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cardiac

Key Points

Arythmogenic right ventricular dysplasia has BOTH:

  • fat in RV wall
  • wall motion abnormality

Signs of Right Heart Dysfunction

  • Straightening or reversal of intraventricular septum
  • Dilitation of right ventricle
  • Collapse of R ventricular free wall

Radiology Signs of Hemodynamically Significant Stenosis

  • Collaterals
  • Post-stenotic dilitation
  • Parvus tardus waveform
  • Aliasing
  • Differential enhancement

CXR Signs of Pericardial Effusion

  • Globular, flask, or water-bottle shaped heart
  • No significant pulmonary venous congestion
  • Loss of retrosternal clear space
  • Fat-pad sign - Oreo sign
  • Seprataion of retrosternal fat from epicardial fat line > 2mm (15%)
  • Co-existent pleural effusions (1/3)

Abnormal Catheter Locations on Lateral

  • Internal mammary vein - anterior
  • PAPVR - middle
  • L SVC - middle (towards coronary sinus)
  • L superior intercostal - posterior

Causes of Ascending Aortic Aneurysms

  • Post-stenotic dilitation
  • Mycotic
  • Syphilitic
  • Sinus of Valsalva aneurysm
  • Cystic medial necrosis (see below)

Cystic Medial Necrosis

  • KEY FINDING is an aneurysm that crosses the sinotubular junction
  • Annuloaortic ectasia is the buzzword
  • Tulip-bulb appearance
  • Predominantly associated w/ Marfan's

LV Aneurysms

True False
Wide Base Narrow Neck
Delayed Enhancement of Myocardium Delayed Enhancement of Pericardium
More Common Less Common
Anterolateral Wall Posterior Wall
Treated w/ Anticoagulation Treated Surgically

Differentials

Infiltrative Disorders of Myocardium

  • Lymphoma
  • Sarcoid
  • Glycogen Storage Diseases
  • Amyloid

Hypertrophic Cardiomyopathy

  • Idiopathic
  • HTN
  • Aortic Stenosis
  • Coarctation

Cardiac Masses

  • Thrombus - most common
  • Metastases
    • breast
    • lung
    • melanoma
    • lymphoma
    • sarcoma
  • Primary benign masses
    • Myxoma (adults, atrial septa)
    • Hemangioma (lightbulb enhancement)
    • Rhabdomyoma (children, regress by adulthood, free wall of RA)
    • Lipoma
  • Primary malignant masses
    • Sarcoma
    • Rhabdomyosarcoma (children)
  • Vascular extension of tumor
    • RCC, HCC, ACC, endometrial, Wilm's
      • Intrachamber involvement
    • Lung CA
      • Pulmonary vein extension
  • Valvular masses
    • Elastofibroma
    • Myxoid degeneration
    • Vegetations

Pericardial Effusion

  • Serous
    • uremia, CVD, myxedema
  • Bloody
    • infarct, trauma, neoplasm
  • Purulent
    • bacterial, viral, TB

Small Cardiac Silhouette

  • COPD
  • Hypovolemia
  • Addison's disease

Pulmonary Artery Stenoses

  • Takayasu's
  • Chronic PE
  • Fibrosing mediastinitis
  • Webs

Causes of PA Pseudoaneurysms

  • trauma
  • iatrogenic
  • mycotic

Causes of Pulmonary HTN

  • Precapillary - obstruction in the central PAs from thromboembolism, tumor, or hypoplastic PAs
  • Capillary - interstitial lung dz, COPD, pneumonectomy, primary pulmonary HTN, Eisenmenger, and widespread airspace disease such as atelectasis, pneumonia, tumor
  • Postcapillary - LV failure, restrictive cardiomyopathy, mitral stenosis, hypoplastic left heart, pulmonary veno-occlusive dz, and fibrosing mediastinitis

Facts

Constrictive Pericarditis

  • Thickened pericardium (does not have to be calcified)
  • Cone-shaped RV
  • D-shaped LV
  • Paradoxical motion of intraventricular septum
  • Sigmoid configuration of intraventricular septum

Hypertrophic Obstructive Cardiomyopathy (HOCM)

  • Asymmetric septal hypertrophy
  • Systolic anterior motion of mitral valve

Myocardial Ischemia/Infarct

Patterns of Enhancement

  • Endocardium - infarct
  • Epicardium - inflammatory process such as sarcoid

Ischemia

  • Has decreased early enhancement
  • No delayed enhancement

Infarct

  • Initial Perfusion Defect
  • Delayed Hyperenhancement (10-15 min delayed images)
  • Cine Imaging with Corresponding Wall Motion Abnormality

Moderator Band

  • One of the trabeculae carneae in the right ventricle of the heart
  • Carries part of the right branch of the AV bundle from the septum to the anterior papillary muscle on the opposite wall of the ventricle

Holt-Oram Syndrome

  • ASD and absent radius

Coronary Artery Anomalies

  • L main origin from R leaflet
  • L main origin from PA (ALCAAPA - Anomalous Left Coronary Artery Arising from Pulmonary Artery)
  • L main arises from R leaflet and travels anterior to PA
    • Seen in congenital heart disease such as Tetralogy
cardiac.txt · Last modified: 2017/07/07 18:30 (external edit)