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NPLEX I 2024 > Cardio Embryo > Flashcards

Cardio Embryo Flashcards

1
Q

What embryological layer does the heart arise from?

A

Mesoderm (lateral splanchnic layer)

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2
Q

The heart & the great vessels come from what cell line?

A

Mesenchymal cells (multipotent stem cells that can differentiate into various cell types i.e. myocytes, adipocytes, osteoblasts)

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3
Q

At what point do vasculogenesis & angiogenesis, blood vessel development begin?

A

At the beginning of the 3rd week

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4
Q

Where do vasculogenesis & angiogensis occur?

A

In the extraembryonic mesoderm of the yolk sac, allantois & chorion. (mesoderm gives rise to new vessels & heart structures)

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5
Q

How does the heart tube form?

A

2 endothelial-lined channels (endocardial heart tubes) fuse together to form 1 heart tube during lateral folding

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6
Q

By the end of the 3rd week, what does the primodial CV system look like?

A

The heart is represented by the heart tubes & is joined by blood vessels from the embryo & extraembryonic membrane

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7
Q

The SVC is developed out of what structure?

A

R common and anterior cardinal veins

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8
Q

truncus arteriosus becomes what

A

Ascending aorta, pulmonary trunk

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9
Q

bublis cordis becomes

A

Smooth parts of L and R ventricles

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10
Q

Primitive ventricle becomes

A

Trabeculated portion of L and R ventricles

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11
Q

primitive atrium become

A

Trabeculated portion of L and R atria

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12
Q

L horn of sinus venosus becomes

A

coronary sinus

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13
Q

R horn of sinus venosus becomes

A

Smooth portion of R atrium

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14
Q

Endocardial cushion becomes

A

Atrial septum, membranous IV septum, AV and semilunar valves

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15
Q

The IVC is developed out of what?

A

Posterior cardinal, subcardinal, supracardinal veins

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16
Q

Primitive pulmonary vein becomes

A

Smooth portion of L atrium

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17
Q

what are the steps of the heart tube forming?

A

splanchnic layer of lateral mesoderm is stim by VEGFs from endoderm to form:

inner mesoderm (hemocytoblast) > RBCs, WBCs

outer mesoderm (angioblast) > BVs, heart tubes

lateral folding fuses heart tubes and pericardial cavities into one of each

during whole process, craniocaudal folding also happens to move heart from head to thorax and INTO pericardial cavity

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18
Q

what holds the heart tube in place in the pericardial cavity?

A

dorsal mesocardium

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19
Q

heart tube layers and origins

A

endocardium (inner) - from angioblasts
myocardium (outer) - from cardiac myocytes

in between is cardiac jelly made by myocardium

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20
Q

aortic sac forms

A

dorsal aortae (outflow tracts)

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21
Q

flow of blood through heart tube

A

sinus venosus > PA > PV > bulbis cordis, truncus arteriosis > aortic sac > dosral aortae

22
Q

aortic arch derivatives:

A

1: maxillary (branch of ext carotid)
2: stapedial, hyoid
3: common carotid, proximal int carotid
4: aortic arch (left) + proximal right subclavin (right)
6: proximal PAs (both sides) and ductus arteriosus (left only)

23
Q

at what week does the heart beat spontaneously? when is polarity established?

A

week 4; first functional organ in vertebrate embryos

left-right polarity starts to establish at wk 4 also

24
Q

the asc aorta and pulmonary trunk are formed from what

A
  1. Bulbar ridges fuse & become an aorticopulmonary septum
  2. Aorticopulmonary septum divides the bulbus cordis & the truncus arteriosus into 2 arterial channels
  3. These 2 channels become the aorta & PT

arise from neural crest cell migrations

25
Q

aortic and pulmonary valves are formed from

A

endocardial cushions of outflow tract

26
Q

mitral/tricuspid valves are formed from

A

fused endocardial cushions of AV canal

27
Q

What 4 main segments compose the IVC?

A
  1. Hepatic segment: from hepatic vein & sinusoids
  2. Prerenal segment: from R. subcardinal vein
  3. Renal segment: from the subcardinal-supracardinal anastomosis
  4. Postrenal segment: from the supracardinal vein
28
Q

The aorta & pulmonary trunk are formed when in gestation?

A

Between week 5 & 6

29
Q

At what point can a fetal heart beat be detected by a Doppler?

A

7 weeks after menses (week 5 in fertilization age terms)

30
Q

3 shunts of fetal circulation

A

Umbilical vein > joins L portal v via ductus venosus > joins hepatic v into IVC to bypass liver

oxygenated blood reaching heart via IVC goes through foramen ovale

deoxy blood from SVC goes through RA > RV > PA > ductus arteriosus > desc aorta

31
Q

The embryonic foramen ovale becomes what after birth?

A

Fossa ovalis (shunted blood from R. atrium to L. atrium)

32
Q

The embryonic ductus arteriosus becomes what after birth?

A

Ligamentum arteriosum (shunted blood from PT into aorta)

33
Q

What forms the atria?

A

The separation into right and left of the primitive sinuatrium or septum primum

34
Q

The fusion of the endocaridal or atrioventricular cushions posteriorly & anteriorly forms what?

A

Tricuspid & mitral inlets which become the AV valves

35
Q

HOw does the right & left ventricle become compartmentalized?

A

2 theories:
1. Trabeculations appear & grow into muscular structures –> coalesce w/ the endocardial cushions –> form IV septum eventually
2. At the apex a primordial muscular IV ridge grows –> fuses w/ the walls of the ventricles –> grows up to the endocardial cushion –> forms IV foramen

36
Q

What does the interventricular foramen result in?

A

By the end of week 7, it closes resulting in the IV septum

37
Q

The umbilical vein becomes what?

A

Ligamentum teres hepatis (round ligament of the liver)

38
Q

The vitelline veins become what?

A

Portal circulation and mesenteric veins

39
Q

The left and right dorsal aorta become what?

A

descending aorta

40
Q

What is the normal physiological process by which truncus arteriosus transforms into asc aorta and pulmonary trunk?

How can this process go wrong? What pathology are associated?

A
  • neural crest cell migration from hindbrain
  • aorta and PA undergo spiral formation > AP septum formed

Pathology: persistent TA
- incomplete AP septum formation due to failure of neural crest cell migration
- leads to mixing of oxygenated + deoxygenated blood
- associated with DiGeorge Syndrome, SCID

Pathology: transposition of great vessels
- failed AP septum spiraling > reversal of PA and aorta
- 2 paralell circuts with deoxygenated blood going in and blood being pumped back out before being oxygenated
- RV > aorta, LV > PA
- incompatible w life without shunts or keeping PDA open; associated with diabetic mothers

41
Q

What are the steps in atrial septation?

A
  1. formation of septum primum
  2. foramen and septum secundum form
  3. foramen ovale closes
42
Q

From where does the septum primum form during atrial septation?

A

Forms inferiorly from superior primitive atria

43
Q

What is the Foramen primum/ostium?

A

An opening between the septum primum and AV cusions/rest of atria

44
Q

Explain the formation of foramen and septum secundum during atrial septation

A

foramen secundum forms with septum primum

septum secundum forms as a superior and inferior segment

opening between septum primum and secondum = foramen ovale

45
Q

What causes the closure of foramen ovale?

A

first breath at birth =

more oxygen > dilation > dec pulmonary vasculature resistence > inc LA pressure + dec RA pressure (more blood in pulmonary vesssels) > inc pressure closes opening

46
Q

What defect can occur during atrial septation?

A

patent foramen ovale (PFO) - failure of septum primum and secondum to fuse after birth

mostly asx
inc in RA pressure can open PFO
clots/DVTs can > SVA or paradoxical embolism bc can pass onto left side of heart and go to brain

47
Q

Ventricular septal defects are usually due to defects in which portion of the IV septum?

A

Membranous

48
Q

What types of atrial septal defects can occur?

A

persistent shunt (whereas PFO is intermittent flap) > wide fixed split S2

secondum type - most common, usu isolated (hypo-/aplasia)

primum: usu occurs with other heart defects

49
Q

What can result from defects of the 4th aortic arch?

A

4th arch: aortic arch (L), prox r subclavian (R)

coarctation (narrowing) of the aorta

50
Q

What can result from defects of the 6th aortic arch?

A

6th: prox PA (R/L), ductus arteriosus (L)

PDA: due to PG
RF: premature
continuous machine line murmur in left infraclavicular/2nd intercostal space
palpable thrill

NPLEX I 2024 (23 decks)

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