deck_4452279 Flashcards by Harry Bhullar

primitive vertebrate CV plan begins.. and present by..

begins mid-week 3 present by week 4

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as they migrate PHF cells specified to form left and righ t sides of heart and to form

atrialeft ventricle part of right ventricle

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secondary heart field (SHF) forms

remainder of right ventricleoutflow tract - conus cordis and truncus arteriosus

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the 5HT PITX2 pathway specificies .. and programs..

left side of bodyprograms heart cells in priamry and SHFs

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master gene for left sidedness

PITX2

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patterning of cardiac progenitor celsl occurs at the same time as

laterality (left-right sidedness) is established

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circuit that supplies and drains the yolk sac ; separate from umbilical artery and vein; called the “nursery for blood vessels”

vitelline vein and artery

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features of embryonic circuit

series of aortic arches connecting to dorsal aortae - d. aortae subdivides into smaller vessels to supply embryo- blood drained by anterior and posterior cardinal veins- common cardinal vein

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bulbus cordis consists of

truncus arteriosusconus cordis

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sinus venosus gives rise to

smooth part of right atrium (sinus venarum)coronary sinusoblique vein of left atrium

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primitive atrium gives rise to

trabeculated part of right and left atria (auricles)

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primitive ventricule gives rise to

trabeculated part of right and left ventricles

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bulbus cordis gives rise to

conus cordis: smooth part of right ventricleaortic vestibule: smooth part of left ventricle

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truncus arteriosus gives rise to

aorta, pulmonary trunk

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blood flow in embryonic dilation

sinus venosus —> primitive atrium –> primitive ventricle –> bulbus cordis —> truncus arteriosus

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more anterior structures (ventricles and outflow tract) are specified as such because of

lower RA concentrations

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cardiac looping, the correct folding of heart (due to its rapid growth) is controlled by

PITX2 and the laterality pathwayif messed, heart could fold in different direction (could still work just fine)

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grow the fastest during cardiac looping

ventricles and outflow tract

dextrocardia caused by - presents as - can be found with - when does it occur embryologically?

heart bends to left instead of right- displaced to right with transposition of heart and great vessels- most common positional abnormality- can be found with situs inversus- during gastrulation or later during cardiac looping

large ocmmunication between chambers that occurs when endocardial cushions fail to fuse – called? what does it result in? blood flow? treatment?

atrioventricular communisresults in common AV canalgiant atrial and ventricular septal defectenlarged pulmonary trunk (less resistance in pulmonary circ. vs. systemic so all blood flows through there)- Tx - put band on pulmonary artery to tie it off (lungs less congested now), then patch between right and left chambers then divide the one valve into two valves

formation of interventricular septum

2 parts:muscular portion devleoping in midline on floor of the PV; growing upward towards ECC - bublar ridges growing downwards to ECC

most VSDs occur in

muscular portion but close spontaneously!

most commonly, surgically corrected VSD defects

membranous!

opening between L & R ventriclesassociated shunting of blood

ventricular septal defects (VSDs)

presenting baby, signs of cyanosis at 1 year check up right ventricle has hypertrophied; signs of pulmonary congestion and edemaauscultation and US shoe normal valvesdiagnosis? disease mechanism?

VSD!- initial lung inflation, RV pressure decreases- get left to right shunting (acyanotic) - causes increased work by RV, hypertrophy and eventual, right-to-left shunting ---> cyanosis- rate depends on size of VSD

vsd 2 facts

25% of congenital heart defects4 types based on position and severity

which types of VSDs can have more significance for conudciton

centralproximalbasal

valve of foramen ovale is derived from

septum primum

foramen ovale upper boundary and lower boundary

upper: septum secundum (upper limb)lower: septum primum

foramen ovale once fused is called

fossa ovalis

RA features in terms of fossa ovale

limbus (septum secundum)fossa ovale( floor, septum primum)

LA features in terms of fossa ovale

fossa ovale (floor, septum SECUNDUM)valve of fossa ovale (septum primum)

ASD, stats, types of defects and what they involve

ASD - common, 10-15% of congenital heart defectsostium (foramen) primum defects - similar to ECC defectssecundum type - involve foramen ovale and septum primum sinus venosus - usually near opening of SVC

ASD is a characteristic finding in this TBX5 gene mutation

Holt-Oram SYndrome [ H for heart!! ]- abnormality of upper extremities- can also have VSD

in the embryo:nutritional circuits are(intra) embryonic circuits are..

nutritional: vitelline and umbilicalintra: cardinal veins

connects umbilical vein with IVC

ductus venosus

marks division between embryonic sinus venosus and embryonic primitive atrium (auricles)

crista terminalis

SVC derived from joining

right anterior cardinal and common cardinal v. via brachiocephalic vein anastamosis

embryo starts out getting drained by umbilical vein, vitelline veins and common cardinal but once sinus venosus is finished developing, we are left with these 3 vessels drianing what

SVC - head & neckIVC - placenta and caudal regions of embryocoronary sinus - heart itself

partition of this forms the aortic and pulmonary semilunar valves

Truncus Arteriosus!

disease pathology of eisenmenger's syndrome; whats failed to form/ fuse? how is the blood shunting initially? later? why?

- equal division of truncus, incomplete fusions of bulbar ridges inferiorly --> VSD - initial L --> R shunt, increased pulmonary blood flow and hypertension- prolif. in intima and media to narrow lumen- increased pulmonary resistance causes R to L shunt and cyanosis

tetralogy of fallotwhat is IT?components? how/ why do they develop?

- pulmonary stenosis- VSD [blood being shunted from right to left ventricle into the aorta]- overriding aorta- rt. ventricular hypertrophy [pulmonary trunk too small so ventricle hypertrophies to compensate][PS listen to H.O.V. ]

breathing new born exhibits severe cyanosis immediately after birth and dies- boh ventricles of normal size, no A or V septal defects- lungs of normal size and well inflateddiagnosis?

transposition of great vessels