Cardiology Quiz: Heart Conditions
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Questions and Answers

In HOCM, what type of contractility can be seen?

  • Good or hyperdynamic contractility (correct)
  • Only hyperdynamic contractility
  • Only good contractility
  • No contractility

    • What is the characteristic of ARVD on MRI?

  • High T2W1 with dilated right ventricle (correct)
  • Low T2W1 with dilated right ventricle
  • Low T2W1 with dilated left ventricle
  • High T2W1 with dilated left ventricle

    • What is Uhl's anomaly characterized by?

  • Paper thin left ventricle with complete absence of musculature
  • Thickened right ventricle with complete absence of musculature
  • Thickened left ventricle with complete absence of musculature
  • Paper thin right ventricle with complete absence of musculature (correct)

    • What is the cause of ischemia, infarction, arrhythmia, and even death in myocardial bridging?

    <p>Length of coronary artery taken an intramyocardial course</p> Signup and view all the answers

    What is the most common cardiac mass?

    <p>Thrombus</p> Signup and view all the answers

    What is the origin of two left-sided bronchial arteries?

    <p>Aorta</p> Signup and view all the answers

    In which percentage of cases does the artery to the SA node arise from the left circumflex artery?

    <p>40%</p> Signup and view all the answers

    What is the characteristic of pericardial thickening in constrictive pericarditis?

    <p>Thickening &gt; 4 mm</p> Signup and view all the answers

    What percentage of myxomas arise from the interatrial septum near the fossa ovalis?

    <p>75%</p> Signup and view all the answers

    In which age range do most myxoma patients present?

    <p>30-60 years</p> Signup and view all the answers

    What is the average size of a myxoma at presentation?

    <p>6 cm</p> Signup and view all the answers

    What percentage of myxomas are sessile?

    <p>25%</p> Signup and view all the answers

    In complete left-sided absence of a defect, where is the heart shifted?

    <p>To the left</p> Signup and view all the answers

    What is a common association of foraminal left-sided defects?

    <p>All of the above</p> Signup and view all the answers

    Which part of the myocardium is uppermost in a standard short axis view?

    <p>Anterior wall</p> Signup and view all the answers

    What is a possible complication of myxoma?

    <p>Both A and B</p> Signup and view all the answers

    What is the likely primary diagnosis of a 40-year-old man with pericardial metastases and pericardial effusion?

    <p>Melanoma</p> Signup and view all the answers

    What is the characteristic MRI feature of metastases from melanoma?

    <p>High signal on T1-weighted imaging</p> Signup and view all the answers

    What is the most likely feature of a left atrial myxoma on MRI?

    <p>Hypointense relative to myocardium on T1-weighted images</p> Signup and view all the answers

    How does a left atrial myxoma appear on steady-state free precession (SSFP) images?

    <p>Hypointense to blood pool and hyperintense to myocardium</p> Signup and view all the answers

    What is the best way to demonstrate the prolapse of a left atrial myxoma through the mitral valve?

    <p>Cine gradient echo imaging</p> Signup and view all the answers

    What is the purpose of delayed contrast-enhanced cardiovascular MR (DE-CMR)?

    <p>To assess cardiac viability</p> Signup and view all the answers

    What is a characteristic feature of a cardiac tumor on MRI?

    <p>Heterogenous appearance on most MRI sequences</p> Signup and view all the answers

    What can cause varying enhancement patterns in a left atrial myxoma on MRI?

    <p>All of the above</p> Signup and view all the answers

    What is the Agatston scoring system used for?

    <p>Quantifying coronary calcification</p> Signup and view all the answers

    What is the most likely unifying diagnosis for a patient with cardiomegaly, multiple rib fractures, and right lower lobe consolidation?

    <p>Chronic alcohol abuse</p> Signup and view all the answers

    What is the likely diagnosis for a patient with exertional dyspnoea, left ventricular dysfunction, and focal hypokinesis in the anteroseptal wall?

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the most likely diagnosis for a patient with a mobile echogenic mass attached to the intra-atrial septum by a stalk?

    <p>Cardiac myxoma</p> Signup and view all the answers

    What is the likely cause of a patient's symptoms if they have focal hypokinesis in the anteroseptal wall?

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the differential diagnosis of a pedunculated intracardiac lesion?

    <p>Atrial myxoma and papillary fibroelastoma</p> Signup and view all the answers

    What is the likely diagnosis for a patient with left ventricular dysfunction and delayed enhanced images showing increased signal in the subendocardium?

    <p>Myocardial infarction</p> Signup and view all the answers

    What is the significance of the delayed enhanced images in the cardiac MRI?

    <p>It shows increased signal in the subendocardium</p> Signup and view all the answers

    What is characterized by the replacement of the myocardium by fatty and fibrous tissue?

    <p>Arrhythmogenic right ventricular dysplasia</p> Signup and view all the answers

    Which of the following is a symptom of Arrhythmogenic right ventricular dysplasia?

    <p>Syncopal episodes</p> Signup and view all the answers

    What is the advantage of MRI over echocardiography in diagnosing ARVD?

    <p>MRI shows evidence of fat and fibrous tissue</p> Signup and view all the answers

    What characteristic makes a diagnosis of a true ventricular aneurysm more likely than a false aneurysm?

    <p>An aneurysm that protruded only in systole</p> Signup and view all the answers

    What is the characteristic of a false aneurysm?

    <p>Protrudes in diastole and systole</p> Signup and view all the answers

    What is the primary reason for a 57-year-old man with diabetes mellitus to undergo coronary artery bypass surgery?

    <p>To relieve anterior chest pain on minimal exertion</p> Signup and view all the answers

    Which of the following native grafts is most appropriate for bypassing the left anterior descending artery?

    <p>Left internal mammary artery</p> Signup and view all the answers

    What is the indication for coronary artery bypass surgery in the 57-year-old man with diabetes mellitus?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Cardiac Conditions

    • HOCM (Hypertrophic Obstructive Cardiomyopathy): may have good or hyperdynamic contractility with SAM (Systolic Anterior Motion) partially obstructing the subaortic region.
    • Left atrial enlargement is seen in rheumatic aortic stenosis, but not in calcific aortic stenosis.
    • Arrhythmogenic right ventricular dysplasia: characterized by fibro-fatty replacement of right ventricular myocardium, causing sudden death in young adults (more in males).
    • Uhl's anomaly: a rare condition with a paper-thin right ventricle and complete absence of musculature.
    • Myocardial bridging: a condition where a length of coronary artery (usually LAD) takes an intramyocardial course, causing ischemia, infarction, arrhythmia, and even death.

    Cardiac Tumors

    • Thrombus (non-enhancing): most common cardiac mass.
    • Metastasis: most common enhancing cardiac mass.
    • Angiosarcoma: most common primary malignant cardiac tumor.
    • Myxoma: most common primary cardiac tumor in adults, typically villous, pedunculated tumors, with only 25% seen as a sessile mass.

    Cardiac Imaging

    • Myocardial perfusion imaging: adenosine is the drug of choice, but not given in asthma patients (dobutamine is given).
    • Pericardial thickening: > 4 mm is seen in constrictive pericarditis, but normal in restrictive cardiomyopathy (normal thickness is 2 mm).
    • Cardiac MRI:
      • Myxoma: appears hypointense relative to myocardium on T1-weighted images.
      • Myocardial infarction: appears as purely subendocardial delayed hyperenhancement in a recognized vascular territory.

    Other

    • Partial anomalous pulmonary venous return (PAPVR): may cause strangulation and have the appearance of a large cardiac silhouette seen in pericardial effusions.
    • Artery to SA node: arises from right coronary artery in 60% cases and from left circumflex artery in 40% of cases.
    • Coronary artery bypass surgery: the most appropriate native graft for bypassing the left anterior descending artery is the left internal mammary artery.

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    Description

    Test your knowledge on various heart conditions including HOCM, aortic stenosis, arrythmogenic right ventricular dysplasia, and Uhl's anomaly.

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