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Block 2 > Week 4: CAI > Flashcards

Week 4: CAI Flashcards

1
Q

Which congenital cardiac defects result in cyanosis?

A
  • Transposition of great vessels
  • Tetralogy of Fallot
  • Truncus arteriosus defects
  • Critical pulmonary stenosis
  • Tricuspid valve atresia
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2
Q

Which congenital cardiac defects does not result in cyanosis?

A
  • Atrial septal defect
  • Ventricular septal defect
  • Atrioventricular septal defect
  • Patent ductus arteriosus
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3
Q

From which embryonic tissue type do the initial pair of heart tubes develop?

A
  • Cardiogenic mesoderm
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4
Q

What happens to the initial pair of heart tubes during embryonic folding?

A
  • Angioblastic cords canalise to form two heart tubes that fuse and subsequently expand
  • Folding occurs due to growth of the heart tube and fixed positions of the aortic arches and venous input
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5
Q

In which direction should the developing heart tube fold?

A
  • Atrium moves cranially, dorsally and to the left
  • Bulbus cordis moves caudally ventrally and to the right
  • Ventricle normally sits anterioly and atria posteriolrly
  • So fold occurs towards the right
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6
Q

Which condition occurs if the heart tube folds in the opposite direction to normal?

A
  • Dextrocardia
  • Ventricle pointing toward right hand side
  • Outflow tracts projecting more toward left hand side
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7
Q

What are the names of the five regions of the growing heart tube?

A
  • (From venous input)
  • Sinus Venosus
  • Atria
  • Ventricle
  • Bulbous Cordis
  • Truncus Arteriosus
  • (to Aortic sac)
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8
Q

Which region of the heart does each of the growing heart tube regions become (or contribute towards)?

A
  • Sinus Venosum - Smooth walled part of RA
  • Atria - Rough walled parts of L&R Atria (eg auricle)
  • Ventricle - Ventricles
  • Bulbous Cordis - Part of outflow tract of both left and right ventricles (may form parts of right ventricle)
  • Truncus Arteriosus - Ascending aorta and pulmonary trunk
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9
Q

What is the dorsal mesocardium and what should happen to it?

A
  • Dorsal mesocardium initially suspends the heart tube but will eventually disappear to allow heart tube to grow and fold
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10
Q

Which structures do the parietal and visceral pericardium cover and where do they meet?

A
  • Reflect off the great vessels where they meet the heart. Cover the whole heart
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11
Q

Is an ASD (Atrial Septal Defect) a congenital cyanotic cardiac defect?

A

NOT Usually

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12
Q

What does an Atrial Septal Defect (ASD) lead to?

A
  • Left-to-right shunt after birth
  • However, some ASDs are asymptomatic, Some close during growth
  • Usually NOT a congenital cyanotic cardiac defect
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13
Q

Describe the formation of the pulmonary veins? What happens to the initial part of the pulmonary venous system?

A
  • Pulmonary veins grow out of the left atrial wall and branch (Primordial pulmonary vein)
  • Proximal parts get incorporated into and form the smooth part of the atrial wall - Large proportion.
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14
Q

Describe the process of atrial Septation

A
  • Atrial septum forms during weeks 4 and 5
  • Endocardial Cushion (EC) tissue begins to grow within the atrioventricular canal.
  • Septum grows and divides Right and Left Atria and ventricles as well as aorta and pulmonary trunk
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15
Q

What is the endocardial cushion? Which passageways sit either side of the EC?

A
  • Tissue which grows within the atrioventricular canal and serves as the point at which division of the left and right occurs through
  • Tricuspid and Bicuspid valves sit either side of the EC
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16
Q

Which part of the atrial septum is relatively rigid and which part is relatively floppy?

A
  • Septum Secundum - Relatively Rigid

- Septum Primum - Relatively floppy

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17
Q

For what functional purpose is the atrial septum formed from two separate tissue with different properties?

A
  • To allow for R->L shunting of blood from Right atrium to Left atrium in-utero where the lungs have not developed yet
18
Q

In which direction does blood shunt between the atria (and ventricle) in-utero? Why does blood shunt in this direction in utero?

A
  • Right to Left
  • To bypass lungs as they are not functional until birth
  • Lungs fluid filled
  • High pulmonary vascular resistance
  • More blood entering right atrium vs left
  • Blood shunted through foramen ovale
  • Due to right side pressure exceeding left side pressure
19
Q

What happens after birth that normally leads to an instant closure of the foramen ovale?

A
  • Lungs drained, air filled and functional (first breaths)
  • Reduced pulmonary vascular resistance
  • Greater pulmonary blood flow
  • More blood entering left atrium
  • Valve of foramen ovale closes as pressure in left side exceeds pressure in right side
20
Q

What is a probe-patent foramen ovale? Is this an issue in an otherwise healthy adult?

A
  • Sometimes the tissues of the atrial septa do not fuse over time after birth. Means blood could still be passed through the shunting route from RA->LA.
  • Normally non-problematic in otherwise healthy adults
  • Can get leakage through during Valsava manouvre as briefly right-sided atrial pressure may exceed left
21
Q

When might a probe-patent foramen ovale be an issue and with what consequence?

A
  • If the patient has a venous embolus
  • May pass through right atrium to left side of the heart
  • Potentially blocking a coronary artery
22
Q

What is an atrial septal defect? (ASD)? In which direction will blood shunt through an ASD after birth and will this result in cyanosis?

A
  • Results in blood shunting Lā€“>R Atria as pressure higher in LA after birth
  • Does not result in cyanosis usually
23
Q

In which part of the Ventricular septum do defects occur most often? Why?

A
  • Membranous tissue of septum
  • Congenital heart failure?
  • 80% of Ventricular Septal Defects
  • Due to Membranous region being more complex to form. Relying on multiple pieces of tissue growing and joining as heart itself is growing and moving
24
Q

How does Aorticopulmonary septum tissue rotate/move during development

A
  • Rotates through 180degrees as it passes cranially away from the heart
  • Results in pulmonary trunk and aorta changing positions relative to each other
25
Q

What is the result of Aorticopulmonary septum formation

A
  • Rotates through 180 degrees and passes cranially away from the heart as Truncal ridges and Bulbar ridges meet
  • Thus, most Inferior level PT Anterior to Aorta
  • Ascends to sit left side of Aorta
  • Most Superior level PT Posterior to Aorta
26
Q

Describe Transposition of great vessels

A
  • Great vessels transposed (Aorta connected to RV and PT connected to LV)
  • Creates two isolated circulations connected only by the ductus arteriosus
  • Cause debated:
  • Maldevelopment of conus arteriosus
  • Maldevelopment of aorticopulmonary septum
27
Q

Why would an ASD, VSD, or patent ductus arteriosus be beneficial in a patient with transposition of the great vessels after birth?

A
  • These defects can result in an alternative pathway for blood flow to partially correct for the transposed blood flow????
28
Q

Describe Common (persistent) Truncus Arteriosus

A
  • Failure of bulbar/truncal ridge formation results in a common arterial outflow tract sitting over (overriding) a VSD (ventricular septal defect)
  • Common arterial outflow tract = Common truncus arteriosus
  • Will receive blood from both L+R Ventricle
  • Mixing of oxygenated and deoxygenated blood will result in newborn having cyanosis
29
Q

What is Tetralogy of Fallot

A
  1. Represents a collection of four cardiac issues
  2. Pulmonary stenosis
  3. RV Hypertrophy
  4. Over-riding aorta
  5. VSD
30
Q

Describe the process of ventricular septation

A
  • Muscular tissue grows from floor of ventricles toward Endocardial Cushion tissue + Aorticopulmonary septum grows down to meet
  • Ventricular septum forms from muscular (majority) and membranous parts.
31
Q

From which tissue types is the ventricular septum formed?

A
  • Muscular tissue
  • Endocardial Cushion tissue
  • Aorticopulmonary tissue
32
Q

Describe the formation of the septum in the arterial outflow tract (truncus arteriosus and Bulbus cordis) of the heart and how it contributes to the formation of the ventricular septum

A
  • 2 Bulbar ridges grow from Bulbus cordis region of arterial outflow tract
  • 2 Truncal ridges grow from Truncus arteriosus region of arterial outflow tract
  • These grow toward to meet each other = Aorticopulmonary septum formation
  • Rotates through 180degrees as it passes cranially away from the heart
  • Extends inferiorly to meet endocardial cushion and muscular tissue to complete ventricular septm
33
Q

What does Aortic Coarctation mean

A

Narrowing of the aorta

34
Q

What can lead to aortic coarctation?

A
  • Defects in aortic arch formation
  • Defects in Remodelling process during aortic arch formation
  • During closure of ductus arteriosus following birth
35
Q

How is the position of Aortic Coarctation classifed?

A
  • Relative to its positional relationship to the ductus arteriosus
  • Preductal, juxtaductal or postductal
36
Q

What are the aortic arch vessels and where are they initially located?

A
  • The vessels which will develop into many of the great vessels in the adult
  • Initially located within Each embryological pharyngeal arch - One aortic arch vessel on both left and right sides
  • 6 pharyngeal arches but Arch 5 disappears during development
37
Q

How many aortic arches are present initially, how many disappear and how many develop?

A
  • 6 x2
  • Arch 5 disappears
  • 5 Develop x2
38
Q

Which major arteries are formed (or contributed to) by aortic arch vessels 3, 4 and 6?

A
  • Pulmonary trunk, Ductus arteriosus, Aortic arch, Brachiocephalic trunk,
39
Q

Why does the left recurrent laryngeal nerve sit under the aortic arch and the right recurrent laryngeal nerve sit under the right subclavian artery?

A
  • L RLN - Sits under Aortic arch as it is associated with Pharyngeal arch 6 and thus gets trapped under the proximal portion of Left aortic arch 6 which forms the ductus arteriosus - Staying trapped in this region after birth
  • R RLN - Sits under left aortic arch 6 distal region which degenerates during development, R RLN ascends to next vessel it gets trapped under which is right aortic arch 4 which forms the proximal portion of the right subclavian artery
40
Q

Which clinical examination findings can aortic coarctation cause? By which routes can arterial blood bypass the coarctation (think about blood supply to the thoracic and abdominal walls)

A

???

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