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207 Cards in this Set
- Front
- Back
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What are the 5 primitive heart tube dilations?
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3. Primitive Ventricle
4. Primitive Atrium 5. Sinus Venosus |
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What will develop from the Truncus Arteriosus?
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Ascending Aorta & Pulmonary Trunk
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What will form from the Bulbis Cordis?
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1. Smooth part of RV (conus arteriorsus)
2. Smooth part of LV (aortic vestibule) |
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What will form from the Primitive Ventricle?
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Trabeculated parts of RV and LV
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What will form from the Primitive Atrium?
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trabeculated parts of RA and LA
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What will develop from the sinus venosus? (3)
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1. smooth part of RA (sinus venarum)
2. coronary sinus 3. oblique vein of LA |
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What is between the Bulbus Cordis and the Primitive Ventricle?
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Bulboventricular Sulcus aka Interventricular Sulcus
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What is between the Primitive Atrium and the Primitive Ventricle?
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AV canal
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What does the Brachiocephalic Trunk develop from?
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R horn of ventral aortic sac
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What does the Right Subclavian develop from?
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4th Arch A
7th cervical intersegmental A |
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The Ventral Aortic Sac, L horn of Ventral Aortic sac, and L 4th arch artery develop what?
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Arch of the Aorta
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What does the Left Subclavian A develop from?
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7th intersegmental A
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The left sinus horn will develop into what?
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Coronary Sinus and Oblique V of LA
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The right sinus horn will develop into what?
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SVC and IVC
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Right Anterior Cardinal V and Common Cardinal V develop what?
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SVC
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Internal Jugual Vein develops from what?
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Anterior Cardinal V
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Anastomose of Vitelline V around the duodenum will develop what?
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Portal Vein
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What three things will arise from the sinus venosus?
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Common Cardinal V
Vitelline V Umbilical V |
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The Common Cardinal V (ant. and post) form what?
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Caval System
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Vitelline V forms what?
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Mesenteric/Portal Venous System
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Umbilical V forms what?
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Internal Iliac and Vesicular V
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What is the opening between the Sinus Venosus and the primitive atrium?
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Sinuatrial Orifice
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What hangs off the Septum Spurium?
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Sinuatrial Orifice
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Septum Spurium will eventually fuse with what?
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Interatrial Septum
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What fuse to form the Septum Intermedium dividing the AV canal into R and L?
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Dorsal and Ventral AV cushions
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What is the gap between the Septum Primum and the Septum Intermedium?
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Foramen Primum
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Before septum primum fuses with septum intermedium what must happen?
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Foramen Secundum must form
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What completes the formation of the interatrial septum?
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fusion of the Foramen Ovale
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Conus Arteriosus fuses with Primitive Ventricle forming what?
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Bulbo(cono)ventricular Cavity
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What seperates the outflow parts of the RV and LV?
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Bulbar (conus) septum
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What swellings will seperate the ascending aorta and the pulmonary trunk by forming AP septum?
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Right Superior and Left Inferior Truncal Swellings
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What grows upward from the floor of bulboventricular cavity dividing it into right and left halfs?
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Primitive Interventricular Septum
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What is the name for the gap between the Bulbar septum and the Primitive Interventricular Septum?
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Interventricular Foramen
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AV cushions appear in septum intermedium, CAUDAL to Bulbar Septum. These will form what?
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proliferate and close the Interventricular Foramen. They will comprise the membranous part of the IV septum.
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What makes up the muscular part of the Interventricular septum?
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Primitive Interventricular Septum
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Fusion of what AV cushions will form the AV septum?
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Superior and Inferior AV cushions fuse in middle of AV canal
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With formation of the AV septum, proliferation of mesenchyme with form what?
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Tricuspid and Mitral Valves
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What form from hollow myocardium and attch via chordae tendinae?
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Mitral and Tricuspid Valves
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What does the Pulmonary and Aortic Semilunar Valves develop from?
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3 endocardial cushions
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What day do blood islands arise from splanchopleuric mesoderm?
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day 17
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What day is vasculogenesis started and medsoderm and endothelial cells form Angioblastic cords?
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Day 18
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What forms from the union of blood vessels (vasculogenesis) in the cardiogenic region with myocardial cells?
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2 endothelial heart tubes
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What does the pericardial cavity develop from?
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Intraembryonic Coelom
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During what week does the heart become ventral to foregut?
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4th week- median ventral fold
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What forms the Myoepicardial Mantle?
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Splanchnopleuric mesoderm lining dorsal pericardial cavity
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The Myocardial Mantle gives rise to what?
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Myocardium and Epicardium
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What comprise the INflow tracts of the heart tube?
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Common Cardinal V
Vitelline V Umbilical V |
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What comprise the OUTflow tracts of the heart tube?
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Dorsal Aortae- will form 1st aortic arch pair
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Heart wall develops from what?
Endocardium: Myocardium: Cardiac Jelly: Epicardium: |
endo- from heart tube
myo- splanchnopleuricmeso. cardiac jelly- secreted by myo. epi- splanchopleuricomeso. |
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What initially hold the heart tube in the primitive pericardial cavity?
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Dorsal Mesocardium
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Rupture of the Dorsal Mesocardium forms what?
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Transverse Sinus and
Oblique Sinus |
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What develops first, inflow or outflow tracts?
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Inflow
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What day does the heart begin to beat?
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22
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What day does bending of the heart begin?
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23
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Circulation of the heart begins what day?
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24
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Bending of the heart is done by what day?
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28
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What divides the R auricle from the RA proper?
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Crista Terminalis
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Primitive RA will form what?
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R Auricle and will sprout Pulmonary V
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Primitive LA will form what?
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L Auricle
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What week is Atrial Septation?
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4th week
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Septum secundum grows down from roof stopping at Septum Intermedium forming the Foramen Ovale. When is this?
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5th week
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What is the lower margin of the septum secundum?
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Limbus Fossa Ovalis
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What is the upper margin of the Septum Primum called?
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Fossa Ovalis
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AV canal shifts ________, bringing truncus arteriosus in line with future LV.
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Right
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When does ventricular septation occur?
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end of 4th week
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When do the heart valves develop?
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weeks 5-8
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When is development of the Arterial system?
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4-5th weeks
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Paired Dorsal Aortae remain seperate in region of aortic arches until below level of what?
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4th Thoracic segment
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Paired Dorsal Aortae will fuse to form what?
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Median Dorsal Aortae
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What are the 3 branches of the Median Dorsal Aorta?
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1. Gut
2. Retroperitoneal Organs 3. Intersegmental Arteries |
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Ventral part of the 3rd Arch develops what?
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Common Carotid
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Dorsal part of 3rd arch forms?
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1st part ICA and ECA arises as a bud
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Left side of 4th arch forms?
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Arch of Aorta
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Right side of 4th arch forms?
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Prox. R subclavian A, proximal part of Arch of Aorta
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Proximal part of the 6th arch forms?
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Prox. part of Pulmonary Arch
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Left side of 6th arch forms?
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Left Pulmonary A and Ductus Arteriosus
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Right side of 6th arch forms?
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R Pulmonary A
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What does the ECA form from?
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Ventral Aortic Roots- cranial to 3rd
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What does the Ventral Aortic Roots between 3 and 4 develop?
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Common Carotid A
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What does the Ventral Aortic Root between 4 and 6 develop?
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R side- Brachiocephalic
L side- Ascending Aorta |
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What does the Dorsal Aortic Roots cranial to 3rd form?
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ICA
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What does the Dorsal Aortic Roots between 3 and 4 form?
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dissappear, so nothing!
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What does the Dorsal Aortic Root between 4 and 6 form?
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R side- central part subclav.A
L side- Descending Aorta |
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What does the Dorsal Aortic Arch caudal to 6 form?
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Descending Aorta
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From cranial to 3rd arch-
Ventral: Dorsal: |
ventral: ECA
dorsal: ICA |
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From 3 to 4th arch-
Ventral: Dorsal: |
Ventral- Common Carotid
Dorsal- nothing b/c only 1 Common Carotid |
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From 4-6 arches-
Ventral: Dorsal: |
Ventral- right side- Brachiocephalic
left side- Ascending Aorta Dorsal- right side- central part subclavian A left side- Descending Aorta |
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From caudal 6 arches-
Ventral: Dorsal: |
Ventral- nothing
Dorsal- Descending Aorta |
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How many babies are born with Congenital Anamolies of CVS?
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1 in 120 births
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What is noncyanotic "blue kid"?
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Left to Right shunts
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What kind of shunt has an elevated preload, with increased chronic output and dilation of loaded chambers?
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Left to Right shunts
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What are some clinical symptoms of Left to Right shunts?
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Growth failure
Diaphoresis Tachypnea Tachycardia |
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What is the most common Left to Right Shunt?
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Ventricular Septal Defect
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What results as from defect of closure of membranous region of IV septum or from malalignment of the outlet component of the septum?
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Ventricular Septal Defect
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What is the Ausculatory sound with a patient who has a Ventricular Septal defect?
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Pansystolic murmur and Mitral Flow Murmur
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Increased pulmonary flow, cardiomegaly, and hyperdynamic precordium are symptoms of what?
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VSD
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What is a defect caused by a Patent Foramen Ovale due to ostium secundum defect?
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Atrial Septal Defect
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What symptoms include prominent PA, cardiomegaly, RV enlargement, pulmonary plethora and is more common in females?
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ASD
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80% of what size patent foramen ovale will close?
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3-8 mm
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What is also known as Endocardial Cushion Defect?
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Atrioventricular Defect
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What is caused by septation failure of the primitive heart tube at the Atrium/Ventricle Jxn?
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Atrioventricular Septal Defect
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What are the 3 components to a AV septal defect?
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1. common AV valve
2. ASD (foramen primum) 3. VSD (inlet, muscular) |
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If patient with AV septal defect has all 3 components then considered what?
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Complete AV defect
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If patient with AV septal defect has 2 components then what is it?
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Partial AV defect
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What is heart sounds are heard with a patient with AV septal defect?
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Mitral and Tricuspid Murmurs
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An older woman with shortness of breath, atrial fibrillation, CHF, pulmonary hypertension, and a tricuspid diastolic murmur is diagnosed with what?
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ASD
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What is the main cause of Patent Ductus Arteriosus?
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Rubella
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Patent Ductus Arteriosus occurs in __ of 10,000 biths.
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8/10,000
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What meds would you give a baby with PDA?
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Indomethacin
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What is increased with premies, has a machinery murmur, bounding pulses, difficulty breathing, enlarged heart and failure to gain weight?
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baby with PDA
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What is it called when neonates ductus arteriosus fails to close 10 days after birth as pulmonary resistance falls?
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PDA
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Ductus Arteriosus should normally close when?
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1-2 hours after birth
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Many babies with PDA have what breathing problems?
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Respiratory Distress Syndrome
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Without treatment, a baby with PDA might have what?
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Eisenmenger syndrome- shunt shifts from L-R to become a R-L shunt causing the baby to be blue.
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A baby with Eisenmeger Syndrome will look like what?
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upper extremities- pink
lower extremities- blue |
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What will lead to Eisenmenger Syndrome?
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Uncorrected ASD, VSD, and PDA
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As pulmonary resistance increases with babies who have a L-R shunt problem, what happens?
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changes to a R-L shunt
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Late cyanosis, clubbing and polycythemia are signs of what?
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Eisenmeger's Syndome
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What will have a S3 and S4?
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Eisenmegers syndrome
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What is a heart anomaly that is associated with situs inversus?
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Dextocardia
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What happens with premature closure of the foramen ovale?
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death shortly after birth, baby will have RH hypertrophy and underdev. LH
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10% of newborns with CHD have what disease?
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Coarctation of the Aorta
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What is narrowing of the Aortic Lumen below the origin of teh L Subclavian A?
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Coarctation of the Aorta
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What type of Coarcation of the Aorta are infants like to have?
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Preductal - ductus arteriosus persists
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What type of Coarctation of the Aorta are adults likely to have?
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Postductal- ductus arteriosus obliterated. More Common.
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In what CHD is collateral circulation established between the proximal and distal parts of the aorta by way of Intercostal A and Internal Thoracic A?
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Postductal Coarctation of Aorta
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With Coarctation of the Aorta, what is the BP and pulse distal to the coarctation?
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Low BP and Low Pulse plus claudication. Ex. Femoral pulse will be low, and Brachial pulse will be high
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What has a systolic murmur, LV hypertrophy, aortic distention, increase in Turners syndrome and Berry's aneurysm?
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Coarctation of the Aorta
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What would you diagnose a child who has shortness of breath, fatigue and lamelessness in legs?
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Coarctation of Aorta (avg life span in 34 yrs.)
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What presents with a S2 widely split to single?
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Pulmonary Stenosis
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What is the 2nd most common CHD defect often associated with other defects?
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Pulmonary Stenosis
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What kind of hypertrophy do you see with Pulmonary Stenosis?
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RV
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What ranges from mild valve stenosis, to critical obstruction, to atresia?
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Pulmonary Stenosis
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What is most common abnormality of the conotruncal region?
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Tetralogy of Fallot
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What are 4 characteristics of Tetraology of Fallot?
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1. Pulmonary Stenosis
2. RV hypertrophy 3. Overdistended Aorta 4. VSD |
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What appears as a Coer en Sabot on an Xray image? (boot)
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Tetraology of Fallot- apex elev. b/c of RV hypertrophy and concavity in area of pulmonary A
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What determines the degree of cyanosis of a baby with Tetraology of Fallot?
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Shunt volume
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What sound do you hear with Tetraology of Fallot?
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Single S2
heart murmur Loud RV outflow Aortic ejection sound |
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What are some common associations with Tetraology of Fallot?
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1. deletions of Ch. 22
2. DiGeorgia syndrome 3. conotruncal anomaly facies (relocardiofacial) 4. Down Syndrome |
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What is caused by failure of the AP septum to spiral?
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Transposition of Great Vessels
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What are some factors that might cause Transposition of Great Vessels?
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1. maternal diabetes
2. rubella 3. poor prenatal nutrition 4. maternal alcoholism |
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If no VSD is present, what happens with Transposition of the Great Vessels?
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Cyanosis
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What is corrected transpition b/c there is an extra link between two sides of the heart?
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L-Transposition (L for link)
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What is it called when patent ductus arteriosus is only connection between systemic and pulmonary circulation?
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D-Transposition
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What are treatment options for Transposition of Great Vessels?
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Surgery and then
Prostaglandin drip to maintain PDA and Ductus Arteriosus |
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What surgery should be performed first to fix Transposition of great Vessels?
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1. Rashkind Procedure- palliative surgery in which you enlarge hole in atrial septum to increase blood mixing
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If a Rashkind Procedure (balloon) doesn't work, what would you do next?
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Blalock-Hanlon- complete removal of atrial septum
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What is the most preferred surgical procedure for the Transposition of Great Vessels, but must be performed before the age of 2?
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Arterial Switch
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What surgery uses layer of pericardium so blood flows RA to LV and LA to RV (Mustard and Senning)?
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Atrial Switch
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What is failure to develop a dividing septum btwn aorta and pulmonary A?
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Truncus Arteriosus- only partial development of AP septum
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What is prob with long arm Ch. 22 where mixed blood from both ventricles goes thru a common trunk and out to Pulmonary A and Aorta?
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Truncus Arteriosus
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What is a very small LV and malformed mitral and aortic valves?
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Hypoplastic LH syndrome
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When does Hypoplastic LH syndrome present?
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when Ductus Arteriosus closes, fatal without transplant or multiple surgeries
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What happens to the heart if the ventral body wall fails to close?
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Ectopia Cordis
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When does the actual lumen of the Umbilical A close?
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2-3 months later
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What closes after the closure of the Umbilical arteries?
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Umbilica V and Ductus Venosus
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What closes by contraction of it's muscular wall and is mediated by bradykinin? (Closes immed. after birth and completely by 1-3 mos later)
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Ductus Arteriosus
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What closure is reversible within the first few days of life?
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Foramen Ovale- by one year old there will be complete fusion of septum secundum and primum
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What is found with Pentalogy of Cantrells (children)?
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1. omphalocele
2. Anterior Diaphragmatic Hernia 3. Sternal Cleft 4. Ectopic Cordis 5. Intracardiac Defect (VSD) |
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Where does the SVC merge with R auricle?
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SA node
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What is the lymph drainage of the heart?
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Subepycardial Plexus to the Tracheobronchial Lymph nodes
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What is the 1st branch off the Ascending Aorta?
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Coronary A
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What determines the dominace of the Coronary System?
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Where Posterior Interventricular A arises from (R is 80% dominant)
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What is main reason for a Transient Ischemic Attack?
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Unstable Coronary A Disease- deposition of lipids on intima, stim. T lymph, stim. macrophages, plaque disruption, reocclusion or tearing
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What would be a mural thrombus with thinned out myocardial scar, with a wide base, and walls composed of myocardium?
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True Aneurysm- everything herniates
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What forms outside the arterial or myocardial wall, is a transmural infarct with rupture, narrow base, wall composed of thrombus and pericardium, and has a big thromus?
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Pseudoaneursym
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What type of aneurysm has a high risk for rupture?
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Pseudoaneursym
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What is Systema Conducens Cordis?
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Conduction System of Heart
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What are the Subendocardial Branches?
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Purkinje Fibers
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How does the RBB communicated with the anterior papillary M?
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via Septal Marginal Trabeculae
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AV nodes stimulates what on the right?
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1.ANTERIOR papillary M (via moderator band)
2. m of IV septum 3. RV wall |
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What divides into 6 smaller roots, and stimulates m of IV septum, anter. and posterior papillary m, and the LV wall?
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AV node branching to the LEFT
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What is the sympathetic innervation to the heart?
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Presynpatic- IML T1-4
Postsyn.-cell bodies in cervial and superior thoracic ganglion to SA and AV nodes and Coronary A |
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What is the parasymphathetic innervation to the heart?
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presyn- fibers from Vagus N
post- cell bodies of intrinsic ganglion in the vicinity- SA and AV nodes, and coronary A |
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What causes vasoconstriction of the Coronary A?
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Parasymphathetic Stimulation- also decreases HR and contraction force
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Thoracic Intersegmental Branches will give rise to what?
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Intercostal Arteries
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Lumbar Intersegmental branches give rise to what?
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Common Iliac Arteries
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Cervical Intersegmentals (1-16) lateral branches give rise to what?
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Vertebral Arteries
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Lateral Branches supply what arteries?
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20 pairs supplying mesonephros- Adrenal A, Renal A, Gonadal A
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What supply the GI blood supply?
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Ventral Branches
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Ventral Branches give rise to Vitelline A. What do those give rise to?
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Celiac, Superior Mesenteric A, Inferior Mesenteric A and Vitelline Duct
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Ventral branches give rise to Allantoic vessels. What do these give rise to?
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Umbilical A
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What is the sprouting of endothelial cells at the apex and base of the heart of coronary arteries?
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Angiogenesis
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Of the venous system, what drains the head, neck, body wall and limbs?
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Cardinal V
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Of the venous system, what develops the liver sinusoids, portal venous system, and ductus venosus?
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Vitelline v
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Where does the L Umbilical V drain in the fetus?
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Ductus venosus- channel that shunts blood from umblical v directly to IVC
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What venous system, develops in the connecting stalk?
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Umbilical V
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Anterior and Posterior Cardinal V form what?
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Common Cardinal V
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Posterior Cardinal V replaced by what?
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Subcardinal and Supracardinal V
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Cardinal V plus a little of Vitelline V develops what?
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IVC and it's branches
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Ventral Branches anastomose with Paired Dorsal Aortae and what develops?
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Connecting stalk to carry blood to placenta
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What is a longitudinal intralumenal tear forming a false lumen in the aorta?
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Aortic Distention- false lumen in descending aorta
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Aortic Distention is seen among who?
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Hypertensive patients and Marfans
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What happens due to a persistent Left Anterior Cardinal V?
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forms a SVC on left, so now you end up with DOUBLE SVC
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What happens with a persistent L supracardinal V?
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An additional IVC forms, so now you have DOUBLE IVC
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Why is there no mixture of O2 blood from IVC with deoxygenated blood from SVC in the fetus?
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Eustachian Valve- helps blood rich in O2 thru RA to LA thru the Foramen Ovale
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How does O2 blood enter the fetus's body?
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Left Umbilical V to Ductus Venosus, mixes with deoxygenated portal blood, enters IVC, and mixes blood from truck and limbs
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With first breath, what opens due to an increase in O2 concentration?
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Pulmonary vasculature
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What closes the Ductus vensosus?
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Obstretical clamping of umbical vessels
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Pressure changes in the LA causes what to close?
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Septum primum closes Foramen ovale
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Pressure changes and low O2 concentration in the Pulmonary A causes what to close?
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Ductus Arteriosus (happens about 15th hour)
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What develops from closing of the Umbilical A?
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Internal Iliac A and Superior Vesicular A
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What develops from closing of the R Umbilical V and Ductus Venosus?
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Ligamentum Teres Hepatis and Ligamentum Venosum
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What develops from closing of the Ductus Arteriosus?
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Ligamentum Arteriosum
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What is it called when the R embryonic arch persists and part of the L regresses?
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Right Aortic Arch-"mirror image"- absent or mild symptoms. bad when the L subclav presses against esoph or trach
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What happens with abnormal R aortic arch developing in addition to the L aortic arch developing?
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Double Aortic A- forms a vascular ring.
RING= DYSOPNEA |
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What is it called when the L Pulmonary A orginates from the R Pulmonary A?
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Pulmonary A Sling-
SLING=DYSPHAGIA |
