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KL Boards > Cardiovascular anatomy > Flashcards

Cardiovascular anatomy Flashcards

1
Q

Double aortic arch

A

Persistence of both 4th arches; fuse distally to form descending aorta

Causes constriction of the esophagus AND trachea; only vascular ring anomaly where tracheal compression causes clinical signs

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2
Q

Persistent right aortic arch

A

Persistence of the right 4th arch

Contriction of esophagus and trachea due to left ligamentum arteriosum or patent ductus arteriosus

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3
Q

Aberrant left subclavian

A

Failure of left 7th intersegmental artery to migrate cranially to reach the 4th arch before separating from dorsal aorta

PRAA is always present

2 forms:

  1. Right ligamentum arteriosum + PRAA + aberrant LSA = ONE SITE of constriction
  2. Left LA + PRAA + aberrant LSA = TWO SITES
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4
Q

Aortic coarctation

A

Severe narrowing of aortic lumen at aortic isthmus (between the LSA and ductus arteriosus) due to spread of ductal tissue into aorta causing constriction at birth

Leads to LV hypertrophy and L CHF

Radiography:
1. indentation of the aorta with severe dilation distally 2. Rib notching - blood shunting into the intercostal and costocervical arteries

Use common carotid artery for angiography approach.

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5
Q

Patent ductus arteriosus

A

PDA caused by partial or complete lack of ductal smooth muscle in the ductus arteriosum

  • types I and II are funnel-shaped, tapering near the PA
  • type III is tubular with no tapering and is not amenable to coiling; these often lead to R→L shunting due to severe postnatal pulmonary hypertension

Shunts located along the left ventral aspect of the descending aorta immediately distal to the left subclavian artery and extend cranioventrally and to the left to connect with the dorsal wall of the MPA adjacent to the PA bifurcation.

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6
Q

Eisenmenger’s syndrome

A

Eisenmenger syndrome (ES) is a constellation of symptoms that arise from a congenital heart defect; initially result in a left-right shunt, which develops into severe pulmonary arterial hypertension (PAH) and elevated vascular resistance –> the left-to-right shunt will become a right-to-left shunt, resulting in significant hypoxemia and cyanosis.

Common with ASD, VSD, and PDA

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7
Q

Ductus arteriosus

A

Ductus arteriosus is derived from the left 6th aortic arch; closes 7-10 days after birth due to rapid increase in PaO2 inhibiting prostaglandins → ductal smooth muscle constriction

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8
Q

Diagnosis of PDA

A

L→R PDA Diagnostics
- Radiographs
Generalized cardiomegaly with hypervascular pattern
Bulges at descending aorta near PDA, left auricle, MPA

  • Angiography
    Aortic injection
    Opacification of PA following injection with aortic dilation and visualization of ductus
R→L PDA
- Radiographs
Right-sided cardiomegaly
Dilated MPA
Variable appearance of lobar and peripheral arteries
  • Angiography
    Injection must be made in RV or MPA
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9
Q

Atrial Septal Defect

A

ASD types

  1. Ostium secundum defect - at or near foramen ovale in upper atrial septum
  2. Ostium primum defect - lower atrial septum
  3. Endocardial cushion defect (cats) - adjacent to AV valve at septum primum
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10
Q

Normal development of atrial septa and ventricular septa

A

Atria and ventricles are a common chamber initially then become a 4 chamber compartment by growth of the cardiac septa

  1. Atrioventricular partitioning: endocardial cushions
  2. Atrial partitioning
    - 1st septum: septum primum –> grows from the dorsal wall of the atrium ventrally towards the endocardial cushions –> a large opening forms which allows blood to shunt from R→L atrium: ostium (foramen) primum –> Ostium primum disappears and a new foramen develops → ostium secundum
    - 2nd septum: septum secundum –> muscular partition arising from the atrial wall, to the right of the septum primum, both dorsal and ventral; not continuous septum –> Foramen ovale → space in between septum

Ventricular partitioning - mainly occurs by inward growth of the ventricular walls.

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11
Q

Patent foramen ovale

A

Not considered a true ASD because the atrial septum forms normally

L→R shunt

  • Shunting occurs during diastole due to low pressure difference across defect.
  • Radiographs: right-sided cardiomegaly (RAE, RVE), pulmonary hypervascular pattern, +/- MPA dilation

R→L shunt: occurs with concurrent severe PS, TVD, or PH

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12
Q

What is the most common cardiac anomaly in cats?

A

VSD

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13
Q

Ventricular septal defect

A

Defect in the perimembranous septum located high on the ventricular septum.

L→R shunt (uncomplicated VSD)

  • Shunting occurs during systole is degree is dependent on defect diameter
  • Consequence –> RAE, RVH (concentric), PAE, LAE, LVH (eccentric)
  • Large shunts: volume overload of left +/- right heart leading to LCHF +/- RCHF
  • Aortic regurgitation can occur due to secondary Ao valve malformation from the shunt being in close proximity to the LVOT.

R→L shunt (complicated VSD)

  • Eisenmenger’s complex (severe PH) or TOF
  • Diffuse cyanosis + secondary polycythemia and hyperviscosity syndrome
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14
Q

Aortic stenosis

A

Subvalvular types (most common
1. **Fibrous ring below the valve (static)
2. Dynamic SAS occurs in cats with HCM due to
systolic anterior motion

May be associated with mitral or aortic valve dysplasia

Consequences:

  • LVH (concentric), LAE, poststenotic dilation of the aorta
  • Aortic insufficiency (mild)
  • Mitral insufficiency
  • Bacterial endocarditis - mild to moderate gradient
  • Fatal arrhythmias - severe gradient
  • Rarely LCHF
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15
Q

Diagnosis of aortic stenosis

A

Radiographs: LAE, LVE, post-stenotic dilatation of the aorta, +/- pulmonary venous congestion

Angiography:

  • LV injection reveals subvalvular stenosis and A/S ratio > 1 (aortic to sinus of Valsalva).
  • Supravalvular injection is also made to rule out aortic insufficiency.
Pressure gradients (▵P = 4V22)
	Normal: 4-16 mmHg (1-2 m/s aortic velocity)
	Mild: < 40 mmHg
	Moderate: 40-80 mmHg
	Severe: > 80 mmHg (poor prognosis)
Velocity measurements
	> 2.5 m/s = SAS
	< 2 m/s = normal 
         2-2.5 m/s = gray zone
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16
Q

Pulmonic stenosis

A

Valvular (most common), subvalvular, supravalvular

Subvalvular type in English bulldogs and Boxers associated with anomalous left coronary artery where left main coronary artery arises from single right coronary artery and encircles the RVOT.

TVD can occur concurrently with PS (RAE)

Consequences
	RVH (concentric)
	RCHF rare unless concurrent TVD
	MPA post-stenotic dilatation 
	Pseudohypertrophy of LV due to ↓ PL

Treatment

  • Balloon valvuloplasty in moderate (probable) to severe cases (always) if the valves are thin and the annulus is not hyperplastic
  • Contraindication: anomalous left coronary artery (this is controversial now)
17
Q

Diagnosis of pulmonic stenosis

A

Radiographs

  • RVE
  • MPA dilation
  • Pulmonary hypoperfusion or normal perfusion

Angiography:
RV injection

Pressure gradients
Mild: < 50 mmHg
Moderate: 50-80 mmHg
Severe: > 80 mmHg

18
Q

Mitral valve dysplasia

A

Common cardiac anomaly in cats, bull terriers, large breeds

Consequences:
massive LAE, LVH (eccentric), LCHF → PH → RCHF

19
Q

What makes up the AV apparatus?

A

major and minor leaflets, chordae tendinae, ventricular wall, valvular annulus and atrium

20
Q

What abnormalities are seen of the AV apparatus?

A

Thickening of the valve leaflets
Underdeveloped chordae tendinae and papillary muscles
Incomplete separation of the valve components Agenesis of valvular tissue

21
Q

Tricuspid valve dysplasia

A

Tricuspid valve dysplasia - Labs, GSD, Old ESD, cats

Concurrent patent foramen ovale or ASD possible

Consequences:
massive RAE, RVH (eccentric), RCHF

22
Q

Normal endocardial cushion development

A

Dorsal endocardial cushion fuses with the septum primum to close the ostium primum in the atrial septum.

The dorsal and ventral endocardial cushions fuse to divide the common AV canal into the left and right AV canals.

AV septum → normal partition between the LVOT and RA

Two separate AV valve rings

23
Q

Endocardial cushion defect

A

Dorsal and ventral endocardial cushions do not close –> cushions cannot fuse with the septum primum to close the ostium primum –> AV valves are placed abnormally low in the ventricle and the aortic valve placed abnormally high → longer LVOT

AV canal defects - AV septum is absent and a common AV orifice with a common fibrous ring and 5-leaflet valve are present.

Complete AV canal defect:
All four chambers communicate with each other through a septum primum ASD, high VSD, and AV valve regurgitation.

Partial AV canal defect (low ASD or high VSD)

24
Q

How do you distinguish ASD/VSD cases from AV canal defect cases?

A

AV canal defects have concurrent moderate to severe mitral regurgitation

25
Q

Conotruncal defect

A
  • Rare in dogs and cats
  • Definition: single artery arises from the base of the heart, giving origin to the systemic, pulmonary, and coronary arteries.
  • Occurs due to complete failure of the conal septum and the truncal septum to septate (conotruncal hypoplasia) during fetal development.
  • VSD is almost always present
  • L→R shunt
Truncus arteriosus forms:
Type I (A) - single pulmonary trunk and single ascending aorta arise from the truncus arteriosus

Type II (B) - right and left PA arise close together from the dorsal wall of the truncus

Type III (C) - One or both PA come off independently from the truncus

Type IV (D) - No PA come off the truncus. Pulmonary circulation provided solely by bronchial arteries.

26
Q

Transposition of the great arteries

A

Aorta originates from the RV and the PA originates from the LV.

Circulation is parallel rather than in series

Concurrent VSD/ASD and PDA (L→R and R→L shunting) occur to maintain life.

27
Q

Tetralogy of Fallot

A

PS
VSD
Overriding aorta
RVH

Pentalogy is concurrent ASD

28
Q

Persistent left cranial vena cava

A

Failure of the left cranial cardinal vein to regress
Usually is concurrent with a normal right CrVC
The persistent left CrVC drains into the great cardiac vein and coronary sinus resulting in enlargement of these structures and connects with the right CrVC
Clinically insignificant
Can be concurrent with a PRAA obstructing the view of the ligamentum arteriosum at surgery

29
Q

What are the 3 sources feeding the cerebral arterial circle (aka Circle of Willis)?

A
  1. Paired internal carotid arteries
  2. Basilar artery (continuation of the ventral spinal artery, which anastomoses with the vertebral artery from subclavian)
30
Q

What is the major artery to supply the caudal brain?

A

Vertebral artery

31
Q

Cerebral arterial circle

A
  1. rostral half gives rise to cranial and middle cerebral arteries
  2. caudal half gives rise to the caudal cerebral and rostral cerebellar arteries
  3. caudal cerebellar artery arises directly from basilar artery
32
Q

What 3 main arteries supply the spinal cord?

A
  1. Ventral spinal artery (follows ventral fissure of cord; supplies the gray matter and adjacent white matter)
  2. Paired dorsolateral spinal arteries (run close to furrow from which dorsal spinal roots arise; supply majority of white matter)
33
Q

Venous drainage of spinal cord

A

vertebral venous plexus, which runs the length of the vertebral column and drains the vertebrae, adjacent musculature, and structures within the vertebral canal

gives rise to segmental veins that leave via intervertebral foramina to join the vertebral, cranial caval, azygous, and caudal caval veins

the plexus consists of paired channels in the epidural space ventral to the cord; these veins are thin walled and have no valves (so blood can flow in either direction)

34
Q

Which veins supply oxygenated blood to the embryonic heart?

A
  1. Umbilical veins

2. Vitelline veins

35
Q

Which veins supply deoxygenated blood to the embryonic heart?

A
  1. Common cardinal veins

2. Subcardinal and supracardinal veins

36
Q

Which embryonic veins make up the hepatic sinusoids and the portal vein

A

Vitelline veins

37
Q

Which embryonic vein forms hepatic segment of CVC?

A

Right Vitelline vein

38
Q

What do the umbilical veins form?

A
  1. Left forms ductus venosus

2. Right disappears

39
Q

What do the cranial cardinal veins form?

A

Cranial vena cava

Internal and external jugular veins

KL Boards (12 decks)

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