic valve patients will get dissection?
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5%
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Aortic stenosis:
Mild Moderate Severe Critical |
1.5-2.0 cm2
1.0-1.5 cm2 <1.0 cm2 <0.75 cm2 |
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Williams syndrome?
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elfing facies, hypercalcemia
PA stenosis, mitral valve prolapse |
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genetic defect associated with supravalvular aortic stenosis?
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elastin gene on chromosome 7 q11.23
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What other arteries are often narrowed with supravalvular aortic stenosis?
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coronary, peripheral pulmonary, renal, carotid
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Is angioplasty useful in supravalvular aortic stenosis?
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no
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treatment of RCA-coronary sinus fistula?
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transcatheter balloon occlusion or surgical resection
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definition of SVG aneurysm?
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>1.5x the normal diameter
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True versus false SVG aneurysms?
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True - asymptomatic, less common, develop later, fusiform
false - symptomatic, more common, develop earlier, saccular |
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sites of SVG aneurysms in descending order?
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LAD>RCA>circumflex or obtuse
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If myocardial signal does not depress or requries a longer TI, consider?
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amyloid
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What is the clinical significance of an anomalous LCx from RCA?
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usually none
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What % chance of sudden death in a patient with malignant course of an anomalous left coronary artery?
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27%
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What % of patients with sarcoid get cardiac disease?
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5%
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What cardiac enhancement pattern in seen in cardiac sarcoid?
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midmyocardial enhancement in a noncoronary distribution...almost always septum and LV wall, rarely RV wall and papillary muscle
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Type I endoleak?
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stent-graft attachment failure
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Type II endoleak?
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feeder vessel, retrograde flow
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Type III endoleak?
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graft integrity
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Type IV endoleak
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graft porosity
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Type V endoleak?
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endotension
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Which endoleak require immediate repair?
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I and III, possibly V
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Which endoleak will most often spontaneously thrombose?
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II and IV
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How is D-TGA treated early on?
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Keep PDA open wiht PGE and perform Rashkind procedure to create and ASD.
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Mustard/Senning procedure?
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atrial switch - excise atrial setpum, create 'baffle' to direct pulmonary venous flow into RV and systemic flow into LV
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Jatene
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arterial switch resect proximal PA and aorta and reverse - coronary aa are placed on the neo aorta
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L-TGA association?
D-TGA associations? |
VSD, pulmonic stenosis
none |
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ARVC?
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fatty replacement of right ventricular myocardium
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Measuring HOCM?
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Measure LV wall thickness at end diastole in short axis - should be less than 3 0mm
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What is the treatment for hypoplastic left heart?
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Blalock-Tausig shunt
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What is a Blalock-Tausig shunt?
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connection of subclavian artery or carotid artery to pulmonary artery in duct dependent congenital heart disease
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What has a 100% specificity for pulmonary HTN?
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segmental artery to bronchus ratio of >1:1
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Size of right interlobar artery for pulmonary HTN
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>1.5 women, >1.6 in men
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5 types of pulmonary HTN?
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1- idiopatic
2 - associated with left heart disease 3 - associated with lung disease or hypoxemia 4 - chronic embolic or thrombotic disease 5 - tumor, fibrosing mediastinitis |
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Laplace law
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tension = pressure x radius
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Three types of cardiomyopathy?
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Restrictive
Dilated hypertrophic |
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Eisenmenger complex?
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VSD, DTGA (different from the syndrome)
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Masslike calcification of the annulus?
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Caseous calcification - on pathology, basophilic toothapste-like substance, W>M
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What is the significance of apical HCM?
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Better prognosis, rarely sudden death
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ASH?
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Septal to posterior wall ratio >1.4:1, anterior motion of anterior leaflet of mitral valve secondary to Bernoulli effect
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Significance of an avulsed noncoronary cusp of the aortic valve>
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associated with pseudoxanthoma elasticum
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Mitral leaflet calcification associated with?
Mitral annulus calcification associated with? |
rheumatic heart disease
aging |
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How many LV aneurysms will get a thrombosis?
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50%
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Definition and diagnosis of LV noncompaction?
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Ratio of noncompacted:compacted LV myocardium of 2.3:1
Poorly organized myocardium with prominent trabeculae |
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What are false cords of the myocardium? What are the consequences
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Linear cords with broad-based attachment projecting into the LV - normal myocardium in an abnormal location.
Can cause valve dysfunction and arrhythmia |
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Linear calcifications within endocardium?
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Endomyocardial fibrosis
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Two types of ventricular diverticula?
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muscular - contract normally
fibrous - akinetic a diverticula contains all layers as opposed to a pseudoaneurysm |
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Most common location to see myocarditis on MR?
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apical walls of LV
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what additonal finding may be seen on MR with acute myocarditis?
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paraspinous muscle enhancement
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Abnormal protrusion of septum from left to right
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interatrial septal aneurysm
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diagnostic criteria for IASA?
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>15mm (>5mm in kids) bowing of septum to other side, with lack of involvement of entire septum
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Most common comlications after coarc repair?
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recurrence, pseudoaneurysms of repair site
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Associations with coarctation of aorta?
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VSD
bicuspid aortic valve aortic hypoplasia, anomlaous R subclavian artery, stenosis of left subclavian artery, coarctation of L PA, Moya Moya |
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Causes fo restrictive cardiomyopathy
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idiopathic, sarcoid, amyloid, scleroderma, hemochromatosis
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Findings of restrictive cardiomyopathy?
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Often the only finding may be mild atrial enlargement
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If a mass is seen on a moving portion of the heart....
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it is suspicious for neoplasm since thrombi form in nonmoving regions (ie, left atrial appendage)
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Most common location of angiosarcoma?
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RA/RV - more common in atrium although undifferentiated more common in ventricle
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Infectious versus congenital aneurysms of aortic root
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infectious involves all sinuses with equal frequency, congenital typically right coronary sinus
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Three types of IAA?
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Type A - distal to Left SC
Type B - b/w L SC and L CC Type C - between L CC and innominate A VSD and PDA are present |
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anaomly associated with IAA?
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aberrant R SC
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What does the flap in a dissection represent?
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the aortic media
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Describe endocardial cushion defect?
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AV valves are completely contiguous separating atrium from ventricle with large VSD
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What type of arrhythmia is associated with endocardial cushion dfect?
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1st degree block
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What is the endocardial cushion?
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Av valves, inlet portion of septum, atrial septum primum
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What classification is used in pulmonary artery stenosis?
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Gay classification
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Most common type of PA stenosis
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supravalvular
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If PA stenosis is central?peripheral?
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likely congenital, likely acquired
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Associations with PA stenosis?
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Williams, Noonan, rubella, chronic PE, silicosis, mediastinitis
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Gay classification of PA stenosis (4)
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1 - single stenosis of main, right, or left
2 - stenosis at bifurcation, extneding left or right 3 - multiple, peripheral 4 - combination of central and peripheral |
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What abnormality may be found in the supravalvular stenosis in williams syndrome?
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ostium of LCA may be isolated and thus impossible to catheterize
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How many patients with sinus venosus ASD have right aortic arch? persistent L SVC?
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25%,16%
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How is a sinus venosus ASD treated
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surgical, endovascular repair is not possible
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What is the developmental error regarding double aortic arch?
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failure of regression of 4th-6th pharyngeal arches
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Which arch is usually dominant in double aortic arch?
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right
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Most common symptomatic vascular ring?
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double aortic arch
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Associations with double aortic arch?
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Digeorge, velocardiafacial syndromes
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Types of right aortic arch?
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aberrant L SC
mirror image isolated L SC |
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Pulmonary sling?
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aberrant L PA from R PA which courses anterior to espohagus and posterior to trachea? The only one to cause anterior indentation of the espohagus
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Two anatomic variants associated with pulomary sling?
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pig bronchus
napkin ring cartilage |
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What would you rather have, left-sided isomerism (polysplenia) or right-sided isomerism (asplenia)?
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left, fewer congenital issues
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What arrhythmia is often seen with Ebhstein anomaly?
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SVT
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What is the most feared complication of partial congenital absence of the pericardium?
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herniation of myocardium with fatal myocardial strangulation/ischemia
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What is the CXR finding in COMPLETE absence of the pericardium?
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posterior and leftward displacement of the cardiac silhouette.
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Where is the abnormal interposition of lung seen on CT with partial absence of pericardium?
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b/w aorta and PA - the preaortic recess
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which area is usually spared in lipomatous hypertrophy of the interatrial septum
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fossa ovalis and thus 'waist' or 'dumbell' sign
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What speical kind of cell may an interatrial lipoma contain and what are the implications with nucs?
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may contain Kupffer cells and thus increased uptake on Tc-99m SC study
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IA lipomas never obstruct AV valves but my narrow IVC or SVC
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no answer
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Where do cardiac mets ususally form?
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myocardium or pericardium - rarely within cardiac chamber
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Where do cardiac mets usually come from?
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lung, breast, melanoma, leukemia/lymphoma, esophageal, reanal
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Three primary aortic tumors
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sarcoma
mfh hemangioendothelioma |
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Benign primary aortic tumors
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papillary fibroelastoma, myxoma, leiomyoma, lipoma
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When do you see separate munbrail and ossification centers?
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Down syndrome
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Pentalogy of Cantrell
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lower sternal defect
high omphalocele pericardial/diaphragmatic defect ventral LV diverticulum |
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five types of ectopia cordis
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cervical,cervical-thoracic,thoracic,thoracoabdominal, abdominal
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is a sternal ossification center present in premature infants?
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yes
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Cardiac implication of long-term dialysis?
which protions of the hear4t are most affected |
metastatic calcifications to myocardium?
LV and septum |
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figure of 3
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coarcation
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cephalization
kerley b edema |
15 mm Hg
18 mm Hg 25 mm Hg |
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pressure gradient
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delta P = 4v^2
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diastolic bounce
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constrictive pericarditis
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Rheumatic heart disease causes mitral___________?
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regurgitation
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Worldwide, most common cause of pericardial calcification
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Tb
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three sites of TAI
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isthmus, root, diaphragmatic haitus
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Is atrium enlarged is ASD? What other anomaly looks the same on CXR?
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No, PAPVR
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What vessel may conatin a right and left SVC
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bridging vein
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Where does a persistent left SVC usually drain
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coroanry sinus
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How does ARVD often present?
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arrhythmia, SVT
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What valvular lesion is associated with sinus of Valsalva aneurysm?
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AR
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Cause of sinus of Valsalva aneurysm?
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weakness at jxn of valve and aorta
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What type of septal defect is associated with sinus of Valsalva aneurysm?
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supracristal VSD
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1-day old CXR - cyanotic, no heart enlargement, edema
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TAPVR
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three types of TAPVR
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I - supracardiac
II - coronary sinus or right atrium III - below diaphragm (portal vein, hepatic veins, ductus venosus) |
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What % of patients with situs inversus totalis have heart anomalies?
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only 5-10%
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If you see a right aortic arch with mirror image branching, what is the most likely congenital heart anomaly?
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TOF
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Of TOF and truncus, which disease entity more often demonstrates right aortic arch with mirror image branching?
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truncus
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Acquired causes of coarctation?
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Takayasu
Giant cell |
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VSD with defect b/w aorta and right ventricular infundibulum
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supracristal - associated with sinus of valsalva aneurysm
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What is a Fontan shunt?
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A shunt b/w the IVC and PA
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What is a Fontan shunt used for?
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tricuspid atresia
HLH (as part of Norwood procedure) |
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What is a cervical aortic arch?
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Rare anomaly in which aortic arch ariseds from 3rd arch rather than fourth, it is usually right-sided
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How is ASH treated?
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septal ablation with ethanol
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4 yo - huge heart, no edema
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Ebstein, pulmonary atresia with intact septum, tricuspid atresia with retstrive VSD
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How do you know it's the right ventricle?
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moderator band, muscular infundibulum, trabecular apex
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How do you repair IAA?
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keep PDA open then create aorto-aortic bypass
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What is a criss-cross heart?
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ventricle positions are transposed (L-bulboventricular loop)
AV connections are concordant |
