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175 Cards in this Set
- Front
- Back
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Name AoV cusps |
Right Left Non-Coronary |
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Sinus of Valsalva located at : |
Ao Root (slightly dilated area) **origin on CA's |
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Distal Abdominal Ao aka |
Infrarenal |
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Aneurysm aka |
ectasia |
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Name 2 types of Aneurysms |
1. Saccular 2. Fusiform |
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Describe Saccular Ao Aneurysm |
weakening of vessel wall at certain area causing an out pouching |
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Saccular Ao Aneurysm commonly d/t |
TRAUMA or syphillis |
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Describe Fusiform Ao Aneurysm |
Uniform dilation of entire circumference |
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Etiology of Ao Aneurysms |
Acquired: ATHEROSCLEROSIS, HTN Congenital: Marfan's |
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Describe Marfan's Syndrome |
MVP Dilation of AoR ( > 3.7 - 4.2cm ) Ao Dissection |
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S&S's of Ao Aneurysm |
Bounding pulse (grade 3) Back Pain (crushing w/ dissection!) |
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MC location for Ao Dissection |
Asc Ao |
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Describe types of Ao Dissection using DeBakey classification: |
Type 1: Dissection of ENTIRE AO!!!! Type 2: Dissection of Asc Ao Type 3: Dissection of Desc Ao |
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Describe Types of Ao dissection using Stanford classification: |
Stanford type A: Prx Ao affected (Debakey 1&2) Stanford type B: Distal Ao affected (Debakey 3) |
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Etiology of Ao Dissection |
MC: HTN & TRAUMA (blunt) |
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Ao Dissection S&S's |
Severe CP w/ Radiation to back & jaw!! |
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New Murmur associated with Ao Dissection would be d/t: |
AI |
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2D/M-mode findings of Ao Dissection |
Intimal flap True/false lumen Pericardial effusion AoR dilation > 3.7 - 4.2cm |
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Describe Ao Pseudoaneurysm |
Contained rupture of Ao wall "pulsating hematoma" |
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Ao Pseudoaneurysm assoc w/
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Cardiac SX trauma Ao dissection |
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2D/ Doppler appearance of Ao Pseudoaneurysm |
Has a neck w/ a jet (communication area)
"TO and FRO" Dp pattern |
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Describe Sinus of Valsalva Aneurysm |
Aneurysm involving any of the sinuses & corresponding coronary cusp |
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Which sinus is most often affected with Sinus of Valsalva Aneurysm?
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Right sinus |
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Which views are best for evaluating Sinus of Valsalva Aneurysm |
PSAX @ base PLAX when RCC or NCC |
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2D findings of a RUPTURED Sinus of Valsalva Aneurysm |
"Windsock" appearance - finger like projection w/ dropout at the tip of the aneurysm |
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Patients most commonly affected by Ao Atherosclerosis |
Older Smokers HTN |
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Name the 3 major types of Cardiac Trauma |
1. Non-penetrating/ blunt 2. Penetrating 3. Iatrogenic |
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Name the 2nd MC cause of sudden cardiac arrest in young athletes (termed 'Commotio Cordis') |
Blunt Trauma |
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Bruised myocardium MC caused by |
Car accident |
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MC 2D finding with Blunt cardiac trauma |
Segmental WMA's |
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Which valves are MC affected in Blunt cardiac trauma? |
Left sided valves (d/t higher pressure) **AoV is MC affected |
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Valves are most vulnerable when: |
They are open! AoV- systole Mv- diastole |
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TV injury assoc w/ |
Rupture of RV free wall |
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Aortic rupture assoc w/ |
Motorcyclists thrown from bike & seatbelt injury |
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Aortic Rupture usually occurs at : |
level of isthmus |
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Which chamber is most susceptible to Penetrating Cardiac trauma? |
RV - most anterior |
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LV aneurysm most often d/t |
Anterior MI |
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MC location of LV aneurysm |
At apex |
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Describe LV Pseudoaneurysm |
Result of LV free wall rupture -blood trapped in pericardium forming contained, pulsating hematoma |
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Etiologies of LV Pseudoaneurysm
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Blunt Trauma cardiac Sx endocarditis Drug abuse (Cocaine) |
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Findings of LV Pseudoaneurysm |
Bidirectional Dp flow Narrow neck: High vel jet Large neck: flow that "washes" back and forth |
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True vs Pseudoaneurysm |
True: Trys to get SMALLER in systole Pseudo: Expands in systole |
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Describe Fetal blood flow |
UmV carries oxygenated blood to - ductus venous - IVC - RA - PFO - LA - LV - Ao *** small amount to RV and MPA which exits thro PDA |
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Describe PDA |
One of MC CHD's Patent Ductus Arteriosus Connects pulm A w/ Ao - results in LEFT to RIGHT shunt |
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PDA located at |
- Slightly left of palm trunk bifurcation - Connects to Ao just after origin of L subclavian A @ Isthmus |
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PDA highly assoc w/ |
- Rubella during pregnancy (German measles) - Premature births - High altitude births |
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Best view to look for PDA |
PSAX @ base |
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CFI Findings of PDA |
Retrograde flow in the MPA originating from the LPA |
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Auscultation of PDA |
Continuous murmur heard over pulmonic area |
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PDA causes enlargement of which side? |
PDA = LEFT HEART ENLARGEMENT |
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M-mode & 2D Findings of PDA |
LVVO LAE Dilated MPA |
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Describe ASD |
Abnormal opening in IAS L to R shunt flow |
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Name 3 types of ASD |
1. Ostium Secundum 2. Ostium Primum 3. Sinus Venosus |
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Describe Ostium Secundum ASD
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MC ASD Mid portion of IAS "T" sign |
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Describe Ostium Primum ASD Location & assoc w/ |
Lower portion of IAS
Assoc w/ T21 & CLEFT MV (ant leaf) |
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Describe Sinus Venosus ASD |
Superior portion of IAS Assoc w/ partial anomalous pulm venous return (PAPVR) |
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Auscultation of ASD |
Increased flow across pulm V causes S2 split -d/t delayed emptying of RV |
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S&S's of ASD |
SOB and Fatigue |
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ASD causes enlargement of which side? |
ASD = RIGHT side enlargement |
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EKG findings of ASD |
RAE RBBB - "rabbit ears" RAD |
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Best view for ASD |
Subcostal |
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2D findings of ASD |
RVVO pattern (RVE/RAE, Paradox SM, RVH) PA enlargement Right heart dilation MVP |
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Dp findings of ASD |
Left to Right shunt flow |
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DDx for ASD |
PFO |
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Aka Aneurysm of IAS |
Floppy septum |
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2D Findings of Aneurysm of IAS |
"jump rope appearance" >/= 1.5cm in length & excursion |
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MC congenital lesion present at birth |
VSD |
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Describe VSD |
An abnormal opening in the IVS *L to R shunt |
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Name the 4 types of VSDs & which is MC? |
1. Membranous - MC type 2. Muscular 3. Outlet 4. Inlet |
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Aka of Membranous VSD |
Perimembranous |
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Describe Membranous VSD |
Located directly below AoV (Upper 1/3 of IVS) often assoc'd w/ abn TV |
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Aka Muscular VSD |
Trabecular |
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Describe Muscular VSD
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Extends from the membranous septum to the apex, Often located near the apex May appear fenestrated/ "swiss cheese" |
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Aka Outlet VSD |
Supracristal Infracristal Subpulmonic Infundibular Doubly committed subarterial defect |
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Describe Outlet VSD |
Near outflow/ semilunar valves Lies directly below pulmonic valve - stradles the Crista Supraventricularis |
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Aka Inlet VSD |
Canal Subvalvular Posterior Atrioventricular |
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Describe Inlet VSD |
Lies post to the membranous septum and btwn the 2 A-V valves |
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Inlet VSD is often assoc w/ ______ defects
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Endocardial cushion defects |
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VSD 2D / M-mode Findings |
LVVO LAE LVH - late in the course |
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Describe Eisenmenger's Syndrome |
Reversal of congenital shunt flow *From Lt ->Rt to Rt ->Lt |
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Tx for Eisenmenger's Syndrome |
Heart-lung transplant |
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Eisenmenger's Syndrome is a cyanotic heart condition consisting of :
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VSD Dextroposition of the Ao PHTN RVH |
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What is a Qp:Qs Shunt Ratio & what is it used for? |
Comparison of vol of Pulm blood flow (Qp) to Systemic blood flow (Qs) - used to detect magnitude shunt & size of defect |
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Echo estimates of volume are based on: |
annulus of area & integral of profile *trace PW waveform |
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Formula to obtain stroke volume for Qp:Qs |
SV = TVI x CSA (Cross Sectional Area) |
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What is used for Qp:Qs for an ASD? |
Qp = RVOT Qs = MV or LVOT |
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What is used for Qp:Qs for a VSD
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Qp = RVOT or MV (BEFORE VSD) Qs = LVOT |
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What is used for Qp:Qs for PDA
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Qp = MV or LVOT (coming from lungs not before bc will pick up shunt) Qs = TV or RVOT (return from systemic circulation) |
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Qp:Qs Ratio is abnormal and Tx is required when |
> 1.5 : 1.0 |
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Aka Endocardial Cushion Defect |
AV canal defect |
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Describe Endocardial Cushion Defect |
Occurs at the region where IAS & IVS join the MV & TV |
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Endocardial Cushion Defect has high assoc w/
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T21 |
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Name 3 Types of Endocardial Cushion Defect |
1. Partial 2. Complete 3. Incomplete |
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Describe a Partial Endocardial Cushion Defect |
Ostium primum ASD Cleft MV |
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Describe a complete Endocardial Cushion Defect |
Ostium primum ASD Inlet VSD Common A-V valve opening over ASD |
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Describe incomplete Endocardial Cushion Defect |
2 sep A-V valve orifices LV to RA shunt Cleft MV |
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Describe Ebstein's Anomaly |
Atrialization of RV TV "apically displaced" (>20mm) Ant leaflet "sail-like" |
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Ebstein's Anomaly Etiology
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Lithium use during pregnancy |
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Auscultation w/ Ebstein's Anomaly |
Widely split S1 Loud S2 "Sail" sound |
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EKG findings w/ Ebstein's Anomaly |
WPW Syndrome type B (Delta Wave) |
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Dp Findings w/ Ebstein's Anomaly |
TR |
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Ebstein's Anomaly associated anomalies
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ASD (75% w/ Rt-Lt shunt) VSD PS PV atresia |
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Describe Tricuspid Atresia |
Congenital Absence of the TV
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Tricuspid Atresia assoc w/ |
Cyanosis ASD (to get out of RA) VSD or PDA (to get to lungs) |
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2D Findings w/ Tricuspid Atresia |
TV orifice & leaflets replaced by band of tissue RV hypoplasia RVH LVE ASD VSD/PDA |
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Describe a Parachute MV |
All chord attach to single large pap m **Results in MS |
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Describe Archade MV |
Chordae insert into multiple small pap ms |
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Describe Double Orifice MV |
2 Sep MV openings All chordae attach to 1 pap m |
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Congenital valvular PS is MC d/t |
Fusion of the valve cusps |
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M-mode findings of Congenital valvular PS |
Increased "a" dip/wave of Post MV ( > 8mm) |
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2D findings of Congenital valvular PS |
Systolic doming of the PV leaflets Post sten dilation of MPA RAE RVH |
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Describe 2 types of Subvalvular Obstruction |
1. Discrete Subaortic Stenosis 2. Tunnel-type SubAo Obstruction |
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Subvalvular Obstructions are freq assoc w/
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VSD |
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Aka Discrete Subaortic Stenosis |
Membranous subaortic stenosis |
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Describe Discrete Subaortic Stenosis |
Thin, fibrous membrane that forms a crescent shape barrier w/in the LVOT |
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Aka Tunnel-type SubAo Obstruction |
Subaortic fibromuscular ridge |
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Describe Tunnel-type SubAo Obstruction |
Diffuse thickening & narrowing of the LVOT assoc w/ CLVH |
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Name 3 Types of Supravalvular AS & which is MC |
1. Hourglass- MC 2. Membanous 3. Strand |
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Describe Hourglass Supravalvular AS |
Firbomuscular thickening (of medial layer) producing narrowing above the sinuses |
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Appearance of Hourglass Supravalvular AS |
Walls appear thick & echogenic |
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Describe Membranous Supravalvular AS |
THIN fibrous membrane just above the valve |
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Describe Strand Supravalvular AS |
Diffuse hypoplasia of the Asc Ao |
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Strand Supravalvular AS usually assoc w/
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Hypoplastic Lt Heart Syndrome |
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Describe Coarctation of Ao |
Congenital narrowing of Ao - just prox or distal to DA (ligament arteriosus) |
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DA connects the the Ao : |
After origin of L Subclav A @ Isthmus |
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Describe Preductal Coarctation of Ao |
Presents in infancy |
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Describe Postductal Coarctation of Ao |
Typically presents after age 20 |
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Coarctation of Ao has high assoc w/ |
BAoV!! PDA VSD AS/LVOTO |
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Clinical symptoms of Coarctation of Ao |
High BP in arms & head Low BP in legs & torso |
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CXR findings of Coarctation of Ao |
The "3" sign |
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CW Dp Findings of Coarctation of Ao |
"Sawtooth" pattern Persistence of high vel flow thru diast |
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What is the Simplified Bernoulli Eq, & what is it used to find? |
4 (V^2) Peak Instantaneous Press Grad |
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In Mod Bernoulli, what is V2, what is V1 |
V2 = CW Dp of LVOT V1 = PW Dp of LVOT |
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What is Modified Bernoulli Eq |
4( V2^2 - V1^2) |
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When is Modified Bernoulli Eq used? |
AS when LVOT >/= 1 m/s or Coarc when prx vel >1.5 m/s |
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Cath Lab only can find _____ Press Grad |
Peak to Peak Press Grad |
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Press Grad Peak Mean Mild AS
Mod AS Sev AS |
Press Grad Peak Mean
Mild AS 16 - 36 <20 mmHg Mod AS 36 - 75 20 - 35 Sev AS > 75 >35 |
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Mean Press Grad Mild MS Mod MS Sev MS |
Mean Press Grad
Mild MS </= 5 mmHg Mod MS 6-12 mmHg Sev MS >12 mmHg |
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Describe BAoV |
Congenital stenosis Usually 2 cusps w/ raphe leaflet MC adult anomaly |
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M-mode Finding of BAoV |
Eccentric closure of AoV |
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2D Findings of BAoV |
"Football shape" opening of AoV |
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MC congenital anomaly that affects the systemic veins |
Persistent Left SVC
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2D Findings of Persistent Left SV |
Vessel btw LAA & LUPV |
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Describe Cor Triatriatum |
Fibromuscular Membranous partition |
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Aka Cor Triatriatum of LA |
Sinister or Sinistrum MC location |
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Aka Cor Triatriatum of RA |
"Dextrum" or Dexter ***RAREEEE |
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Cor Triatriatum Sinister assoc w/
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ASD PHTN |
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Cor Triatriatum Sinister complications
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Right CHF |
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Describe Kawasaki's Disease |
Acute Ferbile Vasculitis *autoimmune dis |
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Kawasaki's Dis may be assoc w/ |
aneurysmal CA |
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S&S's of Kawasaki's Dis |
FUO lasting >5d - unresponsive to anitbiotics Body Rash - erythema |
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Conotruncal Defects are more common in what infants? |
Infants w/ DM mothers |
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One method to improve systemic O2 saturation w/ cyanotic heart dis |
Give prostaglandin to dilate the PDA |
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Describe Transposition of Great Vessels |
When the Ao is ANTERIOR to the Pulm A |
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Name 2 Types of TGV & which is MC |
1. D-Transposition - MC 2. L-Transposition |
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Aka & Describe D-Transposition of TGV |
Aka: Complete transposition Wrong great vessel is attached to each vent Assoc w/ cyanosis POOR PROGNOSIS Must have ASD, VSD, or PDA - MC membranous VSD |
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Aka & Describe L-Transposition of TGV
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"Congenitally corrected" or "Double Discordance" 2 wrong connections, atria connected to wrong vent, vent are connected to wrong vessels Assoc w/ Coarct of Ao |
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Describe the 4 aspects of Tetralogy of Fallot |
1. Large, membranous VSD 2. Large Ao, overriding IVS 3. RVOTO/ PS 4. RVH |
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Dp Findings of TOF |
Dagger shaped spectral trace |
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CXR Findings of TOF |
"Boot shaped" heart |
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TOF highly assoc w/ |
CA anomalies Digital clubbing & cyanotic nail beds Turner's & Noonan's syndrome |
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Describe Pulmonary Atresia |
No pulm bl flow except thro: PDA or bronchiolar collaterals |
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Name 2 Types of Anomalous Pulm Venous Return |
1. Partial (PAPVR) 2. Total (TAPVR) |
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Describe PAPVR |
Some Pulm Vs drain into venous structures & return bl to the RA, remaining to LA |
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Describe TAPVR |
All 4 pulm Vs drain into the RA or to systemic veins **Need to have large ASD so bl can reach Left heart |
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Describe Persistent Truncus Arteriosus |
One Large great vessel Carries both RVOT & LVOT Single, common Semilunar Valve Assoc w/ VSD |
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2D Findings of Truncus Arteriosus |
Large overriding truncal root VSD |
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Aka Single Ventricle |
Double Inlet LV Common Ventricle Univentriular heart |
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Describe Single Ventricle |
Both A-V valves connect to a single vent chamber which then directs bl to both great vessels NO IVS |
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Describe Double Outlet RV |
Both great vessels will arise from the morphologic RV
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Double Outlet RV assoc w/ |
VSD - only outlet for LV ASD PDA LVOTO |
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Most Sev form of LVOTO |
Hypoplastic Left Heart Syndrome |
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Hypo plastic Left Heart Sydrome may be caused by: |
Ao atresia Hypoplasia of Ao Severe AS |
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Hypo plastic Left Heart Includes: |
MV/AoV atresia Endocardial thickening Small LA Must have PDA |
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Findings w/ Hypo plastic Left Heart |
RVE small AoR (<5mm) dilated PA |
