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First Aid > Cardiovascular - Embryology and Anatomy > Flashcards

Cardiovascular - Embryology and Anatomy Flashcards

1
Q

Heart embryology:
Each of these embryonic structures gives rise to…

  • Truncus arteriosus (TA)
  • Bulbus cordis
  • Primitive atria
  • Primitive ventricle
  • Primitive pulmonary vein
  • Left horn of sinus venosus (SV)
  • Right horn of SV
  • Right common cardinal vein and right anterior cardinal vein
A
  • Truncus arteriosus (TA)
    • Ascending aorta and pulmonary trunk
  • Bulbus cordis
    • Smooth parts (outflow tract) of left and right ventricles
  • Primitive atria
    • Trabeculated part of left and right atria
  • Primitive ventricle
    • Trabeculated part of left and right ventricles
  • Primitive pulmonary vein
    • Smooth part of left atrium
  • Left horn of sinus venosus (SV)
    • Coronary sinus
  • Right horn of SV
    • Smooth part of right atrium
  • Right common cardinal vein and right anterior cardinal vein
    • SVC
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2
Q

Heart morphogenesis

  • General
  • Cardiac looping
  • Dynein
A
  • General
    • First functional organ in vertebrate embryos
    • Beats spontaneously by week 4 of development.
  • Cardiac looping
    • Primary heart tube loops to establish left-right polarity
    • Begins in week 4 of gestation.
  • Dynein
    • Defect in left-right dynein (involved in L/R asymmetry) can lead to dextrocardia, as seen in Kartagener syndrome (primary ciliary dyskinesia).
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3
Q

Septation of the chambers:
Atria (262)

A
  1. Septum primum grows toward endocardial cushions, narrowing foramen primum.
  2. Foramen secundum forms in septum primum (foramen primum disappears).
  3. Septum secundum develops as foramen secundum maintains right-to-left shunt.
  4. Septum secundum expands and covers most of the foramen secundum.
    • The residual foramen is the foramen ovale.
  5. Remaining portion of septum primum forms valve of foramen ovale.
  6. Septum secundum and septum primum fuse to form the atrial septum.
  7. Foramen ovale usually closes soon after birth because of increased LA pressure.
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4
Q

Septation of the chambers:
Ventricles

A
  1. Muscular ventricular septum forms.
    • Opening is called interventricular foramen.
  2. Aorticopulmonary septum rotates and fuses with muscular ventricular septum to form membranous interventricular septum, closing interventricular foramen.
  3. Growth of endocardial cushions separates atria from ventricles and contributes to both atrial septation and membranous portion of the interventricular septum.
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5
Q

Septation of the chambers:
Problems

  • Patent foramen ovale
  • Ventricular septal defect (VSD)
A
  • Patent foramen ovale
    • Caused by failure of septum primum and septum secundum to fuse after birth
      • Most are left untreated.
    • Can lead to paradoxical emboli (venous thromboemboli that enter systemic arterial circulation), similar to those resulting from an ASD.
  • Ventricular septal defect (VSD)
    • Most commonly occurs in the membranous septum
    • Acyanotic at birth due to left-to-right shunt.
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6
Q

Septation of the chambers:
Outflow tract formation

  • Formation
  • Conotruncal abnormalities:
A
  • Formation
    • Truncus arteriosus rotates
    • Neural crest and endocardial cell migrations Ž
    • –> truncal and bulbar ridges that spiral and fuse to form aorticopulmonary septum
    • Ž–> ascending aorta and pulmonary trunk.
  • Conotruncal abnormalities:
    • Transposition of great vessels.
    • Tetralogy of Fallot.
    • Persistent truncus arteriosus.
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7
Q

Septation of the chambers:
Valve development

  • Aortic/pulmonary
  • Mitral/tricuspid
  • Valvular anomalies
A
  • Aortic/pulmonary
    • Derived from endocardial cushions of outflow tract.
  • Mitral/tricuspid
    • Derived from fused endocardial cushions of the AV canal.
  • Valvular anomalies
    • May be stenotic, regurgitant, atretic (e.g., tricuspid atresia), or displaced (e.g., Ebstein anomaly).
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8
Q

Fetal erythropoiesis occurs in…

A
  • Young Liver Synthesizes Blood.
  • Yolk sac (3–8 weeks)
  • Liver (6 weeks–birth)
  • Spleen (10–28 weeks)
  • Bone marrow (18 weeks to adult)
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9
Q

Hemoglobin development (264)

  • From fetal to adult hemoglobin
  • HbF
A
  • From fetal to adult hemoglobin:
    • Fetal hemoglobin (HbF) = α2γ2.
    • Adult hemoglobin (HbA) = α2β2.
    • Alpha Always; Gamma Goes; Becomes Beta.
  • HbF has higher affinity for oxygen due to less avid binding of 2,3-BPG.
    • This allows HbF to extract oxygen from (HbA) maternal hemoglobin across the placenta.
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10
Q

Fetal circulation

  • Blood in…
    • Umbilical vein
    • Umbilical arteries
  • 3 important shunts
A
  • Blood in…
    • Umbilical vein has a PO2 of ≈ 30 mmHg and is ≈ 80% saturated with O2.
    • Umbilical arteries has low O2 saturation.
  • 3 important shunts
    1. Blood entering the fetus through the umbilical vein is conducted via the ductus venosus into the IVC to bypass the hepatic circulation.
    2. Most highly oxygenated blood reaching the heart via the IVC is diverted through the foramen ovale and pumped out the aorta to the head and body.
    3. Deoxygenated blood entering the RA from the SVC
      • Goes: RA Ž–> RV –>Ž main PA –>Ž patent ductus arteriosus Ž–> descending aorta
      • Due to high fetal pulmonary artery resistance (due partly to low O2 tension).
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11
Q

Fetal circulation

  • At birth when infant takes a breath
  • Indomethacin
  • Prostaglandins E1 and E2
A
  • At birth when infant takes a breath
    • Decreased resistance in pulmonary vasculature causes increased left atrial pressure vs. right atrial pressure
    • Foramen ovale closes (now called fossa ovalis)
    • Increases in O2 (from respiration) and decreases in prostaglandins (from placental separation) –>Ž closure of ductus arteriosus.
  • Indomethacin
    • Helps close PDA (patent) –>Ž DA remnant (i.e., ligamentum arteriosum).
  • Prostaglandins E1 and E2
    • Keep PDA open.
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12
Q

Fetal-postnatal derivatives

  • Umbilical vein
  • Umbilical arteries
  • Ductus arteriosus
  • Ductus venosus
  • Foramen ovale
  • Allantois
  • Notochord
A
  • Umbilical vein
    • Ligamentum teres hepatis
    • Contained in falciform ligament.
  • UmbiLical arteries
    • MediaL umbilical ligaments
  • Ductus arteriosus
    • Ligamentum arteriosum
  • Ductus venosus
    • Ligamentum venosum
  • Foramen ovale
    • Fossa ovalis
  • AllaNtois
    • Urachus-mediaN umbilical ligament
    • The urachus is the part of the allantoic duct between the bladder and the umbilicus.
    • Urachal cyst or sinus is a remnant.
  • Notochord
    • Nucleus pulposus of intervertebral disc
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13
Q

Coronary artery anatomy

  • SA and AV nodes
  • Coronary artery occlusion most commonly occurs…
  • Coronary blood flow peaks…
  • Left atrium enlargement
A
  • SA and AV nodes
    • Usually supplied by RCA.
    • Infarct may cause nodal dysfunction (bradycardia or heart block).
  • Coronary artery occlusion most commonly occurs…
    • In the LAD.
  • Coronary blood flow peaks…
    • In early diastole.
  • The most posterior part of the heart is the left atrium
    • Enlargement can cause dysphagia (due to compression of the esophagus) or hoarseness (due to compression of the left recurrent laryngeal nerve, a branch of the vagus).
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14
Q

Coronary artery circulations

  • Right-dominant circulation
  • Left-dominant circulation
  • Codominant circulation
A
  • Right-dominant circulation
    • 85%
    • PDA arises from RCA.
  • Left-dominant circulation
    • 8%
    • PDA arises from LCX.
  • Codominant circulation
    • 7%
    • PDA arises from both LCX and RCA.
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15
Q

What the coronary arteries supply

  • Left circumflex coronary artery (LCX)
  • Left anterior descending artery (LAD)
  • Posterior descending/interventricular artery (PDA)
  • Acute marginal artery
A
  • Left circumflex coronary artery (LCX)
    • Lateral and posterior walls of left ventricle
  • Left anterior descending artery (LAD)
    • Anterior 2/3 of interventricular septum
    • Anterior papillary muscle
    • Anterior surface of left ventricle
  • Posterior descending/interventricular artery (PDA)
    • Posterior 1/3 of interventricular septum
    • Posterior walls of ventricles
  • Acute marginal artery
    • Right ventricle
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First Aid (92 decks)

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