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CVS > 3 CVS > Flashcards

3 CVS Flashcards

1
Q

Which organs to the most common congenital defects affect?

A

The heart and cardiovascular system. (1% of live births)

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2
Q

Do many people with congenital cardiac defects life into adulthood?

A

Yes, 90% survive to adulthood.

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3
Q

What is the consequence of high survival rates in people with congenital heart defects?

A

It means that all clinicians are regularly dealing with patients with heart defects.
So treatments, pregnancies, etc. must take this into consideration.

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4
Q

What is the most common cause of maternal death during pregnancy?

A

Maternal congenital heart defect

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5
Q

During which week does the embryo fold?

A

The embryo folds during the 4th week of the embryonic period.

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6
Q

From which (primitive) tissue does the heart arise?

A

mesoderm

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7
Q

How does folding of the embryo change the position of the cardiogenic field?

A

It places the cardiogenic field in the neck of the foetus, later in the thorax

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8
Q

What is the cardiogenic field?

A

It is population of mesodermal cells organised in a horseshoe that have the capacity to differentiate into all the components of the CVS. (blood cells, vessels, heart itself)

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9
Q

Before the embryo folds, how many endocardial tubes do we see?

A

2, one either side of the midline

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10
Q

What is the primitive heart tube?

A

Its just a modified blood vessel. Its the result of the fusion of the 2 dominant endocardial tubes.
It is a linear tube with an inlet and an outlet.

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11
Q

The primitive heart tube must be … to create 4 chambers

A

divided

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12
Q

The inflow vessels and the outflow vessels must be … creating the familiar configuration of vessels returning blood from the systemic circulation and the great vessels taking blood away from the heart

A

remodelled

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13
Q

What are the consequences of heart folding?

A
  1. Maximises the use of space in the pericardial sac
  2. Ensures that tissues inside the primitive heart tube are aligned with each other so that cardiac septation can occur normally.
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14
Q

How are atria placed before and after cardiac looping?

A

Before cardiac looping, atria are a lower segment of the tube, just above sinus venosus (inlets).
After cardiac looping, they become placed behind and above the bulbus cordis and the 1 ventricle.

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15
Q

Which are the zones of the primitive heart tube form top to bottom?

A 
Aortic roots
Truncus arteriosus
Bulbus cordis
Ventricle
Atrium
Sinus Venosus (4 inlet tubes)

=> nothing delimitates these zones! They are just segments of the tube that will go on to develop into mature structures.

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16
Q

the RA develops from… (2) and receives venous drainage from … (1)

A
  • mostly the primitive atrium
  • sinus venosus
  • receives venous drainage from the body (venue cava) and the heart (coronary sinus)
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17
Q

The LA develops from (2) and receives oxygenated blood from … (1)

A
  • from proximal parts of pulmonary veins ++
  • a small portion of the primitive atrium
  • receives oxygenated blood from the lungs
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18
Q

In the foetus, oxygenation occurs in the … because the … don’t work.

A

foetus: oxygenation occurs in the placenta because the lungs don’t work.

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19
Q

In foetal circulation, the inferior vena cava contains oxygenated/deoxygenated blood

A

Foetus: the inferior vena cava contains oxygenated blood! Indeed, it is carrying blood back from the placenta.

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20
Q

The inside of the right atrium is rough/smooth?

A

rough

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21
Q

The inside of the left atrium is rough/smooth?

A

smooth

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22
Q

Why is the internal surface of the right atrium rough?

A

Because the right atrium derives essentially form the primitive atrium, and it is this atrium that is rough (trabecular). Whereas the LA only derives minority from the primitive atrium so is smooth.

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23
Q

What is the shunt that bypasses the liver by joining the placenta to the inferior vena cava called?

A

Ductus venosus

24
Q

What is the shunt bypassing the right ventricle and lungs by joining the RA and the LA called?

A

Foramen ovale

25
Q

What is the shunt bypassing the lungs by joining the pulmonary trunk to the aorta called?

A

Ductus arteriosus

26
Q

What is the foramen ovale?

A

It is a foetal shunt that joins RA and LA, thereby bypassing RV and thus lungs.

27
Q

What is the ductus venous?

A

The ductus venous is a foetal shunt that joins the plcenta to the inferior vena cava there bypassing the liver.

28
Q

What is the ductus arteriosus?

A

It is a foetal shunt that joins the pulmonary trunk to the aorta thereby bypassing the lungs.

29
Q

°Which shunt closes mecanically (1)?

A
  1. Foramen ovale - by the LA pressure increasing at birth
30
Q

How does the foramen oval close, and when?

A

Normally it closes at birth with the increase in LA pressure. but for it to close, the foramen need to not be oppose each other.

31
Q

Which arterial vessels (parts of) derive from the 4th R and L arterial arch?

A

R: proximal part of the subclavian artery
L: aortic arch

32
Q

Which arterial vessels derive from the 6th R and L arterial arch

A

R: right pulmonary artery
L: left pulmonary artery and ductus arteriosus

33
Q

Which name is given to the 6th aortic arch?

A

Pulmonary arch

34
Q

What happens to the left recurrent laryngeal nerve when the heart descends?

A

The nerve hooks around the ductus arteriosus shunt (between PT and aorta)

35
Q

What happens in PDA, ie. Persistent Ductus Arteriosus?

A
  • persistent communication between the pulmonary trunk artery and the descending aorta.
  • failure of physiological closure
  • consequence: oxygenated blood is ending up in the pulmonary arteries.
  • direction of blood shunt: left to right
36
Q

Which way does the blood shunt if the ductus arteriosus fails to close at birth?

A

left to right! from aorta to pulmonary arteries.

37
Q

Where does the septum primum appear?

A

between left and right atria

38
Q

What structure is essential as scaffold for heart septation?

A

endocardial cushions

39
Q

Name an atrial septal defect

A

Ostium secundum defect.

  • Causes:
    1. Septum primum resorbed or too short
    2. Septum secundum too small
40
Q

°What is hypoplastic left heart syndrome?

A

…

41
Q

The ventricular septum has two components, these are:

A
  1. Muscular

2. Membranous

42
Q

°Which structure scan we feel in DR between the atria that is reminiscent of the foetal period?

A

We can feel the… that is reminiscent of the foramen ovale.

43
Q

Is it the muscular or the membranous component of the ventricular septum that forms most of the septum?

A

Muscular

44
Q

Without endocardial cushions we are likely to have … defects

A

septation

45
Q

What is the 1° interventricular foramen?

A

It is the space between the muscular component of the septum and the endocardial cushion. (Later the cushion will grow downwards forming the membranous part of the ventricular septum, thus closing the gap)

46
Q

Absence of 1° interventricular foramen closure will lead to blood shunt in which direction?

A

Left to right

47
Q

Ventricular septal defect is most commonly caused by a defect in which part of the septum?

A

the membranous part that derives from the endocardial cushions.

48
Q

Where else other that for compartment septation to endocardial cushions appear?

A

In the truncus arteriosus. They will lead to septation of the outflow tract.

49
Q

Septation of truncus arteriosus by endocardial cushions growth leads to the formation of which 2 vessels?

A
  1. Aorta

2. Pulmonary trunk

50
Q

What is transposition of the great arteries, what consequences at birth?

A
  • Aorta rises from RV
  • Pulmonary trunk arises from LV
  • consequence: cyanosis as LV is pumping deoxy blood around the body
  • ttt: arterial switch
51
Q

What is the tetralogy of Fallot?

A
  1. Large ventricular septal defect
  2. RV outflow tract obstruction
  3. Conotruncal septum formation defect (importance of neural crest cells that contribute to the formation of endocardial cushions)
52
Q

Which substance kills neural crest cells very quickly at low doses?

A

Alcohol! leading to defects of the brain, face and heart.

Neural crest cells contribute to the endocardial cushion formation.

53
Q

Which nerve corresponds to the 6th arterial arch?

A

the recurrent laryngeal nerve (br vagus, CN X)

54
Q

What mature structure does the bulbus cordis give rise to?

A
  • (part of) the right ventricle
55
Q

Which zone of the primitive heart tube is the LV derived from?

A
  • primitive ventricle
56
Q

Which mature structure does the primitive ventricle give rise to?

A

the left ventricle

57
Q

Which mature structure does the truncus arteriosus give rise to?

A
  • roots and proximal portions of the pulmonary trunk and aorta

CVS (7 decks)

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