Cardiovascular Imaging
Core concepts
Understand coronary CTA: calcium score, stenosis grading, and the role of functional testing. Know cardiac MRI basics: delayed enhancement patterns (subendocardial infarct, mid-wall in non-ischaemic cardiomyopathy, epicardial in myocarditis). Learn aortic pathology: dissection (intimal flap, true/false lumen), aneurysm sizing, and rupture signs. Know pulmonary vascular disease (PE, CTEPH) and congenital basics (ASD/VSD shunts, coarctation). Understand cardiac chambers and valves on echo/CT and the significance of pericardial effusion with tamponade physiology (right heart collapse).
Traps
- Delayed enhancement pattern localises aetiology-subendocardial = ischaemic; mid-wall = non-ischaemic.
- A type B dissection does not involve the ascending aorta-management differs from type A.
- Coronary calcium limits stenosis assessment; a high score may make CTA non-diagnostic.
- Pericardial effusion size does not equal tamponade-look for chamber collapse.
- Do not confuse CTEPH (chronic thromboembolic pulmonary hypertension) with acute PE.
Worked example / rule of thumb
A patient with chest pain and a negative troponin but an intermediate pretest probability: coronary CTA is useful to exclude disease. Rule of thumb: subendocardial delayed enhancement follows a coronary territory = infarct; mid-wall = non-ischaemic. For aortic dissection, type A is a surgical emergency; type B is usually managed medically unless complicated.
Key points
- Delayed enhancement pattern distinguishes ischaemic from non-ischaemic disease.
- Type A vs type B aortic dissection changes management.
- High coronary calcium limits CTA accuracy.
- Tamponade is a physiological diagnosis, not just effusion size.
- Recognise CTEPH versus acute PE.