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EMRCS A - self flash cards > 1- Heart + diaphragm > Flashcards

1- Heart + diaphragm Flashcards

1
Q

What are the five regions that the primitive heart tube divides into?

A

Sinus venosus, atrium, ventricle, bulbus cordis, and truncus arteriosus

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2
Q

What happens to the sinus venosus during development?

A

It becomes incorporated into the atrium.

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3
Q

What happens to the bulbus cordis during development?

A

It becomes incorporated into the ventricle.

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4
Q

What grows out as dorsal and ventral endocardial cushions in the development of the heart?

A

Boundary tissue between the primitive single atrial cavity and single ventricle.

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5
Q

What happens when the endocardial cushions meet in the midline?

A

They divide the common atrioventricular orifice into a right (tricuspid) and left (mitral) orifice.

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6
Q

How does the interventricular septum develop?

A

It develops from the apex towards the endocardial cushions.

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7
Q

What is the foramen ovale?

A

It is a hole in the upper part of the atrium, left by the fusion of the septum primum with the endocardial cushions.

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8
Q

What is the purpose of the septum secundum?

A

It acts as a valve-like structure that allows blood to go straight from the right to the left side of the heart in the fetus.

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9
Q

What happens to the foramen ovale at birth?

A

The increased blood flow through the lungs and rise in left atrial pressure causes the septum primum to be pushed across, closing the foramen ovale.

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10
Q

What is the result of the fusion of the septum primum and septum secundum?

A

It obliterates the foramen ovale, leaving a small residual dimple known as the fossa ovalis.

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11
Q

What structures does the sinus venosus become when it joins the atria?

A

On the right side, it becomes the two vena cava. On the left side, it becomes the four pulmonary veins.

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12
Q

How many pairs of arches does the truncus arteriosus give off?

A

Six pairs.

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13
Q

What happens to the first and second arches during development?

A

They disappear completely.

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14
Q

Which arch remains as the carotid artery?

A

The third arch.

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15
Q

What does the fourth arch become?

A

On the right side, it becomes the subclavian artery.
On the left side, it becomes the aortic arch (giving off the left subclavian artery).

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16
Q

What happens to the fifth arch during development?

A

It disappears.

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17
Q

What does the ventral part of the sixth arch become?

A

It becomes the right and left pulmonary arteries with a connection to the dorsal aorta.

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18
Q

What happens to the sixth arch on the right side?

A

It disappears.

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19
Q

What is the ductus arteriosus?

A

It is a connection between the pulmonary artery and the aortic arch.

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20
Q

How does the developmental anatomy explain the positions of the recurrent laryngeal nerves on each side?

A

On the right side, the fifth and sixth arches disappear, causing the nerve to be hooked around the fourth arch (subclavian artery).
On the left side, the nerve remains hooked around the sixth arch (ligamentum arteriosum in the adult).

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21
Q

How does oxygenated blood travel in fetal circulation?

A

It travels from the placenta along the umbilical vein.

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22
Q

What happens to most of the blood in fetal circulation?

A

It bypasses the liver and joins the inferior vena cava (IVC) through the ductus venosus.

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23
Q

Where does most of the blood pass through in fetal circulation?

A

It passes through the foramen ovale into the left atrium, allowing oxygenated blood to enter the aorta.

24
Q

Where does the remaining blood go in fetal circulation?

A

It goes through the right ventricle and returns to the pulmonary trunk as systemic venous blood.

25
Q

Why does blood in the pulmonary trunk tend to pass down the ductus arteriosus in fetal circulation?

A

Because the unexpanded lungs present high resistance to flow, and the low-resistance ductus arteriosus allows blood to bypass the lungs and enter the aorta.

26
Q

How does blood return to the placenta in fetal circulation?

A

It returns via the umbilical arteries, which are branches of the internal iliac arteries.

27
Q

What happens at birth that affects fetal circulation?

A

The left atrial pressure rises, closing the foramen ovale as the septum primum is pushed against the septum secundum.

28
Q

What happens to the pulmonary artery after birth?

A

Blood flow through the pulmonary artery increases, and it receives poorly oxygenated systemic venous blood.

29
Q

What causes the lowering of pulmonary vascular resistance and the obliteration of the ductus arteriosus after birth?

A

The inflation of the lungs and the increase in oxygen levels.

30
Q

What is dextrocardia?

A

It is a congenital anomaly where the heart is a mirror image of normal anatomy, with the apex pointing towards the right side of the chest instead of the left.

31
Q

What is situs inversus?

A

It is a congenital anomaly characterized by the complete inversion or mirror image of all the internal organs, including the heart and other viscera.

32
Q

When does fusion between the septum primum and septum secundum usually occur in atrial septal defect (ASD)?

A

About 3 months after birth.

33
Q

What percentage of the population may have incomplete fusion between the septum primum and septum secundum?

A

10%.

34
Q

What happens if the septum secundum is too short to cover the foramen secundum in the septum primum?

A

It results in an ostium secundum defect, which allows shunting of blood from the left to the right atrium.

35
Q

What can cause an atrial septal defect (ASD) if the septum primum fails to fuse with the endocardial cushions?

A

An ostium primum defect, which lies immediately above the atrioventricular (AV) boundary and may be associated with a ventricular septal defect (VSD).

36
Q

What is the most common left-to-right shunt abnormality?

A

Ventricular septal defect

37
Q

Can small defects in the muscular part of the septum close on their own?

A

Yes, small defects in the muscular part of the septum may close without intervention.

38
Q

Where are larger defects in the ventricular septum typically located?

A

Larger defects are often found in the membranous part of the septum, just below the aortic valves.

39
Q

What may be required for larger ventricular septal defects?

A

Repair or surgical intervention may be necessary for larger defects in the membranous part of the septum.

40
Q

What is a patent ductus arteriosus (PDA)?

A

It is a left-to-right shunt where the ductus arteriosus, a blood vessel connecting the aorta and pulmonary artery, fails to close after birth

41
Q

Why is it important to surgically correct a patent ductus arteriosus (PDA)?

A

PDA causes increased load on the left ventricle and can lead to pulmonary hypertension

42
Q

What should be taken into consideration during open surgery to close a patent ductus?

A

Care must be taken to avoid injuring the left recurrent laryngeal nerve.

43
Q

What can pulmonary hypertension cause in a left-to-right shunt?

A

It can cause reversed flow, known as right-to-left shunting.

44
Q

What can lead to increased pulmonary flow and contribute to right-to-left shunting in Eisenmenger’s syndrome?

A

ASD (atrial septal defect), VSD (ventricular septal defect), or PDA (patent ductus arteriosus).

45
Q

What is Fallot’s tetralogy composed of?

A

Fallot’s tetralogy consists of:
1/VSD (ventricular septal defect)
2/stenosed pulmonary outflow track
3/ a wide aorta overriding the right and left ventricles
4/ and right ventricular hypertrophy.

46
Q

Why does cyanosis occur in Fallot’s tetralogy?

A

Cyanosis occurs due to the right-to-left shunt across the VSD, resulting in deoxygenated blood mixing with oxygenated blood.

47
Q

What primarily determines the degree of cyanosis in Fallot’s tetralogy?

A

The severity of the pulmonary outflow obstruction primarily determines the degree of cyanosis in Fallot’s tetralogy.

48
Q

What causes coarctation of the aorta?

A

It is caused by an abnormality in the obliterative process that normally closes the ductus arteriosus.

49
Q

What are the clinical features of coarctation of the aorta?

A

Hypertension in the upper part of the body, weak and delayed femoral pulses.

50
Q

What happens in response to coarctation of the aorta?

A

Extensive collaterals develop in an attempt to bring blood from the upper to the lower part of the body.

51
Q

How does coarctation of the aorta appear on a chest X-ray?

A

Enlarged intercostal arteries can cause notching of the inferior borders of the ribs, which can be seen on a chest X-ray.

52
Q

Which valves are more frequently affected by these abnormalities?

A

The pulmonary and aortic valves are more commonly affected compared to the mitral and tricuspid valves.

53
Q

How does the diaphragm develop?

A

The diaphragm develops from the fusion of four parts:
1/ the septum transversum (central tendon),
2/ the mesentery of the foregut (crura and median part),
3/ ingrowth from the body wall,
4/ and the pleuroperitoneal membrane.

54
Q

What are the different types of congenital diaphragmatic hernias?

A

Congenital diaphragmatic hernias can occur depending on which section of the diaphragm fails to close.
These include posterolateral hernia through the foramen of Bochdalek, hernia through a deficiency of the whole central tendon, hernia through the foramen of Morgagni anteriorly, and hernia through a congenitally large esophageal hiatus.

55
Q

Which side is the posterolateral hernia through the foramen of Bochdalek more common?

A

The posterolateral hernia through the foramen of Bochdalek is more commonly found on the left side.

EMRCS A - self flash cards (3 decks)

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