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HE Test 3 > HE 24 & 25 Great Vessels and Heart > Flashcards

HE 24 & 25 Great Vessels and Heart Flashcards

1
Q

draw embryological heart and arches, include all labels and blood flow

A

Aortic arches/aortic sac

truncus arteriosus

dorsal aorta

heart tube

sinus venosus

sinus horns

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2
Q

development of arches:

A

associated with paired pharyngeal arches located on future neck

five arches (six originally) but number 5 is transient so we refer to 1,2,3,4,6

arches not all present at the same time, form cranial to caudal, cranial gone or rearranged before caudal develope.

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3
Q

Rearrangement of arches to great arteries

A

draw new orientation of aortic arch

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4
Q

Recurrent Laryngeal positioning

A

Number 6 right branch is re-routed allowing right recurrent laryngeal to slip up to subclavian vein.

left stays by ligamentum arteriusum and aortic arch, curves posteriorly towards arch.

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5
Q

Coarctation of Heart

A

stenosin or constriction of the aortic arch

cause: unknown, possibly genetic with downs or turners

associated with cardiac valve defects and can go undagnosed until adult.

varies in severity

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6
Q

preductal coractation

A

not as common less than 5%

  • just before ductus arteriosis
  • blood to head and neck normal, ductus arteriosis must supply blood to lower half before birth

BIRTH-FO closes and so should ductus arteriousus
-andministered prostoglandin E2 to keep duct open until repair and be made

  • differential cyanosis: blue tint on legs and lower half but not the head.
  • all blood to lower half mixed, and more venus blood than o2 blood
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7
Q

postductual coarctation

A

less common, just after ductus arteriosus

  • blood to h&E are fine
  • EXTENSIVE collateral circulation is developed prior to birth.

Typically enlargement of internal thoracic and intercostal arteries to re-route blood supply.

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8
Q

Draw early sinus horns to the sinus venarum

A

include three main veins draining in

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9
Q

draw reconfiguration

A

left UV and VV and right Umbilical V all removed

left to right shift

R cardinal inlets become superior and inferior vena cava

left sinus horn becomes coronary sinus out of left cardinal inlet

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10
Q

cardinal vein adult derivatives

A

inlets (come from A/P and YS) to heart to become internal jugular vv
subclavian vv
brachiocephalic vv

most of IVC

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11
Q

overview of heart histology (3 layers)

A

Tunica Intima-endocardium

  • endothelium: simple squamous
  • subendothelial: CT layer

Tunica Media-myocardium
-cardiac muscle

Tunica Adventitia-epicardium
-loose CT and adipose tissue (CA’s)

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12
Q

Cardiac valves

A

specialization of endocardium (TI)

  • extensions of fibroelastic tissue deep to endothelium, covered on lumen surface by endothelium
  • stains blue in Trichrom….collagen?
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13
Q

purkinje fibers

A

like islands withing the subendocardial layer

-layer order: lumen-subendothelial-subendocardial-myocardium

large pale moth eaten cells, modified cardiac muscle fibers
-few myofilaments, not contractile, for heart conduction

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14
Q

timeline overview of heart development

A

week 3:heart and embryonic BV’s forming

  1. embryonic circulation established
    - heart begins to beat
    - cardiac loop complete
  2. partitioning of heat to four chambers
  3. aortic arches undergo primary changes

8 formulation of heart valves completed

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15
Q

Formation of heart

A

Primary heart field: horse shoe shaped cells around cephalic end of embryo

-cells migrated out of the cephalic end of the primary streak (progenitor heart cells) as epiblast left and right sides (invaginated through streak into visceral mesoderm.

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16
Q

creation of PHF interaction of factors

A

Interaction between endoderm and visceral mesoderm @ cranial end

BOTH endoderm and VM secrete BMP2,4 (bmp4 increases FGF8 production-important for expression of cardiac genes)

endoderm secretes Crescent and Cerberus (blocking WNT proteins)

-as a result of BMP & C & C visceral mesoderm driven to NKX2.5 expression which is required for cardiac primary heart field

DRAW

17
Q

PHF established (whats next before folding)

A

PHF: cardiogenic region

cells induced to form

  • cardiac myoblasts
  • angioblasts

new blood vessels coalesce into Heart Tube with R&L portions surrounded by cardiac myoblasts

18
Q

Cephalocaudal Body Folding

A

week 3-4

  • due to differential growth mainly from the neural tube
  • moves heart into position, head end, to cervical end, to thoracic end
  • pericardial cavity flipped to bottom, and gut tube begins forming over top. up to oropharyngeal membrane (look up)
19
Q

lateral body folding

A

weeks 3-4

-due to differential growth mainly from SOMITES

-thoracic region: R&L sides come to gether each with their own portion of pericardial vacity
=fuse tubes of dorsal aorta and make one pericardial vacity

20
Q

Hear forming from two heart tubes

A

result of lateral folding, lumen fuse together (fused EC) and lined by endothelium

cells micrate from the tissues on the surface of the septum transversum and sinus horns to make the epicardium

heart begins to BEAT

21
Q

Secondary Heart field

A

after primary heart field forms, SHF forms more medially, reverse horseshoe.
-made from additional cardiogenic cells of the visceral mesoderm

cephalocaudal folding results in SHF around the PHF

-will become the outflow and inflow structures

associated with pharyngeal arches and developing neck region, and dorsal surface of fused heart

-neural crest associated

  1. cushion tissue formation
  2. SLV formation
  3. control of SHF contributions to card looping
22
Q

cardiac looping beginning

A

Ends week 4

  • creates adult orientation
  • differentiates heart tube regions, heart parts

begins with tube with slight constrictions and slight dilations with just inflow and outflow

Conotruncal Region

  • Truncus arteriosus
  • conus cordis

Bulbous Cordis

Primative Ventricle

Primitive Atria

Sinus venosus

sinus horns

23
Q

Cardiac looping in process

A

rapid growth of outflow end causes lengthening and twisting of the tube around central axis

cells where give rise to this? still unclear

CT and BC grow inferiorly

PV moves to the left

PA moves posterior and superior back to midline (SV follows)

24
Q

molecular basis for looping and dysfunction

A

PITX2

same gene driven by FGF8 making cilia nodal swept left, nodal induces lat plate mesoderm to form left side structures by promoting PITX2

dextrocardia

  • apex to the right
  • can occur alone or with situs inversus (all visceral organs)
25
Q

Sinus Venosus and Primitive Atrium Derivatives

A

Sinus venosus: smooth part of Right atrium

Primitive atrium: pectinate muscle of RA (also makes up right and L auricles

separated by crista terminalis

26
Q

Primitive Ventricle Derivatives

A

Trabeculated part of LV (majority of LV)

27
Q

Bulbous Cordis Derivatives

A

-trabeculated part of RV (majority of RV)

28
Q

Conotruncal region Derivatives

A

AA and Pulmonary Trunk

29
Q

Origin of LA

A

gradual incorporation of the pulmonary veins into the posterior wall

30
Q

Heart Partitioning

A

begins in week five with septation - forming of septa

-at the end of week four you have single atria and single ventricle. by week five all four with endocardial cushion in the middle

31
Q

Heart tube cell layers

A

epicardium

myocardium

cardiac jelly: gel like ECM (hyaluronan)

  • secreted by myoblasts
  • permints shape changes for twisting and folding
  • as heart tube matures, jelly diminishes until myocardium is adjacent to the epicardium
32
Q

cardiac jelly and cushion definition and function

A
  • endocardial cells lining the AV canal undergo EMT and migrate into the cardiac jelly within walls fo av canal and outflow tract
  • the migratory cells are CUSHION CELLS which proliferate and migrate into mesechymal filled bulges called CUSHION TISSUE or endocardial cushions

Note: in the outflow tract Neural crest cells migrate into the cardiac jelly and therefore the outflow is from both endothelial and neural crest.

33
Q

What three cushions are formed

A

A/P or V/D

R/L
R/L conotruncal

34
Q

AP cushion

A

into AV canal growing at eachother until fusion: R& L AV canal

35
Q

Formation of interatrial septum and dysfunction

A

2 septa, three foramen

Septum primum

  • forms first more to the left, Foramen (ostium) primum
  • foramen (ostium) secundum
  • thinner septum and flimsy

septum secundum: forms later and more to right

  • Foramen Ovale
  • much thicker and firm

increased pressure pushes secundum against primum

PFO-patent foramen ovale
ASD: other atrial septal defects

36
Q

Interventricular Septum foramen

A

inferior 2.3 of septum

  • thickest, muscular
  • grows up towards EC
  • leaves a gap before EC

VSD; ventricular septal defects

37
Q

Aorticopulmonary septum definition and formation

A

forms outflow: pulmonary trunk from AA in a spiral

  • completes AV septum (makes up membranous portion)
  • involved cotruncal endocardial cushions (swelling and ridges)

Cotruncal at first receives blood from both ventricles

  • blood flow causes it to twist
  • comes down to span opening,
  • conotruncal cushions come together to create divide to make aorta and pulmonary trunk
  • spirale and twists, and bisect
  • pharyngeal apparatus (CTC’s origin: NC and Endothelial)
  • grows downward while spiraling to finish AV seputm
38
Q

AV valves finish

A

by week 8

fused AP cushions, valve cusps formed from AP cushions

chordae tendinae and pap muslces outgrowth from ventricle walls not EC

Neural crest makes ap septum and SL valves
-bulges in wall of CT region

cusps hollowed SLV from CT forming SLV

AtresiaL absence of cusp

stenosis: narrowing

HE Test 3 (6 decks)

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