Cvs

Front 1

Congenital heart disease CXR approach

Back 1

1.vascularity

2.camber enlargement

3.side of AA

4.situs

5.rib notching

Front 2

Congenital heart disease
Acyanotic heart disease
Increased pulmonary vascularity?

Back 2

(Left to Right Shunt)
With LA enlargement:
-VSD
-PDA
With normal LA:
-ASD
-ECD
-PAPVC and sinus venous ASD

Front 3

Congenital heart disease
Acyanotic heart disease
Normal pulmonary vascularity?

Back 3

Aortic stenosis
Coarctation
Pulmonic stenosis

Front 4

Congenital heart disease
Cyanotic heart disease?

Back 4

Normal or decreased pulmonary vascularity:
-Normal Heart Size (Tetralogy of Fallot, Fallot variants)
-Cardiomegaly RA enlargment (Ebstein's, Tricuspid atresia, Pulmonic atresia)

Front 5

Congenital heart disease
Increased pulmonary vascularity?

Back 5

the "5Ts:"
Transposition of the great arteries
Truncus arteriosis
Total anomalous pulmonary venous connection
Tricuspid atresia
Tingle=single ventricle

Front 6

Congenital heart disease
Pulmonary edema in newborns?

Back 6

Cardiac:
Edema + large heart = hypoplastic RV or LV

Edema + normal heart = TAPVC below diaphragm
Transient tachypnea of newborn
Pulmonary lymphangiectasia
Pulmonary vein atresia
Cor triatriatum
Suprvalvular mitral ring
Parachute mitral valve

Front 7

Congenital heart disease
Massive cardiomegaly in the newborn?

Back 7

Box-shaped right heart (RA enlarged):
Ebstein's
Uhl's
Tricuspid atresia
Herniation of liver into pericardial sac
Massive pericardial effusion

Front 8

Congenital heart disease
Boot-shaped heart?

Back 8

Tetralogy of Fallot
Adults:
-Loculated pleural effusion
-Cardiac aneurysm
-Pericardial cyst

Front 9

Congenital heart disease with normal heart size and normal lungs?

Back 9

Coarctation
Tetralogy of Fallot

Front 10

Congenital heart disease
Skeletal abnormalities and heart disease?

Back 10

- Rib notching: coarctation
- Hypersegmented manubrium, 11 paris of ribs: Down's
- Manubrium, sternal - Turner
- Pectus excavatum: prolapsed MV, Marfan, ASD
- Multiple sternal ossification centers: cyanotic CHD
- Bulging sternum: large L to R shunt
- Scoliosis: Marfan, Tetralogy of Fallot
- Radial ray

Front 11

Congenital heart disease
Inferior rib notching?

Back 11

Aortic obstruction:
-Coarctation
-Interruption of aortic arch
Subclavian artery obstruction:
-Blalock-Taussig shunt (upper 2 ribs)
-Takayasu's (unilateral)
Severely reduced pulmonary blood flow:
-Tetralogy of Fallot
-Pulmonary atresia
-Ebstein's
SVC obstruction
Vascular shunts (AVM of intercostals)
Intercostal neuroma
Osseous abnormality (Hyperparathyroidism)

Front 12

Congenital heart disease
Superior rib notching?

Back 12

Abnormal osteoclastic activity:
-Hyperparathyroidism
-Idiopathic
Abnormal osteoblastic activity:
-Poliomyelitis
-Collagen vascular disease
-Local pressure
-OI
-Marfan

Front 13

Aortic arch anomalies

Back 13

Front 14

Most common types of complete vascular rings

Back 14

Two most common types of complete vascular rings (85–95%)
o Double aortic arch
o Right aortic arch with left ligamentum arteriosum

Hint 14

Front 15

Right aortic arch and congenital heart disease?

Back 15

Truncus arteriosis (50%)
Tetralogy of Fallot (30%)
Transposition of great arteries
Tricuspid atresia
Pulmonary atresia with VSD
Double outlet right ventricle
Pseudotruncus
Asplenia
Pink tetralogy

Front 16

Back 16

Front 17

Acquired heart disease
Approach?

Back 17

Pump failure:
- Outflow obstruction
- inherent wall abnormalities


Increased end diastolic volume:
-Regurgitation
-Shunt

Front 18

Acquired heart disease
Small heart?

Back 18

Normal variant (deep inspiration)
Addison's disease
Anorexia/bulimia
Dehydration
Severe COPD. HIV

Front 19

Acquired heart disease
Left atrial enlargement?

Back 19

Mitral regurgitation (LA and LV enlarged)
Mitral stenosis (LA enlarged, LV normal)
Rheumatic heart disease
A fib
Papillary muscle rupture (MI)

Front 20

Acquired heart disease
Cardiac masses?

Back 20

Thrombus
Lipoma
Infectious vegetation
Neoplasm:
-Mets
-Atrial myxoma
-Rhabdomyoma
-Pericardial cyst
-Angiosarcoma

Front 21

Acquired heart disease
T1 bright cardiac lesions?

Back 21

Benign:
-Thrombus
-Lipoma
-Myxoma
-Lipomatous hypertrophy of the interatrial septum
Malignant (enhances):
-Angiosarcoma

Front 22

Acquired heart disease
Pericardial effusion?

Back 22

CHF
Acute MI
Post-surgical
Autoimmune
Renal failure
Viral infection
Pericardial mets

Front 23

Acquired heart disease
High-cardiac output states?

Back 23

Severe anemia
Peripheral AVM
Liver hemangioma
Thyrotoxicosis
Pregnancy vascular met

Front 24

Acquired heart disease
CHF?

Back 24

High output failure by age:
-Premature: PDA
- 1st week: Hypoplastic left heart syndrom
-2nd week: coarctation
-Infant: VSD
- Adult: ASD
Increased heart size with normal vascularity:
-Pericardial effusion
-Cardiomyopathy
-Valvular disease

Front 25

Cardiovascular calcifications
Pericardial?

Back 25

Pericarditis
Pericardial cysts

Front 26

Cardiovascular calcifications
Myocardial?

Back 26

Coronary arteries
Calcified infarct
Aneurysm
Postmyocarditis

Front 27

Cardiovascular calcifications
Intracardiac?

Back 27

Calcified valves
Calcified thrombus
Tumors

Front 28

Cardiovascular calcifications
Aorta?

Back 28

Atherosclerosis
Syphilitic aortitis
Aneurysm

Front 29

Pneumopericardium?

Back 29

Iatrogenic (aspiration, puncture)
Cardiac surgery
Barotrauma
Fistula from bronchogenic or esophageal carcinoma

Front 30

Coronary aneurysm?

Back 30

Atherosclerotic
Congenital
Periarteritis nodosa
Kawasaki disease
Mycotic
Syphilis
Trauma

Front 31

Pulmonary artery enlargement?

Back 31

Pulmonary artery HTN:
-Primary pulmonary artery HTN
-Secondary pulmonary artery HTN
-PA stenosis (Williams, Rubella, Takayasu's, CHD)
-PA dilatation (post-stenotic jet, Osler-Weber-Rendu)
-Aneurysm cystic medial stenosis (Behcet's, Takayasu's)

Front 32

Pulmonary arterial HTN
Classification?

Back 32

Pre-capillary
Post-capillary

Front 33

Pulmonary arterial HTN
Pre-capillary HTN?

Back 33

Left to right shunts
Chronic PE
Vasculitis/ Connective tissue diseases
Drugs
Idiopathic
Emphysema
Schistosomiasis
Interstitial fibrosis
Fibrothorax, chest wall deformities
Alveolar hypoventilation

Front 34

Pulmonary arterial HTN
Post-capillary HTN?

Back 34

LV failure
Mitral stenosis
LA myxoma
Idiopathic venocclusive disease
Thrombus
Tumor
Mediastinal fibrosis

Front 35

Pulmonary venous HTN

Back 35

LV dysfunction:
-Ischemic heart disease
-Valvular heart disease
-CHD
-Cardiomyopathy
Left atrium:
-Cor triatriatum
-LA myxoma
PVOD
Fibrosing Mediastinitis

Front 36

GROSS CARDIAC ENLARGEMENT

Back 36

- Multiple valve disease (usually initially due to aortic or mitral valve disease, particularly regurgitation, which progresses to left and then right heart failure)
- Pericardial effusions (no single chamber enlargement identifiable)
- Dilated cardiomyopathy
- Ebstein's anomaly (frequently mimics pericardial effusion)
- Arrhythmogenic right ventricular dysplasia
- Heterotropic cardiac transplantation

Front 37

Persistent arterial truncus

Back 37

(50% have a right arch) or tetralogy of Fallot
(20–30%)

Front 38

Back 38

Associations with VSD

Part of Tetralogy of Fallot
50% of patients with a VSD have an associated additional cardiac abnormality
- Coarctation of the aorta
- Aortic stenosis
- Tricuspid atresia

Hint 38

Acianotic

Front 39

Back 39

ASD

- thromboemolic stroke
- Downs (prim)
- Anomalous pulmonary venous return (sinus venosus)
- Holt- oram (sec)
- Lutembacher

Front 40

Back 40

TAPVC associations

Patent foramen ovale, ASD (necessary to sustain life)
• Heterotaxy syndrome (asplenia more common)
• Cat's eye syndrome

Front 41

Back 41

PAPVC associations


- ASD 15% (sinus venosis), supra and cardiac PAPVC lookS like ASD
- infra cardiac PAPVC is part of the hypogenetic lung syndrome (scimitar)

Front 42

Hypogenetic lung syndrome,
congenital pulmonary venolobar syndrome

Back 42

Scimitar syndrome triad:
Right lung hypoplasia, anomalous right pulmonary venous connection to inferior vena cava (IVC), and
anomalous systemic arterial supply to right lower
lobe

Front 43

Tetrology Variants

Back 43

Pentalogy - TOF + ASD
Trilogy - PA stenosis,RVH and PFO
Pink Tet - VSD with mild pulmonic stenosis

Front 44

Back 44

TOF associations:

- Right aortic arch, mirror image branching (25%)
- PA branch stenosis or hypoplasia
- Absence of pulmonary valve
- Patent foramen ovale
- Coronary anomalies: Left anterior descending arising from right coronary and crossing RVOT (4%), with implications for surgical repair

Front 45

HYPOPLASTIC LEFT HEART

Back 45

Spectrum of cardiac anomalies characterized by underdevelopment of LA, LV, MV, aortic valve, and aorta.

Front 46

Aortic root

Back 46

-Valvular
Congenital
Rheumatic
Infectious endocarditis
Trauma
- Aortic root
Syphilis
Dissecting aneurysm
Marfan syndrome
Rheumatoid arthritis
Reiter syndrome
Relapsing polychondritis
Giant cell arteritis
- Subvalvular
Aneurysm of sinus of Valsalva
Subaortic stenosis
High ventricular septal defect

Front 47

Polyarteritis nodosa,

Back 47

-Kussmaul disease - vasculitis of medium & small-sized arteries. -attack by rogue immune cells. -minority of people (about 30%) diagnosed have an active Hepatitis B infection, and men are also twice as likely to get the disease as women.

Front 48

Atrial situs

Back 48

atrial appendages (best method)

 Right atrial appendage is triangular with a wide base

 Left atrial appendage is a tubular structure

Front 49

Atrioventricular connection

Back 49

Irrespective of atrioventricular concordance, the atrioventricular valve is
concordant with the ventricle
o Tricuspid valve always connects to the right ventricle
o Mitral valve always connects to the left ventricle

Front 50

Back 50

Coarctation

Turner's syndrome (20%)
Berry aneurysms 5-10%
Hypertension
Bicuspid valve 75%
VSD
Fetal alcohol syndrome(mid aorta). Cystic medial necrosis of the aorta. Hypoplastic left heart syndrome

Front 51

Back 51

Traumatic aortic injury

Front 52

Cardiac enhancement patterns

Back 52

Front 53

Cardiomyopathies

Back 53

Ischemic Cardiomyopathy

Non Ischemic cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy - Amyloidosis
- Constrictive cardiomyopathy
- Dilated cardiomyopathy
- ARVC
- Myocarditis
- Tako-Tsubo cardiomyopathy

Front 54

DCM

Back 54

- Most common type

- dilatation of all chambers (particularly LV)

- present with CCF

- Patients with midmyocardial enhancement are at higher risk of sudden cardiac death and arrhythmias

- differentiation between idiopathic dilated cardiomyopathy and ischemic dilated cardiomyopathy is important (ENHANCEMENT PATTERN)

Front 55

HCM

Back 55

- idiopathic hypertrophic subaortic

stenosis (IHSS)

- VS acquired LVH and AS

- sudden death

- CMR - enhancement of basal septum

Front 56

RCM (compliance type)

Back 56

- Diminished compliance (=diastolic dysfunction)

- idiopathic vs acquired (infiltration=restrictive pattern)

- important to distinguish restrictive from constrictive cardiomyopathy

Front 57

RCM (volume)

Back 57

- mainly a disease of children

- due to endomyocardial fibrosis (EMF) and Loeffler's endocarditis

Front 58

LVNC

Back 58

- rare form of congenital cardiomyopathy

- emboli (40%) , low output failure

- myocardium has a „spongy‟ appearance, trabeculated

- associated with CHD vs. Isolated form

Front 59

ARVD

Back 59

- There are two variants of ARVC: fatty and fibro-fatty infiltration

- found in the subtricuspid area, the right ventricular apex, and the infundibulum, the 'triangle of dysplasia'

Hint 59

Front 60

LESS COMMON „SPECIFIC‟ CAUSES OF CARDIOMYOPATHY

Back 60

Front 61

Back 61

Unilateral pulm oedema

Hint 61

Front 62

Acute aortic syndrome approach

Back 62

Hint 62

Front 63

Takayasu Classification

Back 63

Front 64

AAA

Back 64

Cx

-

Hint 64