STR Cardiac Curriculum

 

Thoracic Aorta and Great Vessels

1.      State the normal dimensions of the thoracic aorta

2.      Describe the classifications of aortic dissection (DeBakey I,II, III; Stanford A, B), and implications for classification on medical versus surgical management

3.      State and recognize the findings of, and distinguish between each of the following on CT and MR:

·         aortic aneurysm

·         aortic dissection

·         aortic intramural hematoma

·         penetrating atherosclerotic ulcer

·         ulcerated plaque

·         ruptured aortic aneurysm

·         sinus of valsalva aneurysm

·         subclavian or brachiocephalic artery aneurysm

·         aortic coarctation

·         aortic pseudocoarctation

4.      Recognize a right aortic arch and a double aortic arch on a radiograph, chest CT and chest MR

5.      State the significance of a right aortic arch with mirror image branching versus with an aberrant subclavian artery

6.      Recognize a cervical aortic arch on a radiograph and chest CT

7.      Recognize an aberrant subclavian artery on chest CT

8.      Recognize normal variants of aortic arch branching, including common origin of brachiocephalic and left common carotid arteries (“bovine arch”), separate origin of vertebral artery from arch

9.      Define the terms aneurysm and pseudoaneurysm

10.  State the common cardiac anomalies associated with aortic coarctation

11.  State and identify the findings seen in Takayasu’s arteritis on chest CT and chest MR

12.  State the advantages and disadvantages of CT, MRI/MRA and transesophageal echocardiography in the evaluation of the thoracic aorta
 

Ischemic Heart Disease

1.      Describe the anatomy of the coronary arteries and identify the following on a coronary arteriogram and CT scan

·         right coronary artery

·         left main coronary artery

·         left anterior descending coronary artery

·         left circumflex coronary artery

2.      State the clinical significance of coronary arterial calcification on a chest radiograph

3.      Recognize coronary arterial calcification on CT and state the current role of coronary artery calcium scoring with helical or electron beam CT

4.      State which coronary artery is usually diseased when there is papillary muscle dysfunction

5.      Describe the common acute complications of myocardial infarction, including left ventricular failure, myocardial rupture and papillary muscle rupture, and recognize radiologic findings that may indicate these

6.      Describe the common late complications of myocardial infarction, including ischemic cardiomyopathy, left ventricular aneurysm, left ventricular pseudoaneurysm, coronary-cameral fistula, dyskinesis and akinesis and recognize radiologic findings that may indicate these

7.      Identify left heart failure on a radiograph and chest CT

8.      Recognize acute myocardial infarction on MR imaging

9.      Define ejection fraction and state the normal left ventricular ejection fraction

10.  Identify myocardial calcification on CT and state the etiology and significance of this finding

11.  State the difference between a left ventricular aneurysm and pseudoaneurysm

12.  Define and identify myocardial bridging on MR

13.  Define the role of angiography, echocardiography, stress perfusion scintigraphy, chest CT, and chest MRI in the evaluation of a patient with suspected ischemic heart disease, including the advantages and limitations of each modality

 

Myocardial Disease

1.      Define the types of cardiomyopathy (dilated, hypertrophic, restrictive) and list the common causes of each

2.      Define right ventricular dysplasia and identify on MRI

3.      State the most common benign primary cardiac tumors, including myxoma, lipoma, fibroma and rhabdomyoma

4.      State the most common malignant primary cardiac tumors, including angiosarcoma, rhabdomyosarcoma, lymphoma

5.      Distinguish cardiac tumor from thrombus on CT and MRI

6.      State the most common malignancies to metastasize to the heart, and the appearance on a radiograph, chest CT and chest MR

7.      State the advantages and disadvantages of echocardiography, CT, and MRI for evaluation of cardiomyopathy and cardiac tumors 

 

Cardiac Valvular Disease

1.         State the findings that indicate each of the following and identify each on chest radiographs:

·         enlarged right atrium

·         enlarged left atrium

·         enlarged right ventricle

·         enlarged left ventricle

2.         Recognize an enlarged left atrium, vascular redistribution, and mitral valve calcification on a chest radiograph and suggest the diagnosis of mitral stenosis

3.         Recognize an enlarged ascending aorta and aortic valve calcification on a chest radiograph and suggest the diagnosis of aortic stenosis

4.         State the most common etiologies of the following:

·         aortic stenosis

·         aortic regurgitation

·         mitral stenosis

·         mitral regurgitation

·         tricuspid regurgitation

·         pulmonary stenosis

5.         State the cardiac diseases associated with mitral annulus calcification

6.         Identify endocarditis and/or complications of endocarditis on radiographs, chest CT and chest MR

7.         State the advantages and disadvantages of echocardiography and MRI for evaluation of valvular heart disease

 

Pericardial disease

1.      Recognize pericardial calcification on a radiograph and chest CT and list the most common causes

2.      Describe and identify two chest radiographic signs of a pericardial effusion

3.      State five causes of a pericardial effusion

4.      State and recognize the findings of a each of the following on radiography, CT and MR:

·         pericardial cyst

·         constrictive pericarditis

·         pericardial hematoma

·         pericardial metastases

·         partial absence of the pericardium

·         pneumopericardium

 

Congenital Heart Disease in the Adult

1.      Recognize increased vascularity, decreased vascularity and shunt vascularity on a chest radiograph and state the common causes of each

2.      Recognize the following on imaging examinations of the chest, including radiographs, CT and/or MRI:

Heart disease presenting during adulthood

·         Left-to-right shunts and Eisenmenger physiology

·         Atrial septal defect

·         Ventricular septal defect

·         Partial anomalous pulmonary venous connection

·         Patent ductus arteriosus

·         Coarctation of aorta

·         Tetralogy of Fallot and pulmonary atresia with ventricular septal defect

·         Congenitally corrected transposition of the great arteries

·         Persistent left superior vena cava

·         Truncus arteriosus

·         Ebstein anomaly

·         Cardiac malposition, including abnormal situs

Heart disease originally treated in childhood

·         Coarctation of the aorta

·         Tetralogy of Fallot and Pulmonary atresia with ventricular septal defect

·         Complete transposition of the great arteries

·         Congenitally corrected transposition of the great arteries

·         Truncus arteriosus

·         Commonly performed surgical corrections for congenital heart disease

3.      Define the role of angiography, echocardiography, chest CT, and chest MRI in the evaluation of an adult patient with congenital heart disease, including the advantages and limitations of each modality depending on patient presentation.

 

Monitoring and support devices – “tubes and lines”

1.      Be able to identify, state the preferred placement of, complications associated with malposition and identify the location on chest radiography for each of the following :

·         endotracheal tube

·         central venous catheter

·         Swan-Ganz catheter

·         feeding tube

·         nasogastric tube

·         chest tube

·         intra-aortic balloon pump

·         pacemaker and pacemaker leads

·         automatic implantable cardiac defibrillator

·         left ventricular assist device

·         atrial septal defect closure device (“clamshell device”)

·         pericardial drain

·         extracorporeal life support cannulae

·         intraesophageal manometer, temperature probe or pH probe

·         tracheal or bronchial stent

2.      Explain how an intra-aortic balloon pump works