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Cardiopulmonary Exam 1 > Embryological Development of Cardiovascular system Dr. Cole > Flashcards

Embryological Development of Cardiovascular system Dr. Cole Flashcards

1
Q

Timeline: cardiovascular plan begin week ___ and present by week _____

A

3 and present by week 4

first system to develop

embryo can no longer meet nutritional or oxygen needs by diffusion

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2
Q

Development of CVS begins with the migration of _____ cells toward the _____

A

epiblast cells toward the primary heart field

cardiac progenitor cells = epiblast cells

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3
Q

where is the primary heart field?

A

surrounding the cranial neural folds

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4
Q

PHF cell migration

A

during migration they are specified to form left AND right sides:

this includes atria, left ventricle and some of the right ventricles

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5
Q

PHF forms the

A

atria, left ventricle and some of the right ventricle

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6
Q

SHG

A

secondary heart field, responsible for forming outflow tract

consisting of conus cordis amd truncus arteriosus

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7
Q

patterning of cardiac progenitor cells

A

occurs at the same time patterning of the rest of the embryo does

PITX2 programs heart cells in the primary and SHFs

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8
Q

gene/transcription factor PW that leads to development of PHF and SHF

A

5HT –> FGF8 –> Nodal/Lefty –> PitX2

PITX2 master gene for left sidedness

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9
Q

PITX2 problems —> (causes and outcomes)

A

SSRIs taken by new mothers —> interrupt PITX2 leding to heart defects

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10
Q

“a horseshoe shaped endothelial lined tube surrounded by myoblasts”

A

cardiogenic center formed when blood islands merge

this process begins when PHF progenitor cells are induced to form blood islands and cardiac myoblasts.

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11
Q

_____ tubes fuse to form a single primitive heart tube

A

endocardial

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12
Q

Embryonic circuit

A

series of aortic arches that connect to dorsal aortae

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13
Q

Cardinal veins

A

anterior and posterior cardinal veins drain developing embryo

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14
Q

“nursery for blood cells”

A

yolk sac

vitelline: supply and drain yolk sac “nursery for blood cells”

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15
Q

what veins drain into the sinus venosus

A

the anterior and posterior cardinal veins –> common cardinal vein –> sinus venosus

umbilical veins —> sinus venosus
vitelline —> sinus venosus

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16
Q

the embryonic vascular circuit is converted into

A

system and pulmonary portions

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17
Q

Embryonic structure and adult derivative

Truncus arteriosus —>

A

aorta, pulmonary trunk

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18
Q

Embryonic structure and adult derivative

Bulbus cordis —>

A

smooth part of right ventricle (conus cordis)

smooth part of the left ventricle (aortic vestibule (arotic vestibule)

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19
Q

Embryonic structure and adult derivative

Primitive ventricle

A

trabeculated part of left and right ventricles

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20
Q

Embryonic structure and adult derivative

Primitive atrium

A

Trabeculated part of right and left atria (auricles)

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21
Q

Embryonic structure and adult derivative

Sinus venosus

A

smooth part of the right atrium (sinus venarum), coronary sinus, oblique vein of left atrium

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22
Q

Blood flow through embryo

1 —> sinus venosus –> 2 —> 3 —-> 4

A 
umbilical veins (from placenta)
common cardinal vein (embryo)
vitelline veins (yolk sac)
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23
Q

endocardial tube formation

Venous end is specified by

A

RA

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24
Q

endocardial tube formation

lower concentrations of RA specify

A

more anterior structures; ventricles amd outflow tract

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25
Q

by day 22, the fastest growing structures are

A

the truncus arteriosis
bulbus cordis
primitive ventricle

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26
Q

endocardial tube formation

what is it, and what does it become and how does it relate to the heart

A

it’s a primitive tube that arises out of blood islands combining

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27
Q

Day 23: the day the

A

endocardial tube begins to loop under the influecne of PITX2

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28
Q

the primitive ventricle and aorta bend around one another in which directions?

A

the ventricle bends inferiorly and the aorta bends superiorly making an S shape

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29
Q

the “shape” of the cardiac looping goes from ___ to ___

A

C to S

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30
Q

where is the fulcrum of bending in the primitive heart occur?

A

in the primitive ventricle: makes a V around an invisible fulcrum

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31
Q

Dextrocardia

A

heart is supposed to bend toward the left but in this condition the heart bends to the right and there is transposition of the great vessels

most common positional abnormality

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32
Q

Dextrocardia can occur at two times

A

during gastrulation or cardiac looping

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33
Q

Endocardial cushions

A

after folding, there is a narrow passage between PA and PV

dorsal and ventral blocks of tissue grow together

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34
Q

development of the tricuspid and bicuspid valves

A

the narrow AV cannel is formed after looping. dorsal and ventral masses fuse and separate Left and Right AV canals

“endocardial cushions” are the masses that

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35
Q

the critical “first step” in the formation of the 4 chambered heart

A

atrioventricular communis: fusion of endocardial cushions

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36
Q

Atrioventricular communis:

A

defect that occurs when the endocardial cushions fail to fuse, limits amount of blood that reaches the lungs

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37
Q

the effects of a common AV canal

A

enlargened pulmonary artery, decreased pulmonary resistance than in systemic circulation

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38
Q

Interventricular septum formation

A

Two parts: muscular portion devleoping in the midline of the floor of the primitive ventricle

grows upward towards endocardial cushions and down toward bulbar ridges

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39
Q

what defect results when the muscular midline of the interventricular septum fails to fuse

A

the r and l ventricles are not separated

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40
Q

most ventricular septal defects occur in the

A

the muscular portion (which are supposed to spontaneously close)

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41
Q

what kind of ventricular septum defect is most often correct by surgery?

A

membranous defect

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42
Q

VSD

A

ventricular septal defect

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43
Q

VSD causes

A

left to right ventricular shunting

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44
Q

acyanotic

A

(left to right shunting)

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45
Q

VSD pressure causes

A

increased blood flow to heart causes LF to fill —>

pressure causes blood to go into R ventricle —> R ventricle compensates by having to work harder and hypertrophying

46
Q

Conduction effects associated with VSD

A

VSD doesnt effect the ventricular bundle branches almost at all. it is very rare.

47
Q

Atrial septum formation: primums

A

foramen primum is the duct connecting the early atrias

the septum primum is the outgrowing walling superior to the atria

48
Q

Atrial septum formation: secundum

A

the second event is a mass in the middle of the atria primum creating two new openings between the atria

foramen secundum and foramen primum

49
Q

Atrial septum formation: endocardial cushion

A

grow up to merge with the primum, leaving a secundum

50
Q

sequence of foramen formation

A

foramen primum —> foramen primum + foramen secundum —> foramen secundum + outgrowing septum primum —> foramen ovale + upper and lower septum secundum

51
Q

what structures make up the formane ovale?

A

the upper and lower arms of the septum secundum

52
Q

Before birth there’s a foramen ovale. describe the pressure differentials allowing it to work

A

Right atrium has greater pressure causing the foramen ovale shunt to open to the left atrium, which has a lower pressure

53
Q

What is the “valve” between the atria that opens and closes before birth? What are the walls?

A

the arm of the septum primum = valve

upper/lower arms of septum secundum = walls of shunt

54
Q

Foramen ovale —> adult structure

A

fossa ovalis

55
Q

adult heart, LIMBUS =

A

septum secundum

56
Q

adult heart, Fossa ovale =

A

septum primum, the floor

57
Q

valve of the fossa ovale is the ____ while the floor of the fossa ovale is the

A

septum primum

septum secundum

58
Q

atrial septal defects (ASD) : 3 kinds

A

defect in the foramen primum “ostium primum”
defect is similar to one in endocardial cushion

defect in secundum: foramen ovael and septum primum

defect in sinus venosus, usually near openings of SVC

59
Q

Mutations in TBX5 cause

A

thumb anomaly and atrial septal defects. can also impact VSD

60
Q

Sinus Venosus: the changes, and components

A

initially opens dorsally into the primitive atrium, L/R equl
then the R gets bigger L –> R

Shunts involve “nutritional” and embryonic circuits

61
Q

nutritional circuits include

A

vitelline and umbilical

62
Q

embryonic circuit includes

A

cardinal veins

63
Q

Shunt 1 Vitelline Veins

A

liver develops in septum transversum, and is flanked on both sides by vitelline veins

veins grow into liver initially as hepatic sinusoids, veins, IVC, and some GI

64
Q

Shunt 2 Umbilical

A

no direct connection with the heart by converting its liver connection into the ligamentum teres heptis

65
Q

Umbilical vein —> ______ —> ______

A

ductus venosus —> IVC

bypasses liver and directs blood to heart

66
Q

ductus venosus

A

connects umbilical vein with IVC

67
Q

which horn of the sinus venosus enlargens

A

Right horn

68
Q

what primitive structure does the “future superior vena cava” grow into?

A

right horn of the sinus venosum

69
Q

what happens to the sinus venosus?

A

vitelline veins are absorbed into the GI system

umbilical veins are re-routed to utilize the ductus venosus to bypass the liver without having a direct connection to the right atrium

70
Q

what happens to the cardinal veins?

A

Anterior cardinal veins become connected,

anastomosis becomes left brachiocephalic vein

right anterior cardinal and common cardinal become SVC

71
Q

why does the right horn of the sinus venosus get larger?

A

because there’s shunting of the blood to the right atrium

72
Q

Coronary sinus =

A

remnant of Left Horn of sinus venosus

73
Q

sinus venosus becomes the

A

smooth part of the right atrium

74
Q

left horn of sinus venosus

A

becomes coronary sinus, oblique vein of the left atrium

75
Q

Crista terminalis marks the

A

division between sinus venosus and embryonic primitive atrium and auricles

76
Q

truncus arteriosus becomes partitioned to become

A

the aortic and pulmonary semilunar valves

77
Q

partition of the AV canal will form the

A

bicuspid and tricuspid valves

78
Q

neural crest cells migrate to ridges of truncus arteriosus

A

here they contribute to formation of truncus ateriosus

and bulbis cordis

79
Q

Aorticopulmonary septum

A

it twists like a pretzl, making the twisting arrangement of the pulmonic trunk and the aorta

80
Q

the distal aspect of the aorticopulmonary septum has to connect to the

A

endocardial cushions and interventricular septum

81
Q

Eisenmenger’s Syndrome

A

incomplete fusions of bulbar ridges —> inferior VSD

82
Q

there’s a proliferation in intima and media that narrows the lumen in

A

eisenmenger’s syndrome, causes increased pulmonary resistance, causes R–>L shunt cyanosis

83
Q

Tetralogy of Fallot

A

Pulmonary stenosis,
VSD
overriding aorta
Rt. Ventricular hypertrophy

ventricular defect that causes septal in R atrium to remain unfused, so blood is shunted directly into the aorta

84
Q

Arterial System: aortic arches

A

6 pairs of aortic arches

connect the aortic sac and truncus arteriosus to the dorsal aortae

pharyngeal arches organize development of head and neck

85
Q

Aortic Arche 1

A

Contribute to maxillary arteries

86
Q

Aortic Arche 2

A

produce stapedial and hyoid arteries

87
Q

Aortic Arche 3

A

Common Carotid arteries and proximal portion of the internal carotid arteries

88
Q

Aortic Arche 4

A

persists after birth to connect dorsal aorta to ventral aorta = aortic arch

on the right it forms the proximal portion of the right subclavian artery

89
Q

Aortic Arch 5

A

lost, does not develop into anything known

90
Q

Aortic Arch 6

A

Proximal portions develop into pulmonary arteries; distal portion develops into the ductus arteriosus

91
Q

Ductus Arteriosus: what compound is required to sustain it during development?

A

PGE2, prostaglandin 2 by the ductus

92
Q

what kind of medication would a pregnant woman avoid in order to prevent the ductus arteriosus from closing off?

A

NSAIDs: they interfere with prostaglandins

93
Q

Patent Ductus Arteriosus

A

failure of ductus arteriosus to close after birth

94
Q

Branches of the Aorta

cervical intersegmentals —>

A

vertebral arteries

95
Q

Branches of the Aorta

seventh intersegmentals —>

A

subclavian arteries

96
Q

Branches of the Aorta

thoracic intersegmentals —>

A

intercostal arteries

97
Q

Branches of the Aorta

lumbar intercostals —>

A

iliac arteries

98
Q

Branches of the Aorta

lateral segmental branches —>

A

adrenals, renal, gonadal arteries

99
Q

Branches of the Aorta

ventral segmental branches (vitelline and allantoic) —->

A

vitelline —> GI, celiac, superior and inferior mesenteric arteries

allantoic —> umbilical arteries

100
Q

Vitellin veins become the

A

part of IVC, hepatic veins/sinusoids, ductus venosus, portal, superior/inferior mesenteric ans splenic veins

101
Q

TAPVR

A

Total Anomalous Pulmonary Return

102
Q

TAPVR: supracardiac

A

pulmonary veins drain to the right atrium via superior vena cava

103
Q

TAPVR: Cardiac

A

pulmonary veins come together behind heart, drain into right atrium via coronary sinus

104
Q

TAPVR: Infracardiac

A

pulmonary veins drain to the right atrium via hepatic liver veins and IVC

105
Q

All TAPVRs have AT LEAST an

A

ASD

106
Q

what happens to an embryo with a TAPVR who lacks an ASD?

A

baby will die because blood cant be shunted to left side of the heart

107
Q

Right Aortic Arch malformation

A

persistence of right 4th arch distal to the right subclavian

left segment is caudal to left subclavian disappears

isolated

situs inversus complex

108
Q

Doubt Aortic Arch

A

4th aortic arch caudal to right subclavian persists ,creating a vascular ring around trachea and esophagus

109
Q

Coarctation of Aorta

A

Aorta narrows right near ductus arteriosus

110
Q

once PHF cells are established, what happens

A

underlying pharyngeal endoderm induces the cells to form cardiac myoblasts and blood islands through the process of vasculogenesis

111
Q

why do blood islands unite?

A

to form the horseshoe shaped endothelial lined tune surrounded by myocytes called the “cardiogenic region”

Cardiopulmonary Exam 1 (21 decks)

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