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Cardiopulm Exam 1 > Heart Development (EMB) > Flashcards

Heart Development (EMB) Flashcards

1
Q

What day and what week does circulation begin?

A

During the 4th week and on day 22

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2
Q

What embryonic layer is the heart primarily derived from

A

SPLANCHNIC MESODERMMMMMMMMM

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3
Q

Where do primary heart fields come from and what do they give rise to?

A

They come from the mesoderm from the primitive streak

They give rise to the left and right atria and left ventricle

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4
Q

From where does the secondary heart field develop and what does it give rise to?

A

It develops from the mesoderm from pharyngeal arches

It gives rise to the right ventricle, the outflow tract (bulbus cordis and truncus arteriosus), and part of the atria (the venous pole)

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5
Q

What is the dorsal mesocardium and what happens to it?

A

It is a mesentery (double layer of splanchnic mesoderm that provides a route for blood vessels, lymphatics and nerves) that exists at the stage when the two endocardial heart tubes fuse into one.

It disintegrates and becomes the transverse pericardial sinus, which separates the outflow tract from the venous tract

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6
Q

From where do neural crest cells migrate?

A

Pharyngeal arches 3,4,6

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7
Q

What do the neural crest cells help form?

A

They help form the bulbus cordis, truncus arteriosus, and the aorticopulmonary septa

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8
Q

What chemokines regulate cardiac neural crest migration and differentiation?

A

Retinoic Acid (Vitamin A), Hox genes, Nf-1, and PAX3

Note: too much RA when pregnant can cause heart defects, like with Acutane

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9
Q

On what day does sinus venosus form?

A

Day 23

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10
Q

What is the flow of blood in the primitive heart? (Around day 23)

A

Sinus venosus —> atrium —> ventricle —> bulbus cordis —> truncus arteriosus

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11
Q

What is called when the heart does not fold “right-handedly”?

A

It is called dextrocardia, and can elicit symptoms in the affected

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12
Q

What condition produces an asymptomatic pt with dextrocardia?

A

Sinus inversus

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13
Q

When does septation take place?

A

4th-8th week

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14
Q

How are the atrioventricular canals formed?

A

Endocardial cushions begin to form from mesoderm on the ventral and dorsal walls and begin to grow toward one another to eventually fuse, creating two canals between the atria and ventricles

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15
Q

Where do pectinate muscles originate from?

A

The original heart tube

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16
Q

Where do the smooth surfaces in the atria come from?

A

Right horn of sinus venosus

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17
Q

What arises from the left horn of sinus venosus?

A

The coronary sinus

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18
Q

What arises from the right horn of sinus venosus?

A

Smooth surfaces within the atria (sinus venarum), the orifices of the superior and inferior vena cava, the orifice for the coronary sinus, and crista terminalis

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19
Q

Explain the process of how the foramen ovale is formed

A

The septum primum grows inferiorly within the common atrium, allowing blood to flow from right to left via the ostium primum, and before the septum primum completely blocks off the flow of blood, a second hole forms higher up in the septum called the ostium secondum.

A second wall begins to grown inferiorly called the septum secondum, which helps create a right to left shunt in the atria to bypass the lungs

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20
Q

How does the foramen ovale become the fossa ovalis?

A

After birth, the pressure in the left side of the heart is greater than the right, which leads to the septum primum to push against the septum secundum and fuse togther to form the fossa ovalis

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21
Q

How is the interventricular septum formed?

A

Splanchnic mesoderm presses up towards the endocardial cushion, but doesn’t fully make it

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22
Q

What are the bulbis cordis and truncus arteriosus formed from?

A

Neural Crest cells

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23
Q

How much does the aorticopulmonary septum turn to form the outflow tract?

A

180

24
Q

What does the aorticopulmonary septum fuse with?

A

The endocardial cushion

25
Q

What structures does the bulbus cordis give rise to?

A

On the right: conus arteriosus (smooth part of the right ventricle where the blood enters the pulmonary trunk)

On the left: aortic vestibule (smooth part of the left ventricle where the blood enters the aorta)

26
Q

Where are the conotruncal ridges and what are they made from?

A

They’re in the bulbis cordis and they’re derived from neural crest

They help form the aorticopulmonary septum

27
Q

How is the membranous portion of the interventricular septum formed?

A

The right and left bulbar ridges (conotruncal) merge down to the endocardial cushion, which eliminates the interventricular foramen

28
Q

What does the membranous interventricular septum separate?

A

Left and right ventricles

ALSO left ventricle and right atrium

29
Q

Where do the cardiac valves form?

A

Between the truncal and bulbar ridges

30
Q

How do valves form?

A

There are dorsal and ventral valve swellings made of mesoderm and neural crest cells, and the blood flow washing backwards eventually erodes the folds into cusps with their associated sinuses

31
Q

What kind of shunts are acyanotic? How about cyanotic?

A

Left to right are acyanotic

Right to left are cyanotic

32
Q

Describe fetal circulation

A

Blood is shunted from the right atrium to the left atrium, down into the left ventricle and out of the aorta

Blood can also get into the right ventricle and get pumped through the pulmonary trunk into the lungs to help further develop them, but it can also be transferred through the ductus arteriosus back into the aorta/systemic circulation

33
Q

Is a patent ductus arteriosus acyanotic or cyanotic? Why?

A

Acyanotic, because there is still oxygen-rich blood being circulated and there is a left to right shunt. So the oxygen-rich blood is being pumped back into the oxygen-poor blood

34
Q

How can PDA be treated?

A

With a COX-2 inhibitor (like ibuprofen or indomethacin) because COX-2 is an enzyme that promote prostaglandin production, which promotes the PDA to stay open (vasodilator)

35
Q

What are characteristics of a pt with PDA?

A

Continuous “machinery-like” murmur, poor eating, sweating with crying or eating, tachycardia, easily tired, tachypnea, pulmonary hypertension (which can destroy capillaries in the lungs)

36
Q

What is an atrial septal defect?

A

A patent foramen ovale (can vary in severity) and is highly associated with Down’s

Due to excessive cell death of the septum primum or poor development of the septum secundum

37
Q

What are the most common septal defects?

A

Ventricular (more specifically membranous)

38
Q

Are ventricular septal defects acyanotic or cyanotic? Why?

A

Acyanotic, because the oxygen-rich blood is mixing with the oxygen-poor blood as it enters into the left ventricle since it flows back into the right ventricle

39
Q

What are the sx of a VSD?

A

Pulmonary hypertension, dyspnea, and a “harsh” murmur

40
Q

What are AV septal defects a result of?

A

The failure of the endocardial cushions meeting in the middle to assist in the formation of the atrial septum and interventricular septum

41
Q

How are AV septal defects characterized?

A

A pt would present with an ASD, VSD, and abnormal bi/tricuspid valves

Often seen with Down’s

42
Q

Are AV septal defects cyanotic or acyanotic?

A

Acyanotic because it is a left to right shunt

43
Q

What is the cause in corrected transposition of the great vessels

A

Improper septation of the outflow tract and improper rotation of the heart

44
Q

What are the features of corrected transposition of the great vessels?

A

It is acyanotic because there is a left to right shunt from the right ventricle to the left ventricle (primary feature)

45
Q

Is Noncorrected transposition of the great vessels acyanotic or cyanotic? Why?

A

Cyanotic because the great vessels are aligned with the wrong ventricles, so oxygen-poor blood in the right ventricle gets pumped into the PT and aorta

46
Q

What is a treatment for noncorrected transposition of the great vessels?

A

Prostaglandins in order to promote a PDA since it is necessary for life

47
Q

Is Double Outlet Right Ventricle cyanotic or acyanotic and why?

A

It is cyanotic because both the great vessels primarily get blood from the right ventricle, however due to a VSD, there is some oxygenated blood flow from the left ventricle

48
Q

What is the cause of Double outlet right ventricle?

A

There is abnormal migration of the bulbar ridges and misalignment of the ventricular septum

49
Q

Is a patent truncus arteriosus cyanotic or acyanotic? Why?

A

Cyanotic because there is a single great vessel for outflow (due to a failure of the bulbus cordis and the truncus arteriosus developing the conotruncal ridges to further form the aorticopulmonary septum), therefore consistently mixed blood going into the lungs and system

50
Q

What are the features of Tetrology of Fallot?

A

Pulmonary stenosis, interventricular septal defect, over-riding aorta (aka aorta sitting over interventricular septal defect instead of the left ventricle), and a right ventricular hypertrophy, tet spells (when a baby screams or cries and turns blue)

51
Q

What is the cause of TOF (tetrology of fallot)?

A

Unequal division of the outflow tract by the aorticopulmonary septum

52
Q

Is TOF cyanotic or acyanotic?

A

Cyanotic because there is a right to left shunt

The pulmonary valve stenosis leads to deoxygenated blood being shunted into the aorta

PDA is necessary for life

53
Q

What are the features of critical pulmonary stenosis?

A

The cusps of the pulmonary valves are fused or thickened —> decreased pulmonary blood flow leads to cyanosis

54
Q

What are the features of critical aortic stenosis?

A

Tachypnea, poor feeding, poor perfusion, and possible development of hypoplastic left heart syndrome (because the heart has to work harder to pump blood systemically, so it leads to left ventricle muscle hypertrophy and therefore the left ventricle itself becomes hypoplastic since the muscle eats into the space that the ventricle would’ve taken up to hold blood)

Cyanotic disease because of poor perfusion of tissue

55
Q

What is hypoplastic left heart syndrome and its features

A

Occurs when the left ventricle is too small to be functional and results in cyanosis

a PDA and atrial septal defect is essential for life (but still 50% survival rate)

Features: mitral valve stenosis/atresia, left ventricle hypoplastic, aortic valve stenosis/atresia, aortic arch hypoplasia

Cardiopulm Exam 1 (4 decks)

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