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0. Step Ib > Cardio Embryology + congenital tumors > Flashcards

Cardio Embryology + congenital tumors Flashcards

1
Q

Truncus arteriosus gives rise to

A

ascending aorta + pulmonary trunk

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2
Q

bulbus cordis gives rise to

A

smooth parts (outflow) tracts of L/R ventricles

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3
Q

primitive atria gives rise to

A

trabeculated part of L/R atria

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4
Q

primitive ventricle gives rise to

A

trabeculated part of L/R ventricles

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5
Q

primitive pulmonary vein gives rise to

A

smooth part of L atrium

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6
Q

L horn of sinus venosus (SV) gives rise to

A

coronary sinus - resides in the atrioventricular groove on the posterior aspect of the heart

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7
Q

R horn of sinus venosus (SV) gives rise to

A

smooth part of R atrium

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8
Q

R common cardinal vein and R anterior cardinal vein gives rise to

A

SVC

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9
Q

embryonic structures that give rise to smooth parts of the heart only

A

bulbus cordis - smooth parts (outflow) tracts of L/R ventricles
primitive pulmonary vein - smooth part of L atrium
R horn of sinus venosus (SV) - smooth part of R atrium

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10
Q

embryonic structures that give rise to trabeculated parts of the heart only

A

primitive atria - trabeculated part of L/R atria

primitive ventricle - trabeculated part of L/R ventricles

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11
Q

septum primum forms what

A

foramen secundum as it grows towards the endocardial cushions, thereby narrowing foramen primum

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12
Q

septum secundum forms what

A

forms foramen ovale as it covers most of foramen secundum

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13
Q

foramen ovale is comprised of these two structures

A

septum primum

septum secundum

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14
Q

ventricular septum is comprised of these two muscle types

A

smooth (upper) + muscular (lower) parts

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15
Q

what forms the aorticopulmonary septum? What does this go on to form?

What happens if this sequence malfunctions?

A

neural crest + endocardial cell migrations -> truncal + bulbar ridges spiral and fuse -> articopulmonary septum -> ascending aorta + pulmonary trunk

malfunction:

  • > transposition of the great vessels
  • > tetraology of fallot
  • > persistent truncus arteriosus
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16
Q

aortic valve is derived from..

A

endocardial cushions

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17
Q

mitral valve derive from…

A

fused endocardial cushions of the AV canal

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18
Q

pulmonary valve is derived from..

A

endocardial cushions

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19
Q

tricuspid valve is derived from…

A

fused endocardial cushions of the AV canal

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20
Q

valves that derive from fused endocardial cushions of the AV canal…

A

mitral + tricuspid valves

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21
Q

valves that derive from endocardial cushions

A

aortic + pulmonary valves

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22
Q

fetal hemoglobin composition, HgF

A

α2γ2

also due to β thalassemia

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23
Q

adult hemoglobin composition, HgA1 (major)

A

α2β2

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24
Q

HgH composition

A

β4, due to alpha-thalassemia (when 3 copies are deleted, causes hemolysis with hepatosplenomeagly)

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25
Q

adult hemoglobin composition, HgA2 (minor)

A

α2δ2

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26
Q

Hemoglobin Barts

A

γ4, due to alpha-thalassemia (when all 4 copies are deleted; causes hydrops fetalis)

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27
Q

ductus venosus connects?

A

umbilical vein (O2 blood) to IVC; bypasses the liver

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28
Q

patent ductus arteriosus connects?

A

pulmonary artery to aorta

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29
Q

foramen ovale connects

A

L/R atria

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30
Q

fossa ovalis was once the….

A

foramen ovale

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31
Q

ligamentum arteriosum was once the

A

ductus arteriosus

32
Q

ligamentum teres hepatis was once the..

A

umbilical vein

33
Q

umbilical arteries derive from

A

medial umbilical ligaments

34
Q

ligamentum venosum was once the…

A

ductus venosus

35
Q

urachus-median umbilical ligament was once the

A

allantois

36
Q

nucleus pulposus was once the

A

notochord

37
Q

SA/AV supplied by..

A

RCA

38
Q

R dominant circulation

A

PDA arises from RCA

39
Q

L dominant circulation

A

PDA arises from LCX

40
Q

Peak of coronary blood flow

A

early diastole

41
Q

most posterior part of heart

A

LA

42
Q

artery that supplies the lateral and posterior walls of LV

A

LCX

43
Q

artery that supplies the

  • anterior 2/3 of interventricular septum
  • anterior papillary muscle
  • anterior surface of L ventricle
A

LAD

44
Q

artery that supplies the R ventricle

A

Acute marginal artery from teh RCA

45
Q

artery that supplies the posterior 1/3 of the interventricular septum and posterior walls of the ventricles

A

PDA

46
Q

what maintains CO during early stages of exercise?

late stages?

A

early: HR, SV
late: HR (SV plateaus, duh)

47
Q

what shortens diastole time?

A

increased HR/tachycardia

48
Q

does hyperthyroidism increase or decrease pulse pressure?

A

increase

49
Q

does aortic stenosis increase or decrease pulse pressure?

A

decrease

50
Q

does aortic regurgitation increase or decrease pulse pressure?

A

increase

51
Q

does cardiac tamponade increase or decrease pulse pressure?

A

decrease

52
Q

does cardiogenic shock increase or decrease pulse pressure?

A

decrease

53
Q

does arteriosclerosis increase or decrease pulse pressure?

A

increase

54
Q

does obstructive sleep apnea increase or decrease pulse pressure?

A

increase (due to increased sympathetic tone)

55
Q

does exercise increase or decrease pulse pressure?

A

increase

56
Q

does anemia increase or decrease pulse pressure?

A

increase

57
Q

does advanced heart failure increase or decrease pulse pressure?

A

decrease

58
Q

does cardiac tamponade increase or decrease pulse pressure?

A

decrease

59
Q

normal EF?

how does EF change with systolic heart failure? diastolic heart failure?

A

normal EF: >55%

systolic - decreases
diastolic - normal

60
Q

when does normal physiologic splitting occur?

A

during INSPIRATION (drop in intrathoracic P -> increase VR -> increases RV stroke volume -> increase RV ejection time -> delayed closure of pulmonic valve)

61
Q

when and why does wide splitting occur? 2

A

conditions that delay RV emptying

  • pulmonic stenosis
  • RBBB

occurs regardless of breath

62
Q

when and why does fixed splitting occur?

A

ASD (L->R shunt) increases RV volumes -> pulmonic valve closure is greatly delayed

occurs regardless of breath

63
Q

when does paradoxical splitting splitting occur?

A

conditions that delay LV emptying

  • aortic stenosis
  • LBBB
    expiration: split
    inspiration: P2 closes later and moves closer to A2, thereby eliminating the split
64
Q

infantile coarctation of the aorta

where does it occur?
associated disease?

A

proximal to ductus arteriosus

association: Turner syndrome

65
Q

persistent truncus arteriosus

where does it occur?
type of shunt formed?
association?

A

joined pulmonary trunk and aorta, most patients have concurrent VSD

right-to-left shunt

association: Digeorge (22q11)

66
Q

endocardial cushion defects are usually associated with?

Give some examples

A

Downs syndrome

ASD
VSD
AV septal defect

67
Q

Eisenmenger’s syndrome

Pathophysiology?

A

Uncorrected L-> R shunt (VSD, ASD, PDA)

  • -> elevated pulmonary artery (PA) flow and pressures
  • -> PA hypertrophy + RVH
  • -> shunt switches to R->L shunt
  • -> cyanosis, clubbing, polycythemia
68
Q

adult coarctation of the aorta

where does it occur?
signs and sx?

A

distal to ductus arteriosus

signs/symptoms: rib notching, lower extremity pulses weaker than upper

69
Q

total anomalous pulmonary venous return (TAPVR)

A

R->L shunt

pulmonary veins drains into the R heart (SVC, coronary sinus, etc), often has concurrent ASD and PDA to allow for R-> L shunting to maintain CO

70
Q

aortic regurgitation and dissection - association?

A

Marfan’s syndrome

71
Q

VSD

type of shunt?
sx?
association?

A

L->R shunt

harsh holosystolic murmur w/ increased pulmonary vascularity and mid diastolic rumble; thrill

Down syndrome

72
Q

Tricuspid atresia
what is it?
type of shunt?
what is required for viability?

A

missing tricuspid valve, hypoplastic RV

R->L shunt

requires concurrent ASD and VSD for viability

73
Q

transposition of great vessels

what is it?
type of shunt?
what is required for viability?
associations?

A

aorta and pulmonary artery are switched

R->L shunt

needs VSD, PDA, or PFO for survival

association: infant of diabetic mother

74
Q

ASD

type of shunt?
signs and sx?
associations?

A

L->R shunt

signs/sx: fixed split S2, loud S1, mid systolic pulmonary ejection murmur (patients usually present w/ exercise intolerance)

association: Down syndrome

75
Q

tetralogy of fallot

what is it?
type of shunt?
signs and sx?
associations?

A

pulmonary infundibular stenosis, RVH (boot shape), overriding aorta (emerges from both L/R ventricles), VSD

R->L shunt

signs/symptoms: tet spells, squatting relieves cyanosis; harsh systolic ejection murmur

association: Digeorge 22q11

76
Q

PDA

type of shunt?
signs and sx?
treatments (open/close)?
associations?

A

L->R shunt

sx: continuous machine-like murmur
treatment: indomethacin to close, PGE1, PGE2 keeps open
association: rubella

0. Step Ib (19 decks)

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