Fa: Cardiovascular - Embryology & Anatomy

Front 1

Which embryonic structure gives rise to the ascending aorta and pulmonary trunk?

Back 1

Truncus arteriosus (TA)

Front 2

Which embryonic structure gives rise to the smooth parts (outflow tract) of the L & R ventricles?

Back 2

Bulbus cordis

Front 3

Which embryonic structure gives rise to the trabeculated part of the L & R atria?

Back 3

Primitive atria

Front 4

Which embryonic structure gives rise to the trabeculated part of the L & R ventricles?

Back 4

Primitive ventricle

Front 5

Which embryonic structure gives rise to the smooth part of the L atrium?

Back 5

Primitive pulmonary vein

Front 6

Which embryonic structure gives rise to the coronary sinus?

Back 6

L horn of sinus venosus (SV)

Front 7

Which embryonic structure gives rise to the smooth part of the R atrium?

Back 7

Right horn of sinus venosus (SV)

Front 8

Which embryonic structure gives rise to the Superior Vena Cava?

Back 8

- Right common cardinal vein
- Right anterior cardinal vein

Front 9

What does the Truncus Arteriosus (TA) give rise to?

Back 9

- Ascending aorta
- Pulmonary trunk

Front 10

What does the Bulbus Cordis give rise to?

Back 10

Smooth parts (outflow tract) of L & R ventricles

Front 11

What does the Primitive Atria give rise to?

Back 11

Trabeculated part of L & R atria

Front 12

What does the Primitive Ventricle give rise to?

Back 12

Trabeculated part of L & R ventricles

Front 13

What does the Primitive Pulmonary Vein give rise to?

Back 13

Smooth part of L Atrium

Front 14

What does the Sinus Venosus give rise to?

Back 14

- Left horn → Coronary Sinus
- Right horn → Smooth part of R Atrium

Front 15

What do the R Common Cardinal Vein and R Anterior Cardinal Vein give rise to?

Back 15

Superior Vena Cava

Front 16

What is the first functional organ in vertebrate embryos? When does it start working?

Back 16

Heart - beats spontaneously by week 4 of development

Front 17

What is the first step in the morphogenesis of the heart?

Back 17

Cardiac Looping
- Primary heart tube loops to establish L-R polarity
- Begins in week 4 of gestation

Front 18

What can lead to dextrocardia (apex of heart faces R side of body)?

Back 18

Defect in L-R Dynein (involved in L/R asymmetry)
- Seen in Kartagener Syndrome (primary ciliary dyskinesia)

Front 19

What is the defect in Kartagener Syndrome? What does this lead to?

Back 19

- Defect in L-R Dynein (involved in L/R asymmetry)
- Kartagener Syndrome is a primary ciliary dyskinesia
- Causes Dextrocardia

Front 20

What steps lead to septation of the atria?

Back 20

1. Septum primum grows towards the endocardial cushions, narrowing the foramen primum
2. Foramen secundum forms in septum primum (foramen primum disappears)
3. Septum secundum develops as foramen secundum maintains R→L shunt
4. Septum secundum expands and covers most of the foramen secundum. The residual foramen is the foramen ovale.
5. Remaining portion of septum primum forms valve of foramen ovale.
6. Septum secundum and septum primum fuse to form atrial septum
7. Foramen ovale usually closes soon after birth because of ↑ LA pressure

Front 21

What is the first step in septation of the atria?

Back 21

Septum primum grows towards the endocardial cushions, narrowing the foramen primum

Front 22

What is the second step in septation of the atria, after the septum primum narrows the foramen primum?

Back 22

Foramen secundum forms in septum primum (foramen primum disappears)

Front 23

What is the third step in septation of the atria, after the foramen secundum forms in the septum primum?

Back 23

Septum secundum develops as foramen secundum maintains R→L shunt

Front 24

What is the fourth step in septation of the atria, after the septum secundum develops?

Back 24

- Septum secundum expands and covers most of the foramen secundum.
- The residual foramen is the foramen ovale.

Front 25

What is the fifth step in septation of the atria, after the septum secundum covers most of the foramen secundum, leaving only the foramen ovale (residual foramen)?

Back 25

Remaining portion of septum primum forms valve of foramen ovale.

Front 26

What is the sixth step in septation of the atria, after the remaining portion of the septum primum forms the valve of the foramen ovale?

Back 26

Septum secundum and septum primum fuse to form atrial septum

Front 27

What is the seventh step in septation of the atria, after the septum secundum and primum fuse to form the atrial septum?

Back 27

Foramen ovale usually closes soon after birth because of ↑ LA pressure

Front 28

What forms the foramen ovale?

Back 28

Residual foramen secundum (being closed by septum secundum in step 4)

Front 29

What forms the valve of the foramen ovale?

Back 29

Remaining portion of septum primum (green in step 4)

Front 30

What forms the atrial septum?

Back 30

Fusion of septum secundum and septum primum (which previously formed the valve of foramen ovale)

Front 31

What causes closure of the foramen ovale? When?

Back 31

After birth, foramen ovale closes due to increase left atrial pressure

Front 32

What can cause a patent foramen ovale?

Back 32

Failure of septum primum and septum secundum to fuse after birth

Front 33

What happens in a patient that has a patent foramen ovale?

Back 33

- Most are left untreated
- Can lead to paradoxical emboli (venous thromboemboli that enter systemic arterial circulation), similar to those resulting from an Atrial Septal Defect

Front 34

What steps lead to septation of the ventricles?

Back 34

1. Muscular ventricular septum forms; opening is called the interventricular foramen
2. Aorticopulmonary septum rotates and fuses with muscular ventricular septum, closing the interventricular foramen
3. Growth of the endocardial cushions separates atria from ventricles and contributes to both atrial septation and the membranous portion of the interventricular septum

Front 35

What is the first step in ventricular septation?

Back 35

Muscular ventricular septum forms; opening is called the interventricular foramen

Front 36

What is the second step in ventricular septation, after formation of the muscular ventricular septum?

Back 36

Aorticopulmonary septum rotates and fuses with muscular ventricular septum, closing the interventricular foramen

Front 37

What is the third step in ventricular septation, after the aorticopulmonary septum rotates and fuses to the muscular ventricular septum?

Back 37

Growth of the endocardial cushions separates atria from ventricles and contributes to both atrial septation and the membranous portion of the interventricular septum

Front 38

What contributes to both atrial septation and the membranous portion of the interventricular septum?

Back 38

Growth of the endocardial cushions

Front 39

What are the characteristics of a ventricular septal defect (VSD)?

Back 39

- Most commonly occurs in the membranous septum
- Acyanotic at birth due to L→R shunt

Front 40

How does the outflow tract of the heart form?

Back 40

- Truncus arteriosus rotates
- Neural crest and endocardial cell migrations → truncal and bulbar ridges
- Truncal and bulbar ridges spiral and fuse to form aorticopulmonary septum → ascending aorta and pulmonary trunk

Front 41

What are the possible conotruncal abnormalities?

Back 41

- Transposition of the great vessels
- Tetralogy of Fallot
- Persistent truncus arteriosus

Front 42

What do the aortic and pulmonary valves develop from?

Back 42

Derived from endocardial cushions of outflow tract

Front 43

What do the mitral and tricuspid valves develop from?

Back 43

Derived from fused endocardial cushions of the AV canal

Front 44

What are the types of valvular anomalies?

Back 44

- Stenosis
- Regurgitation
- Atresia (eg, triscuspid atresia)
- Displacement (eg, Ebstein anomaly)

Front 45

What are the locations of fetal erythropoiesis? When?

Back 45

Young Liver Synthesizes Blood:
- Yolk sac (3-8 weeks)
- Liver (6 weeks - birth)
- Spleen (10-28 weeks)
- Bone marrow (18 week s- adult)

Front 46

What are the types of hemoglobin?

Back 46

- Fetal hemoglobin (HbF): α2γ2
- Adult hemoglobin (HbA): α2β2

Always Alpha, Gamma Goes, Becomes Beta

Front 47

What is the difference between HbF and HbA in terms of affinity for O2?

Back 47

- HbF has a higher affinity for O2 d/t less avid binding of 2,3-BPG
- This allows HbF to extract O2 from HbA (maternal Hb) across the placenta

Front 48

Which part of fetal circulation has the highest PO2?

Back 48

Blood in umbilical vein has PO2 of ~30 mmHg and is ~80% saturated w/ O2
(from placenta, going to fetal heart)

Front 49

Which part of fetal circulation has the lowest PO2?

Back 49

Umbilical arteries (from fetal heart, returns to placenta to mom)

Front 50

What are the 3 important shunts in fetal circulation?

Back 50

1. Ductus Venosus
2. Foramen Ovale
3. Ductus Arteriosus

Front 51

What is the function of the Ductus Venosus?

Back 51

Blood entering the fetus through the umbilical vein is conducted via the Ductus Venosus (1) into the Inferior Vena Cava to bypass the hepatic circulation

Front 52

What is the function of the Foramen Ovale?

Back 52

Most highly oxygenated blood reaching the heart via the IVC is diverted through the Foramen Ovale (2) and pumped out the aorta to the head and body

Front 53

What is the function of the Ductus Arteriosus?

Back 53

- Deoxygenated blood entering the RA rom the SVC goes: RA → RV → main PA → patent Ductus Arteriosus (3) → descending aorta
- Due to high fetal pulmonary artery resistance d/t low O2 tension

Front 54

What happens to the fetal circulation when an infant takes its birth breath after birth?

Back 54

- ↓ Resistance in pulmonary vasculature causes ↑ LA pressure vs RA pressure
- Foramen ovale closes (now called Fossa Ovalis)
- ↑ in O2 (from respiration)
- ↓ in Prostaglandins (from placental separation)
- Closure of Ductus Arteriosus

Front 55

How can you close a Patent Ductus Arteriosus (PDA)?

Back 55

Indomethacin → forms ligamentum arteriosum

Front 56

How can you maintain a Patent Ductus Arteriosus (PDA)?

Back 56

Prostaglandins E1 and E2 keep PDA open

Front 57

What is the fetal-postnatal derivative of the umbilical vein?

Back 57

- Ligamentum teres hepatis
- Contained in falciform ligament

Front 58

What is the fetal-postnatal derivative of the umbilical arteries?

Back 58

Medial umbilical ligaments

Front 59

What is the fetal-postnatal derivative of the ductus arteriosus?

Back 59

Ligamentum arteriosum

Front 60

What is the fetal-postnatal derivative of the ductus venosus?

Back 60

Ligamentum venosus

Front 61

What is the fetal-postnatal derivative of the foramen ovale?

Back 61

Fossa ovalis

Front 62

What is the fetal-postnatal derivative of the allantois?

Back 62

Urachus-Median umbilical ligament
- Urachus is the part of the allantoic duct between the bladder and the umbilicus
- Urachal cyst or sinus is a remnant

Front 63

What is the fetal-postnatal derivative of the Notochord?

Back 63

Nucleus pulposus of the intervertebral disc

Front 64

What is the fetal structure that forms the ligamentum teres hepatis? Location?

Back 64

- Derived from umbilical vein
- Contained in falciform ligament

Front 65

What is the fetal structure that forms the medial and median umbilical ligaments?

Back 65

- MediaL: derived from umbiLical arteries
- MediaN: derived from allaNtois

Front 66

What is the fetal structure that forms the ligamentum arteriosum and venosum?

Back 66

- Ligamentum arteriosum: derived from ductus arteriosus
- Ligamentum venosus: derived from the ductus venosus

Front 67

What is the fetal structure that forms the fossa ovalis?

Back 67

Foramen Ovale

Front 68

What is the fetal structure that forms the nucleus pulposus of the intervertebral disc?

Back 68

Notochord

Front 69

Which coronary artery supplies the SA and AV nodes?

Back 69

Right Coronary Artery (RCA)

Front 70

What can an infarct of the Right Coronary Artery cause?

Back 70

Nodal dysfunction (bradycardia or heart block)

Front 71

How common is right-dominant circulation? Characteristics?

Back 71

85%
- Posterior Descending Artery (PDA) arises from the Right Coronary Artery (RCA)

Front 72

How common is left-dominant circulation? Characteristics?

Back 72

8%
- Posterior Descending Artery (PDA) arises from the Left Circumflex Coronary Artery (LCX)

Front 73

How common is co-dominant circulation? Characteristics?

Back 73

7%
- Posterior Descending Artery (PDA) arises from both Left Circumflex Coronary Artery (LCX) and the Right Coronary Artery (RCA)

Front 74

Where does coronary artery occlusion most commonly occur?

Back 74

Most commonly in the Left Anterior Descending Artery (LAD)

Front 75

When does coronary artery blood flow peak? Why?

Back 75

Early diastole (the muscles are relaxing so there is more room for blood to flow through arteries)

Front 76

What is the most posterior part of the heart?

Back 76

Left Atrium

Front 77

What can enlargement of the heart (specifically most posterior part / LA) cause?

Back 77

- Dysphagia (due to compression of esophagus)
- Hoarseness (due to compression of the L recurrent laryngeal nerve, a branch of vagus)

Front 78

Which artery supplies the lateral and posterior walls of the left ventricle?

Back 78

Left Circumflex Coronary Artery (LCX)

Front 79

Which artery supplies the anterior 2/3 of the interventricular septum, anterior papillary muscles, and the anterior surface of the LV?

Back 79

Left Anterior Descending Artery (LAD)

Front 80

Which artery supplies the posterior 1/3 of the interventricular septum and the posterior walls of the ventricles?

Back 80

Posterior Descending / Interventricular Artery (PDA)

Front 81

Which arteries supply the interventricular septum?

Back 81

- Anterior 2/3: Left Anterior Descending (LAD)
- Posterior 1/3: Posterior Descending Artery (PDA)

Front 82

what collagen is found in the heart muscle and vessels

Back 82

I

Front 83

what part of the heart spans the most anterior part and can be stabbed in the left 4th intercostal leverl

Back 83

right ventricle

Front 84

what causes coronory sinus dilatations

Back 84

well it drains to right atrium if the right atrium has a lot of pressure due to pulmonary HTN then it will dialte the coronoray artery

Front 85

aortic arch 1:2:3:4:5:6

Back 85

maxilarry aretery

stapedial artery

common carotid and proximal internal carotid

left: airta, R right subclavian

5th degenerates

6th pulmonart artery and ductus arteriosus

Front 86

tetralogy of fallot is due to

Back 86

neural crest cells

Front 87

RCA gives rise to

Back 87

LAD which can give inferior MI

Front 88

lateral MI

Back 88

LCA V5 V6 Vk