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Cardiovascular System > Session 3 > Flashcards

Session 3 Flashcards

1
Q

What is the cardiogenic field? * (* = notes)

A

Tissue in the paraxial mesoderm that differentiates to form blood vessels and blood

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2
Q

What are the blood islands? *

A

Cells that give rise to vascular endothelia and blood cells.

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3
Q

How does lateral folding affect the development of the heart?

A

Creates a heart tube

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4
Q

How does cephalocaudal folding affect development of the heart?

A

Brings the heart tube into the thoracic region

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5
Q

How is the primitive heart tube formed? *

A

Blood islands move towards each other and fuse together to create the primitive heart tube

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6
Q

What are the features of a primitive heart tube?

A
  • Inflow at bottom
  • Outflow at top
  • No valves and no chambers
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7
Q

What is the pericardial cavity?*

A

Where the primitive heart tube is suspended

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8
Q

What are the segments of the primitive heart tube?*

A

(top to bottom)

  • Aortic roots
  • Truncus arteriosus (outflow)
  • Bulbus cordis
  • Primitive ventricle
  • Primitive atrium
  • Sinus venosus (inflow)
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9
Q

Why does the primitive heart tube loop?

A

It runs out of room for expansion

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10
Q

What is looping?*

A
  • Tube elongates
  • Twists and folds up
  • Places inflow and outflow in correct orientation (atrium pushed up posterior)
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11
Q

How does the sinus venosus develop?*

A
  • At start both sides of the body are symmetrical
  • REMODELLING OCCURS
  • Venous return shifts to right sinus horn so left sinus horn recedes
  • Right sinus horn absorbed by enlarging RA
    (will form vena cava?)
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12
Q

How does the right atrium develop?*

A
  • From primitive atrium and sinus venosus
  • From receiving venous drainage from venae cava and coronary sinus
  • Absorbs right sinus horn
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13
Q

How does the left atrium develop?

A
  • Small bit of primitive atrium
  • Absorbs proximal parts of pulmonary veins
  • Receives oxygenated blood from lungs
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14
Q

What is the process of forming the left atrium?*

A
  • Part of atrium forms from absorbed primordial pulmonary vein tissue
  • Expands
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15
Q

What is the oblique pericardial sinus?*

A
  • A structure that forms as left atrium expands and absorbs pulmonary veins
  • Separates left atrium from aorta and oesophagus
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16
Q

What is present in the foetal circulation that is NOT in mature circulation?

A
  • Lungs do not function

- Oxygenation of blood and CO2 removal occur at placenta

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17
Q

What is needed to allow foetal circulation to occur?*

A

Shunts that must close when the baby takes its first breath.

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18
Q

What are features of mature circulation that are absent in foetal circulation?

A
  • Reoxygenation and CO2 removal at the lungs
  • Reoxygenated blood returned to heart
  • Reoxygenated blood pumped around body.
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19
Q

Where does blood from placental circulation enter the heart in the fetus?

A
  • Right atrium

- Wrong side so must move around (via foramen ovale)

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20
Q

Why is there a shunt to bypass the liver in the foetus?

A

Liver is highly metabolically active and can use up the oxygen so must be bypassed.

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21
Q

Why is there a shunt to bypass the lungs in the foetus?

A

The lungs are underdeveloped and would be unable to cope with the volume and pressure of blood.

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22
Q

What is the ductus venosus?

A

The shunt that exists to bypass the liver and deliver blood from placenta to inferior vena cava

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23
Q

What is the ductus arteriosus?

A

The shunt that bypasses the lungs and connects the pulmonary trunk to the aorta

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24
Q

What is the foramen ovale?

A

The shunt that connects right and left atria to allow the movement of blood in the right direction.

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25
Q

What happens to the shunts after birth?

A

Shut when respiration begins due to increases in pressure. At first must be maintained but over time seal naturally.

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26
Q

How are the major arteries leaving the heart created?*

A 
Bilaterally similar (1, 2, 3, 4, 6, with 5 missing in humans) system of arched vessels
- Will undergo rapid, extensive remodelling.
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27
Q

What are the derivatives of the 4th aortic arch?

A
  • Left: arch of aorta

- Right: proximal part of right subclavian artery

28
Q

What are the derivatives of the 6th aortic arch?

A
  • Left: left pulmonary artery and ductus arteriosus

- Right: right pulmonary artery

29
Q

Where is the left recurrent laryngeal nerve?*

A
  • Becomes ‘hooked’ around the shunt between the pulmonary trunk and aorta (ductus arteriosus) (6th arch)
  • Descends down further than the right recurring laryngeal nerve
30
Q

What is the function of the ductus arteriosus?

A
  • Allows communication between aorta and pulmonary artery
31
Q

What happens if the ductus arteriosus fails to close physiologically?

A
  • Blood will shunt from left to right (from aorta to pulmonary trunk)
  • Will shunt from high pressure to low pressure
32
Q

What happens after the looping of the heart tube?

A
  • Atrium and ventricle are linked by ATRIOVENTRICULAR CANAL

- Still remains as a single contractile tube and beats 3 weeks after conception

33
Q

What are the types of septation and how do they happen?

A

All types of septation happen SIMULTANEOUSLY.

  1. Interatrial septum - forms 2 atria
  2. Interventricular septum - forms 2 ventricles
  3. Separation of ventricular outflow tract give aorta and pulmonary trunk
34
Q

What is the function of interatrial septation?

A
  • Build new tissue

- Build the ability to allow right and left shunt that can resolve immediately after birth

35
Q

What does interatrial septation consist of?*

A
  • Septum primum grows towards fused endocardial cushions
  • Ostium primum is a hole that is present before septum primum fuses with the endocardial cushions
  • Ostium secundum appears before ostium primum disappears
  • Septum secundum grows (crescent-shaped septum) an
  • Hole = foramen ovale
36
Q

What do the endocardial cushions do?

A
  • Grow towards each other to develop the heart into the left and right chambers
  • Are dependent on getting to the right place at the right time
37
Q

Describe interatrial septation again. *

A
  • Septum primum grows towards the endocardial cushions
  • Ostium primum is a hole in the septum that allows flow of blood from right to left.
  • Ostium primum grows over and ostium secundum is formed in the septum primium
  • Septum secundum forms, and a hole lower down in the septum secundum forms that is called the foramen ovale
38
Q

How is the foramen ovale created?

A

A higher pressure in the right side of the heart pushes the two septa apart and allows shunting of blood.

39
Q

What are the atrial components derived from primitive atrium?

A
  • Auricles

Increase atrial capacity and the volume of blood that they are able to contain

40
Q

What does the right atrium absorb?

A

Sinus venosus

41
Q

What does the left atrium sprout and what happens to the pulmonary veins?

A
  • Sprouts pulmonary vein

- Absorbs it and the 4 branches

42
Q

Why is the left atrium smooth?

A

Developed from the primitive vein.

43
Q

What is the remnant of the foramen ovale in adults, and what does it look like?

A

Fossa ovalis.

- Small, thin barrier between two atria formed from

44
Q

Why is the right atrium not smooth?

A

Developed from the primitive artery and atrium (pectinate muscles)

45
Q

What does the ductus arteriosus become after closing in adults?

A

Ligamentum arteriosum.

46
Q

Why does the foramen ovale close after birth?*

A
  • Pressure in the left atrium rises above pressure in right atrium
  • Septum primum pushes against septum secundum
  • Interatrial septum leaves pushed together and fuse over time
47
Q

What types of atrial septal defects can occur?*

A
  • Septum primum resorbed and too short
  • Absence of septum secundum
  • Septum secundum too small
  • Absence of both septa primum and secundum
48
Q

What is hypoplastic left heart syndrome?*

A

The left side of the heart is not fully developed, leading to a very small atrium and ventricle

49
Q

What are the suspected causes of hypoplastic left heart syndrome?

A
  1. Defect in mitral/aortic valve development
    - Artresia (prevented flow), limited flow
  2. Ostium secundum is too small
    - Inadequate right to left flow in utero
    USE IT OR LOSE IT
50
Q

What is ventricular septation?

A

Development of the right and left ventricles.

51
Q

What are the 2 components of the ventricular septum?

A
  • Muscular (main)

- Membranous (secondary)

52
Q

What is the function of the muscular portion of the septum?

A
  • Grows upwards towards the fused endocardial cushions
  • Forms most of septum
  • Leaves a gap to be filled by the membranous septum
53
Q

What is the small gap left by the muscular portion called?*

A

Primary interventricular foramen.

54
Q

How does the primary interventricular foramen close?*

A
  • Membranous portion derived from endocardial cushions, so grows downwards towards muscular
  • Prevents communication between right and left ventricles
55
Q

What is the most common cause of ventricular-septal defects?

A

Membranous part does not develop properly

56
Q

How is the outflow tract (pulmonary trunk/aorta) septated?*

A
  • Endocardial cushions in truncus arteriousus
  • Grow towards each other in a staggered, twisted arrangement
  • Form a spiral septum that allows LV to connect to aorta and RV to connect to pulmonary trunk by essentially ‘twisting’ them
57
Q

What are types of congenital birth defects?

A
  • Structural abnormalities

- Complete absence of a structure

58
Q

What can be the causes of congenital birth defects?

A
  • Genetic
  • Exposure to teratogenic agents (eg. warfarin), drugs, chemicals
  • Unexplained causes
59
Q

When do congenital heart defects occur?

A
  • When there are structural defects of either the chambers or the vasculature
  • When there is an obstruction
  • When the shunts do not close and communication between pulmonary and systemic circulations remains intact after birth
60
Q

Why do the heart defects occur in newborns but are okay in the foetus?

A

The foetus has different circulatory needs (all from placental circulation and no functioning lungs as they do not need to breathe in utero) - less complex than mature

61
Q

How common are congenital heart defects?

A

1% of world population

62
Q

What are the implications of 135,000 people in the UK living with congenital heart defects?

A

Implications when women with congenital heart defects.

  • Highest cause of maternal death
  • Drugs are highly teratogenic
63
Q

What is transposition of the great arteries?*

A
  • No spiral septum
  • RV connects to the aorta
  • LV connects to the pulmonary trunk
  • Relates to the development of pulmonary and aortic valves
64
Q

What happens when transposition of the great arteries occur?

A

Cyanosis (not enough oxygen)

65
Q

What is the tetralogy of Fallot?*

A

A composition of 4 defects.

  • Overriding aorta across both ventricles
  • Large ventricular septal defect
  • Right ventricular outflow tract obstruction (trunk stenosis)
  • Right venticular hypertrophy (due to higher resistance)
  • Conotruncal septum (that divides outflow tract) formed defectively

Cardiovascular System (11 decks)

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