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95 Cards in this Set
- Front
- Back
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What is the approach to aquired heart disease on a plain film
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What is the first thing to do decide in aquired heart disease
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if the heart is big or normal
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What are the 2 sign post of aquired heart disease
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left atrial enlargement
enlarged aortic arch |
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If a pt has a small/normal heart and has left atrial enlargement what is the differential
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mitral stenosis
reduced LV compliance |
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What are 3 causes of left ventricular compliance
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restrictive CM
hypertrophic CM constrictive pericarditis |
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If a pt has restrictive CM, hypetrophic CM, or constrictive pericarditis they have a normal/small heart with LAE
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yes
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What is the patient has a small/normal heart and has a large aorta
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aortic stenosis
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What is the ddx for a normal sized heart with disease
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Acute MI
restrictive CM hypertrophic CM contrstrictive CM |
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Can restrictive CM, hypertrophic CM and Constrictive pericarditis have either a enlarged left atrium or normal
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yes
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What are 2 classic plain film findings of mitral stenosis
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LAE
enlarged PA |
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What do you expect to see in a pt with aortic stenosis
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enlarged aorta and normal sized heart
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What is the MC cause of acute pulmonary edema with normal heart size
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acute MI
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What are the two sign post for big heart disease
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LAE
Aortic regurtitation |
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What is the only cause of LAE in a big heart disease
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mitral regurgitation
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What is the only cause of AoE in a big heart disease
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aortic regurgitation
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What should you suspect if there is big heart disease without LAE or AoE
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idiopathic dilated CM
Ischemic CM tricuspid regurgitation RV failure Pericardial effusion |
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What do you suspect if there is left atrial enlargement in a big heart
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mitral regurgitation
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What do you suspect if there is AoE in a big heart
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aortic regurgitation
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What is the differential of a markedly enlarged heart
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tricuspid regurgitation (wall to wall heart)
large pericardial effusion |
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Why is differentiation of restrictive and constrictive pericarditis important
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difference in managment (pericarditis you just take the pericardium off)
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Where do you typically see pericardial calcifications in constrictive pericarditis
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pericardial grooves
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What are the 4 MC causes of constrictive pericarditis
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cardiac surgery
radiation therapy viral TB |
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What are 5 diagnostic features of constrictive pericarditis
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pericardial thickness greater than 4mm
septal bounce RA enlargement No RV enlargement Dilated IVC |
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What is septal bounce
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this is bounce of the septum towards the left ventricle upon opening of the tricuspid valve
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What are the 2 most common causes of constrictive pericarditis
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surgery
radiation |
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How do you determine constrictive Vs restrictive cardiac physiology
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cardiac catheterization
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Which way does the septum bounce in restrictive/constrictive heart diseasee
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towards the left ventricle
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What is the appearance of an acute hematoma on MRI
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bright
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What is the appearance of a subacute hematoma
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heterogeneous
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What is the appearance of a chronic hematoma on MRI T1
(fix last two its for T1) |
Homogenous intermediate
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What is the characteristic area you may see a pericardial cyst
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right cardiophrenic angle
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What does a pericardial cyst look like
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homogenous low density lesion on T1 and bright on T2 (no enhancement)
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What are two patterns of delayed enhancement of ischemic heart disease
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subendocardial
transmural |
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What are the 2 patterns of non-ischemic cardiomyopathy
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sub-epicardial
mid wall |
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What pattern of delayed enhancement would be expected in a patient with myocarditis
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midwall
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What would you expect to see 2 months later in a patient who had myocarditis
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resolution of delayed enhancement
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How do you differentiate between ischemic dilated cardiomyopathy and non ischemic dilated CM
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look for delayed patterns of enhancement
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What are some causes of non-ischemic dilated CM
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HTN
alcohol toxins obesity DM idopathic |
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What is the MCC of dilated CM
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ischemic
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What are the findings of Non-ischemic dilated CM
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LV enlargement
decreased systolic function normal wall thickness delayed enhancement (Not always but if they do it will most likely be a non-ischemic pattern but it can be ischemic) |
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What are the patterns of delayed enhancemet for non-ischemic dilated CM
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59% None
28% midwall 13% ischemic pattern |
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When do you make diagnosis of HOCM
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hypertrophy with no cause for it
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What percent of HOCM have asymmetric septal hypertrophy
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90%
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Why is MR better than echo for looking at the potential HOCM pts
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because you can measure complete LV mass
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What ratio is diagnostic of asymmetric HOCM
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septal/lateral: >1.5
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Do you see delay enhancement in HOCM
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yes (80% of cases) in the diseased portions
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What do you see in HOCM
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the anterior leaflet of the mitral valve will not close during systole and therefore you will never see those valves close together
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What type of dysfunction occurs in restrictive CM; diastolic or systolic
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diastolic
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can pt with restrictive CM have systolic dysfunction too
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yes
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What chambers tend to be enlarged restrictive CM
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RA and LA
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Are the ventricles small in restrictive CM
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yes with wall thickening
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What are the findings of restrictive CM
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RA and LAE
small ventricles wall thickening |
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What type of CM is caused by amyloid
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restrictive CM
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What should you suspect if there is global subendocardial delayed enhancement
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amyloid (will not respect coronary artery territories)
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What percent of cases of amyloid will have global delayed hyperenhancement
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70%
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Are both amyloid and sarcoid types of restrictive CM
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yes
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What percent of pts with pulmonary sarcoid will have cardiac sarcoid
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11%
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Where is hyperenchancement typical seen in sarcoid
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anterolateral and anteroseptal regions
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What pattern of delayed enhancement is seen in sarcoid
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midwall
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What does ARVD stand for
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arrhythomgenic right ventricular dysplasia
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What ventricle is effected by ARVD
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the right ventricle
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What is the clinical SS of ARVD
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syncope/sudden death during exercise
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What do you see on EKG as a result of ARVD
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recurrent VT or PVCs with a RV origin
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What is the pathophysiology of ARVD
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fatty or fibrous degeneration of RV
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What are the MR finding of ARVD
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increased signal on T1
wall thinning aneurysm RV enlargement Regional or global contraction abnormalities |
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What is the T1 MR characteristic of ARVD
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bright (fatty)
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What is the role of MRI for cardiac mass evaluations
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extent and location
tumor Vs thrombus primary Vs secondary benign Vs malignant |
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What are 4 descriptive terms for location of the tumor with regards to the heart
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intracavitary
itnramural pericardial paracardial |
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What is the MC cardiac mass
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thrombus
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What is the appearance of a thrombus on Cine MR
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dark
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Does a thrombus enhance
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no
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What are 2 characteristics of a thrombus in the heart
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dark on cine
no enhancment |
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What is the appearance of tumor on cine
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intermediate
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Does a tumor enhance
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yes
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what are two characterictis of a tumor on MR
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intermediate on MR
contrast enhancement |
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What is the only exception of a intermediate tumor on MR
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myxoma
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Does a myxoma have a stalk
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yes
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What is the appearance of a mxyoma on cine
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brighter than muscle
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T or F; secondary tumors are 40 x more frequent than primary tumors of the heart
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true
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What are the 3 MC secondary tumors of the heart
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breast
lymphoma melanoma |
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What are the 2 most common primary benign tumors of the heart
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myxoma
lipoma |
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What is a common primary malignant tumor of the heart
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angiosarcoma
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What are malignant tumor characteristics of the heart
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wide point of attachment
necrosis or cavitation involvment of > 1 chamber pericardial effusion pulmon mets extension beyond the heart |
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Is angiosarcoma a primary malignancy of the heart
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yes
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Is a wide point of attachement to the heart a sign of a malignant tumor
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yes
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What is the primary technique for evaluation of valvular disease
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echo
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What are the qualitative ways to evaluate the heart
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Cardiac CT and Cine MRI
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What is the best way to quantitatively evaluate the heart
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cine MRI (velocity encoded)
Note Cine MRI is good for qualtitative also |
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What is quantitative cine MR used to evaluate
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the amount of regurgitation
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What is the mercedes benz sign associated with
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inabiltiy of the aortic leaflets to open....aortic stenosis
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If there is alot of calcifications does it significantly limit echocardiography
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yes
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What is a fish mouth aortic valve characteristic of
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a bicuspid aortic valve
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Can you estimate the pressure gradient across a stenosis with velocity encoded cine
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yes (by the bernoulli equation and the peak velocity)
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What annular aortic ectasia (widening of the sinus of valsalva) associtated with
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aortic regurgitation
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What do you expect to see in the flow curve in aortic regurgitation on a flow diagram
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postive flow during systole
negative flow during diastole |
