Cardio Embryology + congenital tumors Flashcards
Truncus arteriosus gives rise to
ascending aorta + pulmonary trunk
bulbus cordis gives rise to
smooth parts (outflow) tracts of L/R ventricles
primitive atria gives rise to
trabeculated part of L/R atria
primitive ventricle gives rise to
trabeculated part of L/R ventricles
primitive pulmonary vein gives rise to
smooth part of L atrium
L horn of sinus venosus (SV) gives rise to
coronary sinus - resides in the atrioventricular groove on the posterior aspect of the heart
R horn of sinus venosus (SV) gives rise to
smooth part of R atrium
R common cardinal vein and R anterior cardinal vein gives rise to
SVC
embryonic structures that give rise to smooth parts of the heart only
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
embryonic structures that give rise to trabeculated parts of the heart only
primitive atria - trabeculated part of L/R atria
primitive ventricle - trabeculated part of L/R ventricles
septum primum forms what
foramen secundum as it grows towards the endocardial cushions, thereby narrowing foramen primum
septum secundum forms what
forms foramen ovale as it covers most of foramen secundum
foramen ovale is comprised of these two structures
septum primum
septum secundum
ventricular septum is comprised of these two muscle types
smooth (upper) + muscular (lower) parts
what forms the aorticopulmonary septum? What does this go on to form?
What happens if this sequence malfunctions?
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
aortic valve is derived from..
endocardial cushions
mitral valve derive from…
fused endocardial cushions of the AV canal
pulmonary valve is derived from..
endocardial cushions
tricuspid valve is derived from…
fused endocardial cushions of the AV canal
valves that derive from fused endocardial cushions of the AV canal…
mitral + tricuspid valves
valves that derive from endocardial cushions
aortic + pulmonary valves
fetal hemoglobin composition, HgF
α2γ2
also due to β thalassemia
adult hemoglobin composition, HgA1 (major)
α2β2
HgH composition
β4, due to alpha-thalassemia (when 3 copies are deleted, causes hemolysis with hepatosplenomeagly)
adult hemoglobin composition, HgA2 (minor)
α2δ2
Hemoglobin Barts
γ4, due to alpha-thalassemia (when all 4 copies are deleted; causes hydrops fetalis)
ductus venosus connects?
umbilical vein (O2 blood) to IVC; bypasses the liver
patent ductus arteriosus connects?
pulmonary artery to aorta
foramen ovale connects
L/R atria
fossa ovalis was once the….
foramen ovale
ligamentum arteriosum was once the
ductus arteriosus
ligamentum teres hepatis was once the..
umbilical vein
umbilical arteries derive from
medial umbilical ligaments
ligamentum venosum was once the…
ductus venosus
urachus-median umbilical ligament was once the
allantois
nucleus pulposus was once the
notochord
SA/AV supplied by..
RCA
R dominant circulation
PDA arises from RCA
L dominant circulation
PDA arises from LCX
Peak of coronary blood flow
early diastole
most posterior part of heart
LA
artery that supplies the lateral and posterior walls of LV
LCX
artery that supplies the
- anterior 2/3 of interventricular septum
- anterior papillary muscle
- anterior surface of L ventricle
LAD
artery that supplies the R ventricle
Acute marginal artery from teh RCA
artery that supplies the posterior 1/3 of the interventricular septum and posterior walls of the ventricles
PDA
what maintains CO during early stages of exercise?
late stages?
early: HR, SV
late: HR (SV plateaus, duh)
what shortens diastole time?
increased HR/tachycardia
does hyperthyroidism increase or decrease pulse pressure?
increase
does aortic stenosis increase or decrease pulse pressure?
decrease
does aortic regurgitation increase or decrease pulse pressure?
increase
does cardiac tamponade increase or decrease pulse pressure?
decrease
does cardiogenic shock increase or decrease pulse pressure?
decrease
does arteriosclerosis increase or decrease pulse pressure?
increase
does obstructive sleep apnea increase or decrease pulse pressure?
increase (due to increased sympathetic tone)
does exercise increase or decrease pulse pressure?
increase
does anemia increase or decrease pulse pressure?
increase
does advanced heart failure increase or decrease pulse pressure?
decrease
does cardiac tamponade increase or decrease pulse pressure?
decrease
normal EF?
how does EF change with systolic heart failure? diastolic heart failure?
normal EF: >55%
systolic - decreases
diastolic - normal
when does normal physiologic splitting occur?
during INSPIRATION (drop in intrathoracic P -> increase VR -> increases RV stroke volume -> increase RV ejection time -> delayed closure of pulmonic valve)
when and why does wide splitting occur? 2
conditions that delay RV emptying
- pulmonic stenosis
- RBBB
occurs regardless of breath
when and why does fixed splitting occur?
ASD (L->R shunt) increases RV volumes -> pulmonic valve closure is greatly delayed
occurs regardless of breath
when does paradoxical splitting splitting occur?
conditions that delay LV emptying
- aortic stenosis
- LBBB
expiration: split
inspiration: P2 closes later and moves closer to A2, thereby eliminating the split
infantile coarctation of the aorta
where does it occur?
associated disease?
proximal to ductus arteriosus
association: Turner syndrome
persistent truncus arteriosus
where does it occur?
type of shunt formed?
association?
joined pulmonary trunk and aorta, most patients have concurrent VSD
right-to-left shunt
association: Digeorge (22q11)
endocardial cushion defects are usually associated with?
Give some examples
Downs syndrome
ASD
VSD
AV septal defect
Eisenmenger’s syndrome
Pathophysiology?
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
adult coarctation of the aorta
where does it occur?
signs and sx?
distal to ductus arteriosus
signs/symptoms: rib notching, lower extremity pulses weaker than upper
total anomalous pulmonary venous return (TAPVR)
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
aortic regurgitation and dissection - association?
Marfan’s syndrome
VSD
type of shunt?
sx?
association?
L->R shunt
harsh holosystolic murmur w/ increased pulmonary vascularity and mid diastolic rumble; thrill
Down syndrome
Tricuspid atresia
what is it?
type of shunt?
what is required for viability?
missing tricuspid valve, hypoplastic RV
R->L shunt
requires concurrent ASD and VSD for viability
transposition of great vessels
what is it?
type of shunt?
what is required for viability?
associations?
aorta and pulmonary artery are switched
R->L shunt
needs VSD, PDA, or PFO for survival
association: infant of diabetic mother
ASD
type of shunt?
signs and sx?
associations?
L->R shunt
signs/sx: fixed split S2, loud S1, mid systolic pulmonary ejection murmur (patients usually present w/ exercise intolerance)
association: Down syndrome
tetralogy of fallot
what is it?
type of shunt?
signs and sx?
associations?
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
PDA
type of shunt?
signs and sx?
treatments (open/close)?
associations?
L->R shunt
sx: continuous machine-like murmur
treatment: indomethacin to close, PGE1, PGE2 keeps open
association: rubella
