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Medicine Cardiovascular > Embryology > Flashcards

Embryology Flashcards

1
Q

Where does the heart originate?

A

It is a mesodermal structure that comes from the visceral mesoderm

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2
Q

What makes a midline tube structure in the development of the heart?

A

As the embryo folds the 2 sides of the horseshoe shape come together

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3
Q

What type of folding moves the heart down to the thoracic cavity?

A

Cranial caudal folding

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4
Q

How many dilatations does the heart tube develop?

A

5

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5
Q

Where does blood flow from and to in the embryological heart?

A

From the sinus venous at the caudal end to the truncus arteriosus at the cranial end

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6
Q

What does the truncus arteriosus form in the adult heart?

A

Aorta and pulmonary trunk

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7
Q

What does the bulbus cordus form in the adult heart?

A

Trabeculated (muscular ridges) part of the right ventricle and the outflow part of both ventricles

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8
Q

What does the embryological ventricle form in the adult heart?

A

Trabeculated part of the left ventricle

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9
Q

What does the embryological atrium form in the adult heart?

A

Trabeculated part of both atria

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10
Q

What do the sinus venosus form in the adult heart?

A

Smooth part of the right atrium and the coronary sinus

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11
Q

5 dilatations that the heart tube develops

A

Truncus arteriosus, bulbus cordus, ventricle, atrium, sinus venosus

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12
Q

On which day does the heart begin to loop and fold?

A

Day 23

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13
Q

As the heart loops and folds, what happens to the:

  • Atrium
  • Ventricle
  • Bulbus cordis
A
  • Atrium moves dorsally and cranially, which impacts the ventricle
  • Ventricle is displaced left, which impacts the bulbus cordis
  • Bulbus cordis is moved inferiorly and ventrally to the right
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14
Q

How many pairs of vessels are there in the development of the vasculature?

A

6

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15
Q

Development of the vessels:

- What do vessels 1 and 2 contribute to?

A

The neck

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16
Q

Development of the vessels:

- What do vessels 3 give rise to?

A

The common carotid arteries, first part of internal carotid artery

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17
Q

Development of the vessels:

- What does the right and left part of vessel 4 give rise to?

A

Right gives rise to subclavian artery, left contributes to part of the aortic arch

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18
Q

Development of the vessels:

- Vessel 5

A

Rudimental or absent

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19
Q

Development of the vessels:

- What does the right and left vessels from pair 6 give rise to?

A 
Right = sprout branches that form pulmonary arteries
Left = forms the ductus arteriosus
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20
Q

3 things each horn of the sinus venosus receives

A

Common cardinal vein (anterior and posterior), vitelline vein, oxygenated blood comes from the placenta via umbilical vein

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21
Q

What does most of the venous drainage in the unformed embryological heart

A

Common cardinal veins

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22
Q

What happens to the following as development of the heart progresses:

  • Umbilical veins
  • Vitelline veins
A
  • Communication between left and right umbilical veins is lost
  • The right vitelline vein gets a lot larger than the left
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23
Q

What do vitelline veins do?

A

Drain the yolk sac

24
Q

What do cardinal veins do?

A

Give systemic venous system - drain blood

25
Q

What do the umbilical veins do?

A

Brings oxygenated blood from the placenta

26
Q

What do the vitelline veins develop into in the adult heart?

A

Portal venous system draining gut, hepatic sinusoids and veins, hepatic portions of IVC

27
Q

What do the anterior cardinal veins drain?

A

Head and neck

28
Q

What do the anterior cardinal veins develop into in the adult heart?

A

Jugular system, left brachiocephalic vein, SVC

29
Q

What do the posterior cardinal veins drain?

A

Trunk

30
Q

What do posterior cardinal veins develop into in the adult heart?

A

Azygous and hemiazygous systems (body wall), gonadal and renal veins, iliac veins, IVC

31
Q

Placental functions

A
  • Foetal homeostasis
  • Gas exchange
  • Acid base balance
  • Nutrient transport to the foetus
  • Waste product transport from the foetus
  • Hormone production
  • Transport of IgG – provide immunity to infectious disease after birth
  • PGE2 (prostaglandin E2) – important in maintaining foetal circulation
32
Q

Where does the placenta sit?

A

End of the umbilical cord. Cross section of the umbilical cord with 2 arteries and 1 vein

33
Q

What does the foetal heart pump blood to the placenta via?

A

Umbilical arteries

34
Q

What does the blood from the placenta return to the foetus via?

A

Umbilical veins

35
Q

3 “shunts” specific to foetal life

A

Ductus venosus, foramen ovale, ductus arteriosus

36
Q

What does the ductus venosus connect?

A

Connects the umbilical vein to the IVC

37
Q

What is the foramen ovale?

A

An opening in the atrial septum connecting the right atrium to the left atrium

38
Q

Function of the foramen ovale

A

Allows oxygenated blood to go into the left atrium, then left ventricle then out the aorta

39
Q

What does the ductus arteriosus connect?

A

Connects pulmonary bifurcation to the descending aorta

40
Q

Function of the ductus venosus

A

Carries the majority of the placental blood straight to the IVC bypassing portal circulation

41
Q

What maintains patency of the ductus arteriosus?

A

Circulating prostaglandin E2 produced by the placenta

42
Q

Adaption of the pulmonary system just after birth

A

Baby inflates lungs and cries and goes from blue to pink, the cord stops pulsating and is clamped shut, the fluid within the lungs gets pushed out of the alveoli when the baby cries and it is reabsorbed by the lymphatic system and the alveoli are able to be filled with air

43
Q

Circulatory changes after birth

A

Decreased pulmonary vascular resistance, increased systemic vascular resistance, more cardiac output to lungs

44
Q

What causes decreased pulmonary resistance after birth

A

The breath in causes the lungs to physically expand, and there is increased circulating oxygen. In lung circulation the oxygen is a vasodilator and this causes decrease in pulmonary resistance

45
Q

How does the foramen ovale close after birth?

A

Pulmonary vascular resistance falls, systemic vascular resistance rises and this causes the left atrial pressure to exceed the right atrial pressure and the flap is pushed closed

46
Q

What causes ductus arteriosus constriction after birth?

A

Increased pO2, decreased flow and decreased prostaglandin

47
Q

What does the ductus arteriosus end up as?

A

Fibrous ligament - ligamentum arteriosum

48
Q

Treatment options for failure of ductus arteriosus closure

A

Wait and see (often close by themselves), NSAIDs, surgery

49
Q

What can be used to keep the ductus arteriosus open when there is ‘duct dependent circulation’

A

IV prostaglandin E2 until an alternative shunt is established or definitive surgery is carried out

50
Q

When does pulmonary resistance reach ‘normal’ adult-type levels?

A

By 2-3 months

51
Q

What causes persistent pulmonary hypertension of the newborn

A

Lung vascular resistance fails to fall as shunts remain (foramen ovale and ductus arteriosus)

52
Q

Risk factors for persistent pulmonary hypertension of the newborn

A

Sepsis, hypoxic ischaemic insult, meconium aspiration syndrome, cold stress

53
Q

Oxygen saturation in baby’s hand vs baby’s foot in persistent pulmonary hypertension of the newborn

A

Both low:

  • Baby’s hand = 80%
  • Baby’s foot = 60%
54
Q

Signs and symptoms of persistent pulmonary hypertension of the new born

A

Blue baby with low oxygen saturations

55
Q

Management of persistent pulmonary hypertension of the newborn:

  • Reduce pulmonary vascular resistance
  • Increase systemic vascular resistance
A
  • Reduce PVR = oxygen, ventilation, sedation, thermoregulation, correction of acidosis, treatment of sepsis, inhaled NO
  • Increase SVR = maintain blood pressure, inotropes, support of other organ function, extra corporeal life support in severe cases

Medicine Cardiovascular (24 decks)

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