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62 Cards in this Set
- Front
- Back
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What does the right atrium have that the left atrium does not?
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-Crista terminalis
-Pectinate muscles |
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What does the left atrium have that the right atrium does not?
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Ostium secundum
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Where do the chordae for the Tricuspid valve insert?
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Into the septum
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Where do the chordae for the mitral valve insert?
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NOT into the septum
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How many papillary muscles are there for the
-tricuspid valve? -mitral valve? |
Tricuspid = several
Mitral = two |
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What are the trabeculae like in the
-Right ventricle -Left ventricle |
RV = coarse trabeculations
LV = fine trabeculations |
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Which ventricle has an infundibulum?
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RV only
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Whats the difference between the AV-semilunar valves in the right vs left ventricle?
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RV = valve discontinuity
LV = valve continuity |
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Where are the SA and AV nodes found?
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In the RIGHT atrium
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How is the SA node situated in the right atrium?
How is the AV node situated in it? |
SA node = subepicardially
AV node = subendocardially |
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What is the only normal pathway for conduction from the atria to the ventricles?
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Via the AV bundle
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What does the bundle of His pass through?
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The inferior margin of the membranous septum.
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What does the right bundle branch pass through on its way to the RV free wall?
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The septal and moderator bands
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When do most Congenital heart abnormalities form?
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During embryogenesis weeks 2-10
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What is the most common congenital heart defect?
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VSD
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What are the top 5 congenital cardiac abnormalities?
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1. VSD
2. ASD 3. PDA 4. Coarctition of Aorta 5. TOF |
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What 2 cardiac malformations are more common in females?
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-ASD
-PDA |
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What 3 cardiac malformations are more common in males?
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-Coarctition of the aorta
-Transposition of great vessels -Hypoplastic left ventricle |
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What % of CHD has well defined genetic or environmental influences?
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10%
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What % have chromosomal abnormalities?
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5-8%
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In which chromosomal syndrome is there 90% involvement of cardiac defects? 50%? 40%?
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90 = Trisomy 18
50 = Trisomy 21 40 = Turner's 45XO |
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What percent of cardiac defects are related to teratogenes?
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2-4%
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What are 3 common teratogens?
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-Cocaine
-Alcohol -Metabolic syndromes |
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What is the nature of inheritance for most CHD?
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Sporadic
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What are 5 risk factors for development of a congenital heart defect that can be detected in utero? (lowest specificity to highest)
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Family history 1%
Maternal diabetes 5% Fetal arrhythmia 10% Major organ defect, karyotype 25% CHD on echocardiogram duh!! 40% |
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How can babies survive to birth with congenital heart defects?
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The defects are tolerated well in utero bc of the parallel doubly connected fetal circulation.
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What CHD's don't survive in utero?
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Regurgitant lesions
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Why don't Regurgitant lesions survive in utero?
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Because there is volume overload of the right circulation - develops into fetal hydrops.
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What is fetal hydrops?
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Abnormal fetal fluid balance
-GENERALIZED EDEMA |
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What is a way to detect fetal hydrops?
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Skin thickening on fetal sonogram
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Where do effusions collect in fetal hydrops?
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In at least one body cavity:
-Peritoneal -Pleural -Pericardial |
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What are 5 maternal risk factors for fetal hydrops?
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-Diabetes
-Hemoglobinopathy -Rh isoimmunization -Prior pregnancy with it -CHD w/ failure |
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What are 4 lesions that are NOT considered to be congenital heart defects?
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1. Bicuspid aortic valves
2. Peripheral pulmonary artery stenosis 3. Persistant PDA of prematurity 4. Mitral valve prolapse |
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What are the 5 chromosomal defects associated with CHDs?
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Trisomy 13, 15, 18, 21
Turner syndrome (45XO) |
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List the 5 main steps in embryogenesis regarding the heart:
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1. Specification of cardiac cell fate
2. Morphogenesis and looping of the heart tube 3. Segmentation and cardiac chamber growth 4. Cardiac valve formation 5. Connection of the great vessels to the heart |
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What are 2 very important transcription factors in cardiac organogenesis?
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TBX5
NKX2.5 |
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In what syndrome is TBX5 transcription factor mutated?
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Holt-Oram syndrome
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What are the defects found in Holt-Oram syndrome?
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heart, arm, and hand
-ASD -VSD |
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What does a mutaiton in only one copy of NKX2.5 result in?
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Nonsyndromic ASD
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What is NKX2.5 the human counterpart to?
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The drosophila Tinman gene
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What happens in embryonic flies if both copies of tinman gene are absent?
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The heart is then absent
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What are 4 CHDs that result from mesenchymal migration errors in outflow tract septation?
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1. Isolate interruption of the aortic arch
2. PDA 3. Truncus arteriosus 4. TOF |
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What chromosomal defect causes hypoplasia of the 4th branchial arch, and 3rd/4th pharyngeal pouches?
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Chromosome 22q11.2
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What are the 2 main defects (in addition to CHDs) seen in Ch 22q11.2 defects?
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-Immunodeficiency (thymic hypoplasia)
-Hypocalcemia (Parathyroids) |
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What do extracellular matrix abnormalities with cell-cell and cell-ECM junction defects cause?
-2 CHDs seen in what syndrome? |
-Endocardial cushion defects
-AV septal defects Seen in Down syndrome (trisomy21) |
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In what process are Situs and Looping defects important factors?
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Determining Laterality
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What are the 3 subsets of CHD lesions based on physiological and clinical features?
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1. Left to right shunts
2. Right to left shunts 3. Obstructive malformations |
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What is another name for
-L to R shunts -R to L shunts |
L-R = Acyanotic
R-L = Cyanotic |
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What is the main pathological effect of L-R shunts?
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An increase in pulmonary blood flow to 2-4X the systemic circulation
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What are the 4 main L-R shunt defects?
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-VSD
-ASD -AVSD -PDA |
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How do you remember the L-R shunts?
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They all have a D
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What is the main physiologic difference between ASDs and the other 3 L-R shunts?
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ASDS = pulmonary volume increases only
VSDs/AVSDs/PDA = volume AND PRESSURE increase in pulmonary circuitry |
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How does the pulmonary vasculature respond to a L-R shunt, regardless of the type?
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CONTRACTURE - increased resistance of the small terminal muscular arteries in the lung.
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What is the hallmark of R-L shunts?
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Cyanosis of skin and mucous membranes
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Why is there cyanosis in R-L shunts?
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Because of DIMINISHED pulmonary bloodflow, resulting in deoxygenated systemic blood.
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What are the 5 types of R-L shunts?
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The 5 T's
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What are the 5 T's?
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-TOF
-T of GV -Truncus arteriosus -Tricuspid atresia -Total anomalous pulmonary veinous connection |
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What complication are R-L shunts prone to develop?
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Thromboemboli
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What can happen to thromboemboli in R-L shunts?
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They can pass into the systemic circulation, causing paradoxical embolization with systemic infarcts.
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What are 2 clinical signs of long standing R-L shunts?
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-Polycythemia
-Hypertrophic osteoarthropathy -Clubbing |
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What are Obstructive malformations?
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Hypoplasia or atresia of any of the major valves or narrow areas under and above the valves.
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What are the 4 obstructive malformations?
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1. Coarctition of the aorta
2. Pulmonary stenosis/atresia 3. Aortic stenosis/atresia 4. Mitral stenosis w/ restrictive foramen ovale |
