For Paola
Hypertrophic
-
- Apical Hypertrophic Disease
- Asymmetric
- 022H ASH Cardiomyopathy
- Age Related
- 022H ASH Cardiomyopathy
- Concentric
- Biventricular(infiltration)
- Other
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Dressler’s Syndrome | Post-Injury Syndrome | Post-MI Syndrome Post-Pericardiotomy Syndrome |
Definition: Delayed autoimmune pleuropericarditis occurring weeks to months after myocardial infarction or cardiac surgery. Comment: Body develops antibodies against pericardial antigens exposed during injury. |
• Effusion: Pericardial and pleural effusions • Enhancement: Thickened, enhancing pericardium • Lung: Basal consolidation |
Pericardium | Inflam | Dressler’s Syndrome | |
| Libman-Sacks Endocarditis | Autoimmune Valvulitis | SLE Endocarditis Verrucous Endocarditis |
Definition: Sterile, inflammatory vegetations associated with Systemic Lupus Erythematosus (SLE). Comment: Can occur on the undersurface of valves (unlike infective endocarditis). |
• Vegetation: Small, wart-like masses • Position: Both sides of valve leaflets (atrial and ventricular) • Distribution: Mitral valve most common |
Mitral / Aortic Valve | Inflam | Mitral Valve Pathology | |
| Myocarditis (Giant Cell/Autoimmune) | Inflammatory Myopathy | Fulminant Myocarditis | Definition: Severe, often fatal autoimmune inflammation of the myocardium characterized by multinucleated giant cells. Comment: Often presents with rapidly progressive heart failure or arrhythmia. |
• Function: Rapidly progressive heart failure (dilated/hypokinetic) • MRI: Diffuse Late Gadolinium Enhancement (LGE) • Edema: High T2 signal |
Myocardium | Inflam | Myocarditis | |
| Pericarditis (Acute) | Pericardial Inflammation | Viral Pericarditis Idiopathic Pericarditis |
Definition: Acute inflammation of the pericardial layers, most commonly viral or idiopathic in origin. Comment: Presents with pleuritic chest pain relieved by leaning forward. |
• Enhancement: Thickened, avidly enhancing pericardium • Fluid: Small to moderate simple effusion • Fat: Stranding of epicardial fat |
Pericardium | Inflam | Acute Pericarditis | |
| Rheumatic Heart Disease | Post-Streptococcal | Rheumatic Fever | Definition: Chronic valve damage resulting from an autoimmune reaction to Group A Beta-hemolytic Streptococcus. Comment: The Mitral valve is affected in nearly all cases; Aortic in 20-30%. |
• MV: Commissural fusion (“Hockey Stick”), Stenosis • AV: Leaflet thickening, triangular systolic orifice • LA: Enlargement and calcification |
Valves (Mitral/Aortic) | Inflam | Rheumatic Heart Disease | Case 014H |
| Sarcoidosis (Cardiac) | Granulomatous | Cardiac Sarcoid | Definition: Infiltration of the myocardium by non-caseating granulomas. Comment: Can mimic MI but typically does not follow coronary territories. “The Great Imitator.” |
• MRI: Patchy, mid-wall or epicardial LGE (non-coronary) • PET: Focal FDG uptake (active phase) • Nodes: Hilar lymphadenopathy |
Myocardium / Conduction | Inflam | Sarcoidosis Overview | Case 016H |
Inflammation and Immune Disorders of the Heart
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Chagas Disease | Parasitic Infection | American Trypanosomiasis | Definition: Chronic cardiomyopathy caused by the parasite Trypanosoma cruzi. Comment: Endemic to Latin America. A classic cause of apical aneurysms in the absence of CAD. |
• Structure: Apical Aneurysm (Left Ventricle) • Function: Dilated Cardiomyopathy • GI: Associated megaesophagus/megacolon |
Left Ventricle | Infection | LV Aneurysm (Causes) | |
| Hydatid Cyst (Cardiac) | Parasitic Infection | Echinococcosis | Definition: Cystic infestation of the myocardium by Echinococcus granulosus. Comment: Rupture can cause anaphylactic shock. |
• Character: Multiloculated cystic mass (“Mother and Daughter” cysts) • Wall: Calcified rim • Position: Intra-myocardial (IVS or LV wall) |
Myocardium | Infection | Cardiac Cysts | |
| Infective Endocarditis | Bacterial Infection | Bacterial Endocarditis SBE |
Definition: Microbial infection of the endocardial surface, typically the valves, forming vegetations. Comment: Staph aureus (acute) and Strep viridans (subacute) are common pathogens. |
• Mass: Mobile, oscillating vegetation • Destruction: Valve perforation or paravalvular abscess • Emboli: Septic emboli to lungs (Right) or brain/kidney (Left) |
Valves | Infection | Bacterial Endocarditis | |
| Myocarditis (Viral) | Viral Infection | Coxsackie Myocarditis | Definition: Direct viral injury and subsequent immune response damaging the myocardium. Comment: MRI is the gold standard for non-invasive diagnosis (Lake Louise Criteria). |
• MRI: T2 high signal (Edema) + Early/Late Gadolinium Enhancement • Pattern: Epicardial or mid-wall (Lake Louise Criteria) • Function: Global hypokinesis |
Myocardium | Infection | Viral Myocarditis | |
| Pericarditis (Tuberculous) | Mycobacterial Infection | TB Pericarditis | Definition: Chronic infection of the pericardium by Mycobacterium tuberculosis. Comment: A common cause of constrictive pericarditis in developing nations. |
• Character: Grossly thickened, irregular pericardium • Calcification: Extensive (“Armor Heart”) • Function: Constrictive physiology (ventricular interdependence) |
Pericardium | Infection | Constrictive Pericarditis | |
| Syphilitic Aortitis | Spirochete Infection | Luetic Aortitis | Definition: Tertiary syphilis affecting the vasa vasorum of the ascending aorta. Comment: Leads to destruction of the media and “tree-barking” of the intima. |
• Calcification: “Tree-bark” linear calcification of Ascending Aorta • Shape: Saccular aneurysm • Valve: Aortic regurgitation |
Aorta (Ascending) | Infection | Aortic Aneurysms |
Infections of the Heart
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Linkable Page (Context) | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Cardiac Tamponade | Compression | Pericardial Tamponade | Definition: Hemodynamic compromise caused by fluid accumulation in the pericardial space compressing the heart. Comment: The rate of accumulation is more critical than the volume. |
• Chambers: Diastolic collapse of RA and RV (early diastole) • IVC: Dilated with no respiratory variation (plethora) • Septum: Septal bounce (ventricular interdependence) |
Pericardium | Mechanical | Tamponade | Case 88H |
| Prosthetic Dehiscence | Device Failure | Valve Dehiscence Paravalvular Leak |
Definition: Separation of the sewing ring of a prosthetic valve from the tissue annulus. Comment: Often caused by infection (ring abscess) or suture failure. |
• Motion: “Rocking” motion of the valve on cine imaging • Flow: Paravalvular regurgitation (leak outside the ring) • CT: Perivalvular hypoattenuation (abscess) |
Prosthetic Valve | Mechanical | Prosthetic Valves | |
| Tension Pneumothorax | Extrinsic Compression | Tension PTX | Definition: Accumulation of air under pressure in the pleural space, compressing the mediastinum. Comment: A life-threatening emergency requiring immediate decompression. |
• Shift: Mediastinal shift away from the air • Shape: Depression/Inversion of the hemidiaphragm • Heart: Compression of the RA/RV impairing filling |
Pleura / Mediastinum | Mechanical | Faces of Pneumothorax | Case 92L |
Maligbnat and Benign Tumors of the Heart
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Angiosarcoma | Malignant Neoplasm | Primary Cardiac Sarcoma | Definition: The most common primary malignant tumor of the heart, arising from endothelial cells. Comment: Highly aggressive with a predilection for the Right Atrium. |
• Character: Large, heterogeneous, invasive mass • Enhancement: “Sunray” appearance (avid/heterogeneous) • Effusion: Hemorrhagic pericardial effusion |
Right Atrium | Neoplasm (Malignant) | Faces of Angiosarcoma | |
| Lymphoma (Primary) | Malignant Neoplasm | Cardiac Lymphoma | Definition: Extranodal Non-Hodgkin Lymphoma involving the heart. Comment: Often associated with immunocompromised states (HIV/Post-transplant). |
• Character: Homogeneous, infiltrating soft tissue mass • Location: Right Atrium / AV Groove • Effect: Encircles vessels/coronaries without compressing them (“Sandwich sign”) |
Right Atrium | Neoplasm (Malignant) | Faces of Lymphoma | |
| Metastasis (Cardiac) | Malignant Neoplasm | Secondary Tumor | Definition: Spread of cancer from a distant primary site to the heart or pericardium. Comment: 20-40x more common than primary cardiac tumors. Common sources: Lung, Breast, Melanoma. |
• Location: Pericardium (Effusion/Nodules) > Myocardium • Appearance: Multiple nodules or diffuse infiltration • Enhancement: Enhances with contrast (unlike thrombus) |
Pericardium / Myocardium | Neoplasm (Malignant) | Faces of Metastasis | |
| Fibroma | Benign Neoplasm | Cardiac Fibroma | Definition: A benign, solitary congenital tumor composed of fibroblasts and collagen. Comment: Second most common pediatric tumor. Can cause arrhythmias or obstruction. |
• Character: Homogeneous, hypointense (dark) on T2 MRI • Calcification: Central calcification is common • Location: Ventricular septum or free wall |
Ventricles | Neoplasm (Benign) | Faces of Fibroma | |
| Lipoma | Benign Neoplasm | Fatty Tumor | Definition: Encapsulated benign tumor composed of mature adipocytes. Comment: Distinct from Lipomatous Hypertrophy (which is non-encapsulated septal fat). |
• Density: Homogeneous fat density (-100 HU) • Signal: High T1/T2 (suppresses with Fat Sat) • Location: Subendocardial, intramuscular, or epicardial |
Atrium / Ventricle | Neoplasm (Benign) | Faces of Lipoma | |
| Myxoma | Benign Neoplasm | Atrial Myxoma | Definition: The most common primary cardiac tumor (benign, gelatinous). Comment: 75% occur in Left Atrium attached to Fossa Ovalis. Can embolize or obstruct the mitral valve (mimicking MS). |
• Attachment: Pedunculated stalk on IAS • Motion: Mobile; may prolapse through valve • Character: Heterogeneous enhancement; calcification rare |
Left Atrium | Neoplasm (Benign) | Faces of Myxoma | Case 044H Case 045H |
| Papillary Fibroelastoma | Benign Neoplasm | Cardiac Papilloma | Definition: Small, benign valvular tumor resembling a sea anemone. Comment: The most common tumor of the heart valves. High risk of embolization (stroke/MI) despite being benign. |
• Location: Aortic or Mitral Valve leaflets • Size: Small (< 1 cm), mobile, pedunculated • Motion: “Shimmy” or vibration on Echo |
Valves | Neoplasm (Benign) | Faces of Fibroelastoma | |
| Rhabdomyoma | Benign Neoplasm | Hamartoma | Definition: Benign hamartoma of cardiac myocytes. Comment: The most common pediatric heart tumor. Strongly associated with Tuberous Sclerosis. Often regress spontaneously. |
• Number: Often multiple • Location: Ventricular walls or Septum • Echo: Hyperechoic (bright) nodules |
Ventricles | Neoplasm (Benign) | Faces of Rhabdomyoma |
Mechanical Abnormalities
| Finding | Definition & Comment (P-SSPCT-C) | Diagnosis | Mod | Cat | Linkable Page (Context) | Linkable Image (Game) |
|---|---|---|---|---|---|---|
| Compression, Tamponade | Definition: Accumulation of pericardial fluid under pressure, compressing cardiac chambers. Comment: Diastolic collapse of the RA (early) and RV (late) is diagnostic. The IVC is dilated (plethora) without respiratory variation. |
Cardiac Tamponade | Echo/CT | Compression | Tamponade | Case 88H |
| Compression, Tension PTX | Definition: Accumulation of air under pressure in the pleural space. Comment: Causes mediastinal shift away from the air, compressing the SVC/IVC and impairing venous return (Obstructive Shock). |
Tension Pneumothorax | CXR/CT | Compression | Tension Pneumothorax | Case 92L |
| Restriction, Constrictive | Definition: Thickened, calcified pericardium limiting diastolic filling. Comment: Causes Ventricular Interdependence (septal bounce) where the RV and LV compete for fixed space. “Square root sign” on pressure tracing. |
Constrictive Pericarditis | CT/MRI | Restriction | Constrictive Pericarditis | |
| Rupture, Papillary Muscle | Definition: Tear of the papillary muscle body or head, usually 3-7 days post-MI. Comment: Causes acute, severe Mitral Regurgitation. The Posteromedial muscle (supplied only by RCA) ruptures more often than the Anterolateral (dual supply). |
Papillary Muscle Rupture | Echo | Rupture | Acute Mitral Regurgitation | Case 57H |
| Rupture, Pseudoaneurysm | Definition: Contained rupture of the ventricular free wall. Comment: The wall is composed of pericardium and thrombus (no myocardium). Communicates with the ventricle via a narrow neck. High risk of rupture. |
Ventricular Pseudoaneurysm | CT/MRI | Rupture | RV Pseudoaneurysm Case | Case 30F |
| Rupture, Septal (VSR) | Definition: Tear in the Interventricular Septum following transmural MI. Comment: Creates an acute Left-to-Right shunt. Clinically presents with a new harsh holosystolic murmur and hypotension. |
Ventricular Septal Rupture | Echo/CT | Rupture | Ventricular Septal Defects | |
| Failure, Dehiscence | Definition: Separation of a prosthetic valve sewing ring from the tissue annulus. Comment: Causes “Rocking” motion of the valve and paravalvular leak. Often due to infective endocarditis (ring abscess). |
Prosthetic Valve Dehiscence | Echo/CT | Device | Prosthetic Valves |
Trauma to the Heart
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Aortic Transection | Vascular Injury | Traumatic Aortic Rupture | Definition: Near-complete tear of the aortic wall layers caused by rapid deceleration. Comment: Most commonly occurs at the aortic isthmus due to tethering by the Ligamentum Arteriosum. High mortality at scene. |
• Direct: Pseudoaneurysm, intimal flap, or contour irregularity at isthmus • Indirect: Mediastinal hematoma, apical capping |
Aorta (Isthmus) | Trauma | Traumatic Aortic Injury | |
| Cardiac Contusion | Myocardial Injury | Myocardial Bruise | Definition: Bruising of the myocardium following blunt chest trauma (e.g., steering wheel impact). Comment: The Right Ventricle is most commonly injured due to its anterior position behind the sternum. Can mimic MI clinically. |
• MRI: Focal edema (High T2) and LGE matching impact site • Echo: Focal wall motion abnormality (often RV) |
Myocardium (RV) | Trauma | Cardiac Trauma | |
| Foreign Body (Penetrating) | Penetrating Injury | Bullet / Shrapnel / Needle | Definition: Presence of an external object within the cardiac structures. Comment: Can be acute (GSW) or chronic (IV drug user with needle embolus). Risk of erosion, tamponade, or infection. |
• CT: High-density streak artifact from metallic object • Location: Intracavitary, intramural, or pericardial |
Heart (Any) | Trauma | Foreign Body (Needle Case) | Case 48M |
| Hemopericardium | Pericardial Injury | Blood in Pericardium | Definition: Accumulation of blood within the pericardial sac. Comment: In trauma, usually indicates cardiac rupture or coronary artery laceration. Rapid accumulation leads to tamponade. |
• CT: High-density fluid (60-80 HU) in pericardial space • US: Echogenic fluid with clot strands |
Pericardium | Trauma | Hemopericardium | |
| Pneumopericardium | Pericardial Injury | Air in Pericardium | Definition: Presence of air within the pericardial sac. Comment: Indicates communication with the airway (tracheobronchial rupture), esophagus, or penetrating chest wall injury. |
• CXR: “Halo sign” of continuous air band surrounding the heart • CT: Air density anterior to the RV |
Pericardium | Trauma | Pneumopericardium | Case 31M |
| Traumatic VSD | Myocardial Injury | Septal Rupture | Definition: Tear in the interventricular septum caused by severe blunt compression or penetrating trauma. Comment: Results in an acute Left-to-Right shunt and potential heart failure. |
• Doppler: High-velocity systolic jet across septum • CT: Contrast jet extending from LV to RV |
Septum | Trauma | Traumatic VSD |
Metabolic Diseases of the Heart
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Amyloidosis (Cardiac) | Infiltrative / Storage | Stiff Heart Syndrome ATTR / AL Amyloid |
Definition: Extracellular deposition of insoluble amyloid fibrils within the myocardial interstitium. Comment: Causes a restrictive cardiomyopathy. The “Sparkling” texture on Echo is classic but nonspecific. |
• MRI: Diffuse subendocardial or transmural LGE; inability to null myocardium (T1) • Size: Concentric bi-ventricular thickening • Atria: Bi-atrial enlargement and septal thickening |
Myocardium | Metabolic | Faces of Amyloidosis | Case 70F (Amyloid CT/MRI) |
| Carcinoid Heart Disease | Hormonal / Toxic | Hedinger Syndrome | Definition: Fibrous plaque deposition on heart valves caused by high circulating serotonin from neuroendocrine tumors. Comment: Sparing of the left heart is typical (unless a PFO exists) because lungs inactivate serotonin. |
• Valves: Thickened, retracted, fixed leaflets (Tricuspid/Pulmonic) • Function: Mixed severe Regurgitation and Stenosis • Liver: Metastases usually present |
Tricuspid / Pulmonic | Metabolic | Faces of Carcinoid | Case 118 (56M) (Tip of Iceberg) |
| Fabry Disease | Storage Disease | Anderson-Fabry | Definition: X-linked lysosomal storage disorder (deficiency of alpha-galactosidase A) causing glycosphingolipid accumulation. Comment: Mimics Hypertrophic Cardiomyopathy (HCM). Low T1 mapping values are pathognomonic. |
• MRI (LGE): Mid-wall fibrosis in the basal inferolateral wall (classic) • Character: Low native T1 values (unlike other hypertrophies which are high) • Size: Concentric LV Hypertrophy |
Left Ventricle | Metabolic | Concentric HCM (Fabry) | Case 64F (Heterozygote) |
| Hemochromatosis | Storage Disease | Iron Overload Cardiomyopathy | Definition: Intracellular accumulation of iron within cardiomyocytes leading to toxicity and fibrosis. Comment: Reversible cause of heart failure. “Bronze Diabetes” is the clinical triad. |
• MRI (T2*): Myocardium appears black (hypointense) due to iron effect • Function: Restrictive (early) to Dilated (late) pattern • Liver: Concomitant iron overload (dark liver) |
Myocardium | Metabolic | Dilated Cardiomyopathy | Case 41M (Iron Overload) |
| Glycogen Storage Disease | Storage Disease | Pompe Disease (Type II) | Definition: Inherited deficiency of acid alpha-glucosidase leading to massive glycogen accumulation in lysosomes. Comment: Presents in infancy with massive cardiomegaly and hypotonia (“floppy baby”). |
• Size: Massive, generalized biventricular hypertrophy • Function: Severe obstruction and eventual systolic failure • EKG: Giant QRS complexes and short PR interval |
Ventricles | Metabolic | Pediatric Cardiomyopathy |
Circulatory Diseases of the Heart
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Acute Myocardial Infarction | Ischemic Heart Disease | Heart Attack STEMI / NSTEMI |
Definition: Myocardial necrosis due to acute obstruction of a coronary artery. Comment: “Time is Muscle.” Complications include rupture, VSD, and aneurysm. |
• MRI: Subendocardial or Transmural LGE (vascular territory) • Echo: Regional Wall Motion Abnormality (RWMA) • Edema: High T2 signal (acute) |
Myocardium | Circulatory | Myocardial Infarction | Case 004H |
| Coronary Artery Anomaly (High Risk) | Congenital / Vascular | Anomalous Origin | Definition: Origin of a coronary artery from the opposite cusp causing an inter-arterial course. Comment: The vessel courses *between* the Aorta and PA. High risk of sudden death in young athletes. |
• CT: “Inter-arterial” course • Shape: Slit-like orifice or acute take-off angle • Structure: RCA from Left Cusp (or LCA from Right) |
Coronary Arteries | Circulatory | Coronary Anomalies | |
| Ischemic Cardiomyopathy | Ischemic Heart Disease | Post-MI Heart Failure | Definition: Global ventricular dysfunction resulting from severe CAD or prior infarction. Comment: The most common cause of heart failure. Distinct from Dilated CM by the presence of scar. |
• MRI: Subendocardial scarring (LGE) following vascular territories • Shape: Remodeling / Dilation • Function: Reduced EF |
Left Ventricle | Circulatory | Ischemic Cardiomyopathy | |
| Cardiogenic Shock | Hemodynamic Failure | Pump Failure | Definition: State of end-organ hypoperfusion due to cardiac pump failure. Comment: Commonly caused by massive MI, acute MR, or tamponade. Mortality is high. |
• Lungs: Pulmonary Edema (Batwing) • Heart: Dilated, poorly contractile chambers (or mechanical defect) • IVC: Dilated (Plethora) |
Systemic | Shock | Heart Failure & Shock | |
| ARVC | Cardiomyopathy | Arrhythmogenic RV Dysplasia | Definition: Genetic replacement of RV myocardium with fibro-fatty tissue. Comment: “Triangle of Dysplasia” (Inflow, Outflow, Apex). Major cause of sudden death in young people. |
• MRI: Fatty infiltration / Wall thinning • Shape: Aneurysmal outpouchings (“scalloping”) • Function: RV dyskinesis |
Right Ventricle | Cardiomyopathy | ARVC | |
| Dilated Cardiomyopathy | Cardiomyopathy | DCM Congestive CM |
Definition: Ventricular dilation and impaired contraction (systolic failure) not explained by CAD or loading conditions. Comment: Causes: Idiopathic, Viral, Alcohol, Peripartum. |
• Size: Globular enlargement (LVIDd > 5.8cm) • MRI: Mid-wall fibrosis (LGE) or no scar • Valve: Functional MR/TR |
Ventricles (LV/RV) | Cardiomyopathy | Dilated CM | Case 007 |
| Hypertrophic Cardiomyopathy (HCM) | Cardiomyopathy | HOCM / IHSS | Definition: Genetic disorder defined by inappropriate LV hypertrophy (>15mm) without a cause. Comment: Often Asymmetric Septal Hypertrophy (ASH). Risk of LVOT obstruction (SAM). |
• Shape: Septal thickening > 1.5x posterior wall • MRI: Patchy fibrosis at insertion points • Motion: Systolic Anterior Motion (SAM) of MV |
Left Ventricle | Cardiomyopathy | Hypertrophic CM | Case 068H (Apical HCM) |
| Restrictive Cardiomyopathy | Cardiomyopathy | Stiff Heart | Definition: Primary diastolic dysfunction with preserved systolic function and normal wall thickness. Comment: Least common CM. Causes: Amyloid, Sarcoid, Radiation, Endomyocardial Fibrosis. |
• Atria: Bi-atrial enlargement (massive) • Ventricles: Normal size, thick walls • Function: Diastolic Failure |
Myocardium | Cardiomyopathy | Restrictive CM | |
| Takotsubo Cardiomyopathy | Cardiomyopathy | Broken Heart Syndrome Stress Cardiomyopathy |
Definition: Transient regional systolic dysfunction mimicking MI, triggered by emotional stress. Comment: Classic “Apical Ballooning” with basal hyperkinesis. Coronaries are normal. |
• Shape: “Octopus Pot” (narrow neck, ballooned apex) • Motion: Apical akinesis • Time: Recovers in weeks |
Left Ventricle | Cardiomyopathy | Takotsubo | Case 021H |
Congenital
Congenital: SVC, IVC, Right Atrium, Tricuspid Valve
| Disease / Diagnosis | Definition & Comment (P-SSPCT-C) | Grouped Category | Mod | Cat | Linkable Page (Context) | Linkable Image (Game) |
|---|---|---|---|---|---|---|
| Interrupted IVC (Azygos Cont.) | Definition: Absence of the hepatic segment of the IVC with drainage via a dilated Azygos vein. Connections: Hepatic veins drain directly into RA; Lower body drains via Azygos to SVC. Comment: Often associated with Polysplenia / Heterotaxy syndromes. |
Venous Anomaly | CT/MRI | Congenital | IVC Anomalies | |
| Persistent Left SVC | Position: Vertical vessel lateral to the Aortic Arch, draining into Coronary Sinus. Connections: Drains Left Jugular/Subclavian -> Coronary Sinus -> RA. Comment: Most common thoracic venous anomaly. Causes a dilated Coronary Sinus. |
Venous Anomaly | CT/CXR | Congenital | Persistent Left SVC | |
| Scimitar Syndrome (PAPVR) | Shape: Curvilinear vessel (“Turkish Sword”) along right heart border. Connections: Right Pulmonary Veins drain into IVC. Comment: Associated with Right Lung Hypoplasia (Hypogenetic Lung Syndrome). |
Venous Anomaly | CXR/CT | Congenital | Scimitar Syndrome | |
| ASD, Primum | Position: Defect in the lower atrial septum (near AV valves). Time: Failure of septum primum to fuse with endocardial cushions. Comment: Part of the AV Septal Defect (Endocardial Cushion Defect) spectrum. |
Atrial Septal Defect | Echo | Congenital | ASD Types | |
| ASD, Secundum | Position: Defect at the Fossa Ovalis (central septum). Definition: Most common ASD (70%). Comment: Causes Left-to-Right shunt and RV volume overload (RVE). |
Atrial Septal Defect | Echo/MRI | Congenital | Secundum ASD | |
| ASD, Sinus Venosus | Position: High in the septum near SVC junction (Superior) or IVC (Inferior). Connections: Almost always associated with PAPVR (RUPV into SVC). Comment: Not a true septal defect, but a deficiency of the wall between SVC and LA. |
Atrial Septal Defect | CT/MRI | Congenital | Sinus Venosus Defect | |
| Cor Triatriatum Dexter | Parts: Membrane dividing the Right Atrium. Time: Persistence of the right valve of the sinus venosus. Comment: Rare. Can obstruct the Tricuspid Valve or IVC. |
RA Anomaly | Echo | Congenital | Cor Triatriatum | |
| Ebstein’s Anomaly | Position: Apical displacement of the septal tricuspid leaflet. Parts: “Atrialized” portion of RV reduces functional RV volume. Shape: “Box-shaped” heart on CXR. Comment: Associated with WPW and PFO/ASD. |
TV Anomaly | CXR/MRI | Congenital | Ebstein’s Anomaly | |
| Tricuspid Atresia | Definition: Complete absence of the Tricuspid Valve (no RA-RV connection). Connections: Requires ASD (for RA output) and VSD/PDA (for pulmonary blood flow). Comment: Causes Hypoplastic Right Ventricle. |
TV Anomaly | Echo | Congenital | Tricuspid Atresia |
Congenital: RV, RVOT, Conotruncal
| Disease / Diagnosis | Definition & Comment (P-SSPCT-C) | Grouped Category | Mod | Cat | Linkable Page (Context) | Linkable Image (Game) |
|---|---|---|---|---|---|---|
| Double Outlet RV (DORV) | Connections: Both Aorta and Pulmonary Artery arise predominantly (>50%) from the RV. Definition: A spectrum of defects usually involving a VSD. Comment: Physiology depends on VSD location (Subaortic vs Subpulmonic). |
Conotruncal | MRI/Echo | Congenital | DORV | |
| Pulmonary Atresia (w/ VSD) | Definition: Complete obstruction of RVOT with a VSD. Comment: Considered severe Tetralogy of Fallot. Pulmonary blood flow supplied by MAPCAs (collaterals) or PDA. |
Conotruncal | Angio/CT | Congenital | Pulmonary Atresia | |
| Tetralogy of Fallot (TOF) | Parts: 1. VSD, 2. Overriding Aorta, 3. RVOT Obstruction (PS), 4. RV Hypertrophy. Shape: “Boot Shaped Heart” (Coeur en sabot) due to uplifted apex. Comment: Most common cyanotic heart disease. |
Conotruncal | CXR/CT | Congenital | Tetralogy of Fallot | |
| Transposition (D-TGA) | Connections: Ventriculo-Arterial Discordance (Aorta from RV, PA from LV). Shape: “Egg on a String” appearance on CXR (narrow mediastinum). Comment: Parallel circuits; incompatible with life without mixing (ASD/VSD/PDA). |
Conotruncal | CXR/Echo | Congenital | Transposition (TGA) | |
| Truncus Arteriosus | Parts: Single arterial trunk arising from the heart supplying Coronaries, Aorta, and PAs. Time: Failed septation of the embryonic truncus. Comment: Always associated with a large VSD. |
Conotruncal | CT/MRI | Congenital | Truncus Arteriosus | |
| Pulmonary Stenosis (Valvular) | Shape: Systolic doming of leaflets. Connections: Post-stenotic dilation of MPA/LPA. Comment: Can be isolated or part of syndromes (Noonan’s). |
RVOT Obstruction | Echo | Congenital | Pulmonary Stenosis | |
| RV Hypoplasia | Size: Small, under-developed RV cavity. Connections: Secondary to Tricuspid Atresia or Pulmonary Atresia with intact septum. Comment: Requires univentricular palliation (Fontan). |
Ventricular Defect | MRI | Congenital | Hypoplastic Right Heart |
Congenital: LA, MV, Left Ventricle
| Disease / Diagnosis | Definition & Comment (P-SSPCT-C) | Grouped Category | Mod | Cat | Linkable Page (Context) | Linkable Image (Game) |
|---|---|---|---|---|---|---|
| Cor Triatriatum Sinister | Parts: Membrane dividing LA into proximal (veins) and distal (appendage/valve) chambers. Comment: Presents like Mitral Stenosis. Rare. |
LA Anomaly | Echo | Congenital | Cor Triatriatum | |
| Cleft Mitral Valve | Shape: Cleft/split in the Anterior Mitral Leaflet. Connections: Causes Mitral Regurgitation. Comment: Classic feature of Partial AV Septal Defect (Primum ASD). |
MV Anomaly | Echo | Congenital | Cleft Mitral Valve | |
| Parachute Mitral Valve | Connections: All chordae attach to a single papillary muscle. Shape: Funnel-like stenosis. Comment: Component of Shone’s Complex (Multiple left-sided obstructions). |
MV Anomaly | Echo | Congenital | Congenital MV Anomalies | |
| Hypoplastic Left Heart (HLHS) | Size: Severe underdevelopment of LV, Mitral Valve, Aortic Valve, and Aortic Arch. Connections: Systemic flow dependent on PDA. Comment: Critical ductal-dependent lesion. |
Ventricular Defect | Echo/MRI | Congenital | HLHS | |
| LV Non-Compaction | Character: Deep trabecular recesses (“Spongy” myocardium). Size: Non-compacted to Compacted ratio > 2.3. Time: Arrest of compaction (Week 5-8). |
Cardiomyopathy | MRI | Congenital | Non-Compaction | |
| VSD (Membranous) | Position: Upper septum (in membranous portion). Definition: Most common VSD type (70%). Comment: Often closes spontaneously. Small defects cause loud murmurs (Maladie de Roger). |
Ventricular Septal Defect | Echo | Congenital | VSD Types |
Congenital: LVOT, Aorta, Coronaries
| Disease / Diagnosis | Definition & Comment (P-SSPCT-C) | Grouped Category | Mod | Cat | Linkable Page (Context) | Linkable Image (Game) |
|---|---|---|---|---|---|---|
| Bicuspid Aortic Valve | Parts: 2 Cusps (Fusion of R-L most common). Shape: “Football” orifice; Systolic doming. Comment: Associated with Aortic Coarctation and Ascending Aortic Aneurysm. |
Valvular Anomaly | Echo/MRI | Congenital | Bicuspid Valve | |
| Subaortic Membrane | Parts: Fibrous ridge or membrane below the AV. Connections: High velocity jet causing damage to AV leaflets (AR). Comment: Discrete Subaortic Stenosis. |
LVOT Obstruction | Echo | Congenital | Subaortic Stenosis | |
| Coarctation of Aorta | Size: Focal narrowing of aortic isthmus. Shape: “3 Sign” on CXR. Connections: Rib notching (intercostal collaterals). Comment: Causes upper limb HTN and lower limb hypotension. |
Aortic Arch Anomaly | CT/CXR | Congenital | Coarctation | |
| Double Aortic Arch | Parts: Aorta splits into R and L arches encircling trachea/esophagus. Shape: Complete vascular ring. Comment: Causes compression symptoms (stridor, dysphagia). |
Vascular Ring | CT/MRI | Congenital | Vascular Rings | |
| Patent Ductus Arteriosus | Connections: Communication between Descending Aorta and Left PA. Time: Failure of fetal ductus to close (Post-natal). Comment: Continuous “Machinery” murmur. Indomethacin helps close it; Prostaglandins keep it open. |
Shunt | Echo | Congenital | PDA | |
| ALCAPA | Connections: Anomalous Left Coronary Artery from Pulmonary Artery. Physiology: “Steal” phenomenon (blood flows from coronary into PA). Comment: Causes infant myocardial infarction/ischemia. Bland-White-Garland syndrome. |
Coronary Anomaly | Angio/CT | Congenital | ALCAPA | |
| Anomalous Origin (High Risk) | Position: Coronary artery coursing *between* the Aorta and Pulmonary Artery (Interarterial). Comment: High risk of sudden death in young athletes due to compression during exercise. |
Coronary Anomaly | CT Angio | Congenital | Coronary Anomalies |
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| ARVC | Inherited Cardiomyopathy | Arrhythmogenic RV Dysplasia | Definition: Genetic defect in desmosomes leading to fibro-fatty replacement of the RV myocardium. Comment: Major cause of sudden cardiac death in young athletes. “Triangle of Dysplasia” involves Inflow, Outflow, and Apex. |
• MRI: Fatty infiltration, wall thinning, and aneurysms • Function: RV dilation and global/regional dysfunction • Epsilon Wave: Pathognomonic EKG finding |
Right Ventricle | Inherited | ARVC | |
| Dilated Cardiomyopathy (Familial) | Inherited Cardiomyopathy | Familial DCM | Definition: Genetic form of DCM (often cytoskeletal protein mutations like Lamin A/C or Titin). Comment: Accounts for 20-35% of all DCM cases. Indistinguishable from idiopathic DCM on imaging without family history. |
• Size: Globular LV enlargement • Function: Systolic failure (Reduced EF) • MRI: Mid-wall septal fibrosis (LGE) is common in Lamin A/C mutations |
Left Ventricle | Inherited | Dilated Cardiomyopathy | Case 007H |
| Hypertrophic Cardiomyopathy (HCM) | Inherited Cardiomyopathy | HOCM / IHSS | Definition: Autosomal dominant disorder of the sarcomere causing inappropriate hypertrophy (>15mm) without a hemodynamic cause. Comment: Asymmetric Septal Hypertrophy (ASH) is the classic pattern. Risk of obstruction (HOCM) and sudden death. |
• Shape: Asymmetric septal thickening (>1.5x posterior wall) • Motion: Systolic Anterior Motion (SAM) of Mitral Valve • MRI: Patchy LGE at RV insertion points |
Left Ventricle | Inherited | Hypertrophic CM | Case 068H |
| LV Non-Compaction | Inherited Cardiomyopathy | Spongy Myocardium | Definition: Arrest of normal myocardial compaction during weeks 5-8 of embryology. Comment: Results in a two-layered myocardium: a thin compacted epicardial layer and a thick non-compacted endocardial layer. |
• Character: Deep trabecular recesses communicating with the cavity • Ratio: Non-compacted to Compacted ratio > 2.3 (in diastole) • Location: Apex and Lateral wall |
Left Ventricle | Inherited | Non-Compaction | |
| Marfan Syndrome | Connective Tissue Disorder | Fibrillin-1 Mutation | Definition: Autosomal dominant connective tissue disorder affecting the skeletal, ocular, and cardiovascular systems. Comment: Cardiovascular mortality is due to aortic root dilation, dissection, or rupture. |
• Aorta: “Tulip Bulb” root aneurysm (Annuloaortic Ectasia) • Valve: Mitral Valve Prolapse (MVP) and Aortic Regurgitation • Chest: Pectus excavatum / carinatum |
Aorta / Valves | Inherited | Marfan Syndrome | |
| Noonan Syndrome | Genetic Syndrome | Male Turner Syndrome | Definition: Autosomal dominant disorder (RAS-MAPK pathway) associated with short stature and heart defects. Comment: The cardiac phenotype is often Pulmonary Stenosis (dysplastic valve) and/or Hypertrophic Cardiomyopathy. |
• Valve: Pulmonary Stenosis (thickened, dysplastic leaflets) • Myocardium: Concentric or Asymmetric Hypertrophy (mimics HCM) |
Pulmonary Valve | Inherited | Pulmonary Stenosis |
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Amyloidosis (Cardiac) | Protein Infiltration | Stiff Heart Syndrome ATTR / AL Amyloid |
Definition: Infiltration of the myocardial interstitium by insoluble amyloid fibrils. Comment: The classic cause of Restrictive Cardiomyopathy. T1 mapping on MRI is diagnostic (high native T1). |
• MRI: Diffuse subendocardial LGE; inability to null myocardium • Size: Concentric thickening of LV and RV • Atria: Bi-atrial enlargement |
Myocardium | Infiltrative | Faces of Amyloidosis | Case 006H |
| Endomyocardial Fibrosis | Fibrotic Infiltration | Löffler’s Endocarditis | Definition: Infiltration by eosinophils (Löffler’s) leading to dense apical fibrosis and thrombosis. Comment: A major cause of restrictive cardiomyopathy in tropical regions. Causes “Apical Obliteration.” |
• Shape: Obliteration of the LV/RV apex by thrombus/fibrosis • Function: Restrictive filling pattern • MRI: Apical subendocardial LGE |
Ventricles (Apices) | Infiltrative | Restrictive CM (EMF) | |
| Hemochromatosis | Iron Infiltration | Iron Overload | Definition: Infiltration of cardiomyocytes by iron, causing toxicity. Comment: Reversible cause of heart failure. Leads to Dilated or Restrictive physiology. |
• MRI (T2*): Low signal intensity (dark myocardium) proportional to iron load • Liver: Associated dark liver • Function: Diastolic dysfunction (early) |
Myocardium | Infiltrative | Hemochromatosis | Case 41M |
| Lipomatous Hypertrophy | Fatty Infiltration | Lipoma of IAS | Definition: Infiltration of the Interatrial Septum by non-encapsulated fat. Comment: Benign and usually incidental. Distinguished from Lipoma by its “Dumbbell” shape (sparing the Fossa Ovalis). |
• Character: Fat density (-100 HU) or high T1 signal • Shape: Bilobed or Dumbbell shape • Position: Interatrial Septum |
Interatrial Septum | Infiltrative | Fat in Atrial Septum | |
| Sarcoidosis (Cardiac) | Granulomatous Infiltration | Cardiac Sarcoid | Definition: Infiltration of the myocardium by non-caseating granulomas. Comment: “The Great Imitator.” Can cause arrhythmias (heart block/VT) and heart failure. |
• MRI: Patchy, non-vascular distribution of LGE (Basal Septum is common) • PET: Focal FDG uptake (active inflammation) • Nodes: Hilar adenopathy |
Myocardium | Infiltrative | Cardiac Sarcoidosis | Case 016H |
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Anthracycline Toxicity | Drug Toxicity | Doxorubicin Cardiomyopathy Chemo Heart |
Definition: Dose-dependent, cumulative myocardial damage caused by chemotherapeutic agents (e.g., Adriamycin). Comment: Causes irreversible myocardial cell death and fibrosis. |
• Function: Global hypokinesis and reduced EF • Shape: Dilated Cardiomyopathy phenotype • MRI: Diffuse interstitial fibrosis (High T1) |
Myocardium | Iatrogenic | Dilated Cardiomyopathy | |
| Catheter/Lead Perforation | Procedural Complication | Cardiac Perforation | Definition: Penetration of the myocardial wall by a pacemaker lead, wire, or catheter. Comment: The RV apex is the most common site due to the thin wall. |
• Position: Lead tip extends beyond the epicardial fat border • Effusion: Hemopericardium / Tamponade • CT: Tip seen within extracardiac fat or liver |
RV Wall | Iatrogenic | Pacemaker Complications | |
| Post-Pericardiotomy Syndrome | Post-Surgical | Dressler’s Syndrome | Definition: Inflammatory pericarditis occurring days to weeks after cardiac surgery (CABG/Valve). Comment: Autoimmune reaction to pericardial injury. |
• Effusion: Loculated or free pericardial fluid • Enhancement: Thickened pericardial layers • Pleura: Associated pleural effusions |
Pericardium | Iatrogenic | Post-Pericardiotomy Syndrome | |
| Pulmonary Vein Stenosis | Post-Ablation | PV Stenosis | Definition: Acquired narrowing of the pulmonary vein ostia following Radiofrequency Ablation (RFA) for Atrial Fibrillation. Comment: Causes localized pulmonary venous hypertension in the affected lobe. |
• Size: Focal constriction at the veno-atrial junction • Lung: Focal ground-glass opacity (edema) in the drained lobe |
Pulmonary Veins | Iatrogenic | Pulmonary Vein Stenosis | |
| Radiation Heart Disease | Therapy Related | Radiation Induced Heart Disease | Definition: Spectrum of cardiac damage resulting from thoracic radiation (Breast Ca, Lymphoma). Comment: Manifests 10-20 years post-treatment. Fibrosis is the hallmark. |
• Valve: Fibrotic thickening/calcification (Aortic/Mitral) • Aorta: “Porcelain Aorta” (circumferential calcification) • Coronary: Ostial stenosis |
Valves / Pericardium | Iatrogenic | Radiation Heart Disease |
| Disease / Diagnosis | Grouped Category | Alternative Names | Definition & Comment | Imaging Features | Structure | Category | Link to TCV Page | Linkable Case Examples |
|---|---|---|---|---|---|---|---|---|
| Idiopathic Dilated CM | Primary Cardiomyopathy | DCM | Definition: Dilation and impaired contraction of the left or both ventricles with no identifiable cause (after ruling out CAD, Alcohol, Viral). Comment: Diagnosis of exclusion. Represents ~50% of all DCM cases. |
• Size: Globular enlargement (LVIDd > 5.8cm) • MRI: Absence of LGE (or mid-wall septal streak) • Function: Reduced EF (< 40%) |
Ventricles | Idiopathic | Dilated Cardiomyopathy | Case 007H |
| Idiopathic Pulmonary HTN | Pulmonary Vascular | IPAH / Primary PHTN | Definition: Elevated pulmonary artery pressure (mPAP > 20 mmHg) with no identifiable secondary cause (Lung, Left Heart, or TE disease). Comment: A diagnosis of exclusion affecting the pulmonary arterioles (plexiform lesions). |
• Size: Dilated MPA (> 29mm) • RV: Hypertrophy and Dilation • Lung: Clear parenchyma (“Pruning” of distal vessels) |
Pulmonary Artery | Idiopathic | Pulmonary Hypertension | |
| Idiopathic Restrictive CM | Primary Cardiomyopathy | Primary Restrictive CM | Definition: Restrictive filling pattern with normal wall thickness and systolic function, without infiltrative disease. Comment: Rare. Must exclude Amyloidosis and Sarcoidosis. |
• Atria: Massive Bi-atrial enlargement • Ventricles: Normal size and thickness • Function: Severe diastolic dysfunction (Grade III/IV) |
Myocardium | Idiopathic | Restrictive CM |