rdcs prep

thx jack :)

1

basal inferoseptal

2

mid inferoseptal

3

apical septal

4

apical lateral

5

mid anterolateral

6

basal anterolateral

7

basal inferior

8

mid inferior

9

apical inferior

10

apical anterior

11

mid anterior

12

basal anterior

13

basal inferolateral

14

mid inferolateral

15

mid anteroseptal

16

basal anteroseptal

what structures does the RCA feed?

inferior, inferoseptal, RV apex, RV free wall, IAS

what structures does the LCX feed?

lateral segments

what structures does the LAD feed?

anterior, anteroseptal, LV apex, generally the apical segments

what does TOF cause?

severe cyanosis

TOF characteristics

1. VSD

2. overriding AO

3. pulmonary/infundibular stenosis

4. RVH

what heart defects are common with trisomy 21/down syndrome

AVSD, CHD (in >50% of cases)

what structures don’t form correctly in trisomy 21 patients?

endocardial cushions (MV, TV, & AV septum)

in trisomy 21, if there is a complete AVSD…

primum ASD + inlet VSD + common AV valve

in trisomy 21, if there is a partial AVSD…

primum ASD + abnormal MV + NO VSD

why would trisomy 21 result in pulmonary HTN?

left to right shunting occurs

what is wolf-parkinson-white syndrome?

• abnormal electrical pathways in the heart

• causes disruption of normal rhythym

• arrhythmia & changes to wall motion are common

what is commonly seen with WPW?

• early systolic notching of the posterior wall or IVS

• wall motion changes

• arrhythmias

characteristics of Ebsteins anomaly

apical displacement of the TV

what is the s wave on hepatic vein PW?

ventricular systole (normal = below baseline)

what is the d wave on hepatic vein PW?

ventricular diastole (normal = below baseline)

what is the a wave on hepatic vein PW?

atrial systole (normal = above baseline)

should the s or d wave of the hepatic veins be a higher velocity on PW?

s wave

what characteristic on PW of the pulmonary veins will severe MR demonstrate?

systolic flow reversal

what is the s wave on pulmonary vein PW?

systole

what is the d wave on pulmonary vein PW?

early diastole

what is the a wave on pulmonary vein PW?

late diastole

hypertrophic cardiomyopathy

• ⇩LV dimension

• ⇧A, E/A < 0.8

• Lower E, Higher A

• Mitral regurgitation

restrictive cardiomyopathy

• Endocarditis, infection(amyloidosis) 

• grade 3 DD, increased stiffness

• ⇧atrial size 

• ⇩LV size

• ⇧E, E/A > 2

dilated cardiomyopathy

• ⇩EF%

• ⇧Ventricles AND Atria

• Thrombus formation

• common with diabetics & alcohol use

average E/e’ diastolic dysfunction

>14

average e’ diastolic dysfunction

<6.5 cm/s

septal e’ diastolic dysfunction

<6 cm/s

lateral e’ diastolic dysfunction

_{<7 cm/s}

TR velocity diastolic dysfunction

>2.8 m/s

PASP diastolic dysfunction

>35 mmHg

LAVI diastolic dysfunction

>34 mL/m²

LARS diastolic dysfunction

</= 18%

if E/A is </= 0.8…

grade I DD

if E/A is <2…

grade II DD

if E/A is >2…

grade III DD

MVP murmur

mid-systolic click and late systolic murmur at the apex

MR murmur

high pitched blowing holosystolic murmur with radiation to the axilla

MS murmur

low pitched diastolic rumble with opening snap/click at apex

SEVERE AI/AR murmur

AUSTIN FLINT!!!!

low pitched, mid-diastolic rumble at apex

AS murmur

high pitched systolic crescendo-decrescendo murmur with systolic ejection click at RSB

TR murmur

holosystolic high pitched blowing murmur that may be intensified with inspiration at SSN

TS murmur

diastolic rumble with an opening snap that varies with respiration at mid sternum

PR murmur

low bitched diastolic rumble that may be intensified with inspiration at the left of the sternum

PS murmur

harsh systolic ejection click that may be intensified with expiration at the right of the sternum

PDA murmur

continuous throughout cardiac cycle

VSD murmur

harsh holosystolic murmur that does not radiate or change with respiration located at the left sternal border

general stenotic murmur

crescendo/decrescendo

what does tamponade look like on m-mode & PW?

RV collapse

flow changes vary with respiration

if a patient has an aortic coarctation, what other abnormality are they likely to have?

bicuspid AV (most people have both)

MVP

leaflet bows into LA during systole (>2mm displacement)

flail MV

leaflet TIPS go into LA during systole from ruptured chordae (BIG MR JET)

cleft MV

actual split in the leaflet

constrictive pericarditis can look similar to…

RCM

has similar E/A pattern

what is the key difference in constrictive pericarditis and RCM?

CP has respiratory variation

constrictive pericarditis:

e’ is preserved or increased

myocardium is intact

eggshell pericardium

RCM:

e’ is reduced due to myocardial stiffening

inhalation with tamponade

right side E velocity increases

left side E velocity decreases

exhalation with tamponade

right side E velocity decreases

left side E velocity increases

E wave

early passive LV filling

A wave

atrial kick/contraction

normal E/A value

>1 (E bigger than A)

low E/A

impaired relaxation

high E/A

>/= 2

restrictive filling

E/e’ >14

elevated filling pressure

which is a cardiac emergency: LV pseudoaneurysm or true aneurysm?

PSEUDO: high risk of rupture

when is the septal TV leaflet seen?

when the IVS or coronary sinus ostium is visible

when is the posterior TV leaflet visible?

when the probe is angled more inferiorly towards the right so the septum leaves the image

what percentage of adults have a PFO?

30%

myxoma

MC benign cardiac tumor

MC associated with systolic embolic events

MC in LA with grape cluster appearance

rhabdomyoma

MC benign tumor in peds

MC in RV

adults (18) with tuberous sclerosis

90% of patients have multiple tumors

papillary fibroelastoma

MC valvular tumor

attached to surface of aortic or MV leaflets

small and mobile (can mimic vegetation)

angiosarcoma

MC primary malignancy of the heart

RCC infiltration

finger like projection

MC in IVC that extends into the RA

what percentage of cardiac tumors are benign?

80%

are metastatic malignancies or primary malignancies more common in the heart?

metastatic malignancies (up to 40% more common)

impaired relaxation grade I E/A

< 0.8

pseudonormal grade 2 E/A

<2 + elevated LAP

restrictive grade 3 E/A

>/= 2 + elevated LAP

VSD

MC defect in peds

perimembranous VSD

MC type - upper portion of the septum by semilunar valves

muscular VSD

muscular portion (mid) of IVS

outlet VSD

in RVOT by pulmonic valve

inlet VSD

posterior septum near posterior leaflet of TV

septum secundum

MC form of congenital heart disease in adults

lower septum by IVS