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37 Cards in this Set
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congenital heart disease-schematic approach summary
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group 1: Increased pulmonary flow, non cyanotic->left to right shunts
group 2: normal or decreased pulmonary flow, cyanotic, normal heart size->TOF group 3: normal or decreased pulmonary flow, cyanotic, increased heart size->ebstein's anomaly group 4: increased pulmonary flow, cyanotic->T lesions group 5: pulmonary edema, cyanotic->infradiaphragmatic TAPVC, heart stress |
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congenital heart disease: group 1, increased pulmonary flow, noncyanotic
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group 1 lesion
I I Left atrial enlargement - + ------------------------- ASD I I PAPVC I I aortic arch enlarge - + _____________ VSD PDA *papvc to svc, associated with sinus venosus asd |
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TOF
1 VSD (high) 2 overriding aorta 3 pulmonary stenosis (infundibular) 4 RV hypertrophy right arch 25% severe variant-pulmonary atresia with VSD severe variant-pulmonary atresia with VSD |
group 2
normal heart size (RV hypertrophy) booth shaped cyanotic normal or decreased pulmonary flow right arch 25% |
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Ebstein's
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group 3
cyanotic increased heart size normal or decreased pulmonary flow ddx tricuspid atresia with restricted ASD, pulmonary stenosis with intact ventricular septum, tricuspid regurgitation of the newborn |
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TGA
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group 4
increased pulmonary flow cyanotic narrow heart base ddx TGA, truncus arteriosus, TAPVC, tricuspid atresia, tingle ventricle, DORV, DOLV |
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TAPVC supracardiac type
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group 4
increased pulmonary flow cyanotic widened mediastinum ddx TGA, truncus arteriosus, TAPVC, tricuspid atresia, tingle ventricle, DORV, DOLV |
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TAPVC infradiaphragmatic type
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group 5
pulmonary edema cyanotic normal heart size and superior mediastinum ddx reversible heart stress secondary to severe anemia, asphyxia, hypocalcemia, hypoglycemia, arrhythmia, hypervolemia, myocarditis structural-coarctation (1-3 weeks) |
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occult L-R shunt
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supracristal VSD
sinus venosus ASD PAPVC -RUL vein to SVC or RA hypogenetic lung syndrome (scimitar syndrome) -PAPVC usually below diaphragm -hypoplastic lung, PA, bronchus |
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acquired heart disease approach: small heart
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+LAE
mitral stenosis reduced LV compliance restrictive CM hypertrophic CM constrictive pericarditis +AoE aortic stenosis -LAE and -AoE myocardial and pericardial acute MI restrictive CM hyptrophic CM constrictive pericarditis |
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acquired heart disease approach: big heart
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+LAE
mitral regurgitation +AoE aortic regurgitation -LAE and -AoE myocardial and pericardial iodiopathic dilated CM ischemic CM tricuspid regurgitation right ventricular failure pericardial effusion |
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MRI of constrictive pericarditis
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able to distinguish from restrictive CM
pericardial calcification-grooves causes cardiac surgery, radiation therapy, viral or uremic pericarditis, TB MRI features pericardial thickeness >= 4mm septal bounce RA enlargement usually no RV enlargement dilated IVC |
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MRI of pericardial hematoma
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MRI features
acute-T1 bright subacute-heterogenous chronic-homogenous intermediate |
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MRI of pericardial cyst
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T1-low or intermediate
T1+C-no enhancement T2-homogenously bright |
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patterns of myocardial enhancement on MRI
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ischemic-transmural or subendocardial
nonischemic-subepicardial, midwall, or patchy |
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MRI of nonischemic cardiomyopathy
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idiopathic, SAH, alcohol, toxins, obesity, DM
LV(RV) enlargement decreased systolic function normal wall thickness delayed enhancement 59% no HE 28% midwall HE 13% HE c/w CAD (subnedocardial or transmural) |
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MRI of hypertrophic cardiomyopathy
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hypertrophy with no P overload
asymmetric septal hypertrophy 95% septal apical anywhere (posterolateral, anterolatera) symmetric 5% wall thickness wall thickness>12mm (absence of HTN, etc) septum:posterolateral wall ratio>1.5 subvalvular aortic stenosis systolic anterior motion of mitral valve indications for MRI unusual distribution measure LV mass distinguish HCM from tumor interrogate subvalvular stenosis MRI features septal/lateral > 1.5 on short axis hyperenhancement 80% flow jet in LVOF on three plane anomalous anterior motion of septal mitral valve leaflet |
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MRI of restrictive cardiomyopathy
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diastolic dysfunction
mild-moderate systolic dysfunction RAE, LAE small ventricles wall thickening |
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MRI of amyloidosis
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usually RCM
MRI features HE 70%-global subendocardial delayed enhancement without respect for vascular territory right atrial involvement |
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MRI of sarcoidosis
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usually RCM
11% cardiac sarcoid MRI features patchy areas of HE anterolateral or antero septal, midwall |
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ARVD
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recurrent VT or PVCs of RV origin
syncope/sudden death during exercise fatty/fibrous degeneration of RV MR findings: increased T1 signal wall thinning/aneurysm RV enlargement regional/global contraction abnormality |
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MRI thrombus vs tumor
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thrombus
dark on cine MR no contrast enhancement tumor intermediate on cine MR exception-myxoma (brighter?) contrast enhancement |
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cardiac tumors
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secondary tumors 40x more frequenct
breast lymphoma melanoma primary benign myxoma lipoma primary malignant angiosarcoma mfh leiomyosarcoma fibrosarcoma chondrosarcoma osteosarcoma lymphoma |
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coronary CTA indications
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coronary artery disease
intermediate suspicion of disease discrepant pre and post test probability and symptoms grafts followup for stenosis inability to visualize during cath stents follow-up-assessment for in-stent stenosis anomalous coronary arteries 50% cutoff for significant confirmed with cardica cath because PPV<NPV NPV > 95% |
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cardiac MRI protocol for enhancement
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0.2 mmol/kg gadolinium
10-15 minute delay inversion recovery to selectively null myocardium |
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role of viability in MRI
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residual myocardium >= 5.5
or ratio of viable myocardium/total wall thickness > 50% probably regain function |
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hybernating myocardium
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wall thinning, decreased function, no enhancement
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coronary artery aneurysm
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causes
atherosclerosis trauma vasculitis (kawasaki) criteria 1.5 x normal lumen anticoagulation >8mm |
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aortic pseudoaneurysm
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infection
penetrating ulcer trauma acute chronic |
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annuloaortic ectasia
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connective tissue disoder
marfans (50%) ehlers-danlos cystic medial necrosis increased risk for dissection/rupture intervention when >5cm (thoracic aorta cutoff is 6 cm, however, lower threshold for annuloaortic aneurysm) |
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thoracic aortic dissection
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hypertension
atherosclerosis annuloarotic dissection vasculitis true lumen displaced anteromedially |
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type A dissection complications
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aortic valve rupture
pericardial hemorrhage coronary artery dissection carotid/vertebral dissection |
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distribution of cardiac supply
LAD diagnol branches-anterior wall septal perf-septum LCx obtuse marginal-lateral wall RCA acute marginal-right vent free wall post desc artery-post surface post lateral-inferior wall |
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infarcts
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ct
wall thinning subendocardial low density perfusion fat MRI wall thinning wall motion abnormality delayed enhancement |
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myocardial infarct complications
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aneurysm
apical wide neck low risk rupture pseudoanuerysm posterior/diaphragmatic narrow neck high rupture risk |
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nonischemic delayed enhancement
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ddx
more common myocarditis amyloid sarcoid less common cardiomyopathies hypertrophic cm dilated cm arvd |
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causes of sudden cardiac death in a young patient
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hypertrophic cardiomyopathy
anomalous coronary arrythmogenic right ventricular dysplasia myocarditis |
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pulmonary arterial hypertension
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ddx
left sided heart disease (ie mitral stenosis) pulmonary veno-occlusive dz parenchymal lung dz chronic pulmonary embolism shunts (ASD, VSD, etc) primary |