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37 Cards in this Set

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congenital heart disease-schematic approach summary
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
congenital heart disease: group 1, increased pulmonary flow, noncyanotic
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
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%
Ebstein's
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
TGA
group 4

increased pulmonary flow
cyanotic
narrow heart base

ddx
TGA, truncus arteriosus, TAPVC, tricuspid atresia, tingle ventricle, DORV, DOLV
TAPVC supracardiac type
group 4

increased pulmonary flow
cyanotic
widened mediastinum

ddx
TGA, truncus arteriosus, TAPVC, tricuspid atresia, tingle ventricle, DORV, DOLV
TAPVC infradiaphragmatic type
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)
occult L-R shunt
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
acquired heart disease approach: small heart
+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
acquired heart disease approach: big heart
+LAE
mitral regurgitation
+AoE
aortic regurgitation

-LAE and -AoE
myocardial and pericardial
iodiopathic dilated CM
ischemic CM
tricuspid regurgitation
right ventricular failure
pericardial effusion
MRI of constrictive pericarditis
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
MRI of pericardial hematoma
MRI features

acute-T1 bright
subacute-heterogenous
chronic-homogenous intermediate
MRI of pericardial cyst
T1-low or intermediate
T1+C-no enhancement
T2-homogenously bright
patterns of myocardial enhancement on MRI
ischemic-transmural or subendocardial

nonischemic-subepicardial, midwall, or patchy
MRI of nonischemic cardiomyopathy
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)
MRI of hypertrophic cardiomyopathy
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
MRI of restrictive cardiomyopathy
diastolic dysfunction
mild-moderate systolic dysfunction
RAE, LAE
small ventricles
wall thickening
MRI of amyloidosis
usually RCM

MRI features
HE 70%-global subendocardial delayed enhancement without respect for vascular territory
right atrial involvement
MRI of sarcoidosis
usually RCM
11% cardiac sarcoid

MRI features
patchy areas of HE anterolateral or antero septal, midwall
ARVD
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
MRI thrombus vs tumor
thrombus
dark on cine MR
no contrast enhancement

tumor
intermediate on cine MR
exception-myxoma (brighter?)
contrast enhancement
cardiac tumors
secondary tumors 40x more frequenct
breast
lymphoma
melanoma

primary benign
myxoma
lipoma

primary malignant
angiosarcoma
mfh
leiomyosarcoma
fibrosarcoma
chondrosarcoma
osteosarcoma
lymphoma
coronary CTA indications
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%
cardiac MRI protocol for enhancement
0.2 mmol/kg gadolinium

10-15 minute delay

inversion recovery to selectively null myocardium
role of viability in MRI
residual myocardium >= 5.5
or
ratio of viable myocardium/total wall thickness > 50%

probably regain function
hybernating myocardium
wall thinning, decreased function, no enhancement
coronary artery aneurysm
causes
atherosclerosis
trauma
vasculitis (kawasaki)

criteria
1.5 x normal lumen

anticoagulation
>8mm
aortic pseudoaneurysm
infection
penetrating ulcer
trauma
acute
chronic
annuloaortic ectasia
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)
thoracic aortic dissection
hypertension
atherosclerosis
annuloarotic dissection
vasculitis

true lumen displaced anteromedially
type A dissection complications
aortic valve rupture
pericardial hemorrhage
coronary artery dissection
carotid/vertebral dissection
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
infarcts
ct
wall thinning
subendocardial low density
perfusion
fat

MRI
wall thinning
wall motion abnormality
delayed enhancement
myocardial infarct complications
aneurysm
apical
wide neck
low risk rupture

pseudoanuerysm
posterior/diaphragmatic
narrow neck
high rupture risk
nonischemic delayed enhancement
ddx
more common
myocarditis
amyloid
sarcoid

less common
cardiomyopathies
hypertrophic cm
dilated cm
arvd
causes of sudden cardiac death in a young patient
hypertrophic cardiomyopathy

anomalous coronary

arrythmogenic right ventricular dysplasia

myocarditis
pulmonary arterial hypertension
ddx
left sided heart disease (ie mitral stenosis)

pulmonary veno-occlusive dz

parenchymal lung dz

chronic pulmonary embolism

shunts (ASD, VSD, etc)

primary