Curriculum in cardiac imaging
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| Valvular Heart Disease |
| Vascular Medicine |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
A suggested curriculum in cardiac imaging has been established by the North American Society of Cardiac Imaging.
The original document can be viewed here.
Physiological aspects of cardiac imaging
- Normal cardiac cycle (systole and diastole)
- Electrocardiography
- Control of excitation and conduction in the heart
- Characteristics of normal sinus rhythm
- Common abnormalities in EKG
- Premature atrial contraction / premature ventricular contraction
- Atrial fibrillation / atrial flutter / Atrioventricular block
- Current of injury (signs of myocardial ischemia and infarction)
- Physiologic anatomy of cardiac muscle
- Mechanics of cardiac contraction
- Physical basis for blood flow, pressure and resistance
- Ventricular volume and pressure relationship
- Preload
- Afterload
- Practical cardiac measurements
- Ejection fraction
- Stroke volume
- Cardiac Output
- Left ventricular mass
- Flow calculation (Q = V x A)
- Gradient calculation (Bernoulli equation, G = 4 x PV2)
- Qp/Qs ratio
- Normal cardiac and pulmonary pressures
- Vascular regions supplied by the coronary arteries
- Standard nomenclature for topographic imaging of the heart
- Ventricular volume and pressure relationship
Anatomy of the heart and great vessels
- Normal morphology and structure
- Embryology
- Fetal circulation
- Normal cardiac and peri-cardiac structures to include
- Eustachian valve
- Thebesian valve / coronary sinus
- Right and left atrial appendages
- Moderator band
- Endocardial cushion
- Atrioventricular valves (tricuspid and mitral)
- Semilunar valves (aortic and pulmonic)
- Sinus of Valsalva
- Coronary arteries and major branches
- Coronary veins including coronary sinus
- Superior vena cava and deep mediastinal veins (e.g. azygous vein)
- Pericardium
- Pulmonary arteries
- Pulmonary veins
- Common variants
- Anomalous coronary artery
- Persistent left superior vena cava
- Azygous continuation of the inferior vena cava
- Segmental Anatomy of the Heart
- Atrial situs
- Ventricular situs
- Identification of great vessels
- Assess pulmonary arteries and veins
- Identify systemic venous return
- Normal Adult Heart Measurements
- Left ventricular wall thickness, diameter, fractional shortening and end-diastolic volume and volume index
- Left atrium size
- Right ventricular wall thickness and size
- Right atrial size
- Diameter of the thoracic aorta
Techniques for imaging the heart and great vessels
- Radiography
- Computed tomography
- Indications
- Coronary calcium scoring
- Cardiac CT
- Coronary CTA
- Physics and cardiac imaging considerations including ECG gating techniques
- Coronary artery calcium scoring
- Coronary CTA
- Aortic CTA
- Pulmonary CTA
- Advantages and Limitations
- Indications
- Magnetic resonance imaging
- Indications
- Physics and imaging considerations, including pulse sequences, ECG-gating techniques, and respiratory compensation strategies
- Wall motion studies
- Myocardial perfusion and viability scanning
- Valvular disease assessment
- Blood flow quantification
- Coronary MRA
- MR of the aorta
- Pulmonary MRA
- Atherosclerotic plaque evaluation
- Advantages, Limitations and contraindications
- Cardiac Scintigraphy (including PET)
- Indications
- Physics and cardiac imaging considerations
- Multiple-gated acquisition (MUGA)
- Myocardial perfusion and viability scanning
- Shunt evaluation
- Advantages and Limitations
- Other (working understanding)
- Echocardiography (transthoracic and transesophageal)
- Indications
- Technique including standard views and use of color Doppler
- Advantages and Limitations
- Cardiac and coronary catheter angiography
- Indications
- Technique including standard views and transcatheter tools (e.g. intraluminal ultrasound)
- Advantages and Limitations
- Echocardiography (transthoracic and transesophageal)
Congenital heart disease: Basic
- Cyanotic versus acyanotic presentations
- Most common lesions:
- Ventricular septal defect
- Patent ductus arteriosus
- Atrial septal defect
- Tetralogy of Fallot
- Pulmonary stenosis
- Obstruction of the aorta (aortic coarctation and interruption of the aorta)
- Transposition of the great vessels (D- vs. L-transposition)
- Endocardial cushion defect
- Aortic valvular disease
- Total anomalous pulmonary venous connection and Partial anomalous pulmonary venous connection
- Truncus arteriosus
- Vascular rings
- Situs Anomalies and (asplenia and polysplenia)
Unusual congenital heart disease: Advanced
- Double outlet right ventricle
- Single ventricle
- Cor Triatriatum
- Hypoplastic left heart syndrome
- Aortic atresia
- Mitral atresia
- Hyopoplastic right heart syndrome
- Tricuspid atresia
- Uhl’s anomaly
- Right ventricular dysplasia
- Pulmonary valve atresia
- Ebstein’s anomaly
- Congenital absence of the pericardium
- Indications for and post-operative assessment of
- Mustard
- Senning
- Rastelli
- Fontan
- Norwood
- Jatene
- Blalock-Taussig
- Potts
- Waterston-Cooley
- Glenn
- Rashkind
- Ross Procedure
- Late or Adult presentations of congenital heart disease
- Mitral valve prolapse
- Aortic stenosis (e.g. valvular and subvalvular)
- Sinus of Valsalva aneurysm
- Marfan’s syndrome
- Bicuspid aortic valve
Ischemic heart disease
- Risk factors, primary prevention and screening
- Inducible myocardial ischemia
- Acute MI
- Chronic MI
- Post-MI complications
- Cardiac rupture
- LV aneurysm
- Papillary muscle rupture
- Congestive heart failure
- Dressler’s syndrome
- Myocardial viability
- Stunned myocardium
- Hibernating myocardium
- Therapeutic and interventional options
Valvular Heart Disease
- Aortic stenosis
- Valvular aortic stenosis
- Subvalvular aortic stenosis
- Supravalvular aortic stenosis
- William’s syndrome
- Aortic insufficiency
- Mitral stenosis / mitral insufficiency
- Parachute mitral valve
- Tricuspid stenosis / tricuspid regurgitation
- Miscellaneous:
- Degenerative calcification
- Calcified aortic stenosis
- Mitral annular calcification
- Myxomatous degeneration
- Carcinoid syndrome
- Infective endocarditis
- Rheumatic heart disease
- Degenerative calcification
- Therapeutic and interventional options
Cardiac and pericardial masses
- Primary lesions
- Myxoma
- Lipoma
- Angiosarcoma
- Rhabdomyoma
- Metastasis
- Therapeutic and interventional options
Acquired diseases of the thoracic aorta
- Aneurysms
- Atherosclerotic
- Marfan’s syndrome
- Ehlers-Danlos syndrome
- Pseudoaneurysms
- Mycotic
- Post-traumatic and post-surgical
- Dissection
- Intramural hematoma
- Aortitis
- Atherosclerosis
- Plaque
- Penetrating ulcer
- Therapeutic and interventional options
- Dissection
Cardiomyopathy
- Hypertrophic cardiomyopathy
- Idiopathic hypertrophic subaortic stenosis
- Dilated Cardiomyopathy
- Ischemic
- Non-ischemic
- Restrictive (also infiltrative) cardiomyopathy
- Amyloidosis
- Sarcoidosis
- Storage diseases
- Infection
- Radiation
- Therapeutic and interventional options
- Amyloidosis
Diseases of the Pericardium
- Acute pericarditis
- Constrictive pericarditis
- Pericardial effusion
- Pericardial cyst
- Pericardial defect
- Therapeutic and interventional options
Miscellaneous
- Arrhythmogenic Right Ventricular Dysplasia (ARVD)
- Coronary artery / sinus of Valsalva aneurysm and fistula
- Pulmonary arterial hypertension
- Pulmonary embolism
- Cardiac transplantation
- Automatic Inplantable Cardioverter Defibrillator (AICD)
- Pacemakers
- RF ablation for atrial fibrillation