Exam 2 Embryology and Anatomy Flashcards
(52 cards)
1
Q
The aortic sac in the embryo gives rise to…
A
the brachiocephalic artery and the right side of the aortic arch in the adult.
2
Q
The first and second aortic arches in the embryo…
A
regress and are not present in the adult.
3
Q
The third aortic arches in the embryo become…
A
the common carotid arteries and proximal internal carotid arteries in the adult.
4
Q
The dorsal aorta is lost between… On the right, the dorsal aorta is lost…
A
aortic arches 3 and 4. distal to the 7th intersegmental artery
5
Q
The left fourth aortic arch in the embryo becomes…
A
part of the aortic arch in the adult.
6
Q
The right fourth aortic arch in the embryo becomes…
A
the proximal right subclavian artery in the adult.
7
Q
The right sixth aortic arch in the embryo becomes…
A
the right pulmonary artery in the adult.
8
Q
The left sixth aortic arch in the embryo becomes…
A
the left pulmonary artery and the ductus arteriosus in the adult.
9
Q
The right seventh intersegmental artery in the embryo…
A
becomes the distal right subclavian artery in the adult.
10
Q
The foramen ovale in the heart of the embryo becomes…
A
the fossa ovale in the heart of the adult. (located in the right atrium)
11
Q
The ductus arteriosus between the pulmonary trunk and aorta of the embryo becomes…
A
ligamentum arteriosum in the adult.
12
Q
The umbilical vein the embryo becomes…
A
the round ligament of the liver in the adult.
(passes from the umbilicus to the porta hepatis)
13
Q
The umbilical arteries in the embryo become…
A
the abdominal ligaments in the adult.
14
Q
The ductus venosus in the embryo becomes…
A
the ligamentum venosus in the adult.
(It passes through the liver from the left branch of the portal vein and attaches to the IVC)
15
Q
The following teratogens cause which congenital heart defects?
- Lithium
- Alcohol
- Retinoic acid
- Maternal diabetes
- Maternal rubella
A
- Lithium: Ebstein’s
- Alcohol: VSD
- Reinoic acid: TGA
- Maternal diabetes: TGA, HCM, VSD, CoA (Coarctation of the Aorta)
- Maternal rubella: PDA, PS (pulmonary stenosis), AS (aortic stenosis)
16
Q
If dextrocardia is present, which orientation of the organs will result in the least amount of complications?
A
Dextrocardia with situs inversus totalis (total reverse order of organs in thorax and abdomen)
17
Q
Atrial Septal Defect (ASD)
- What is it?
- Most common type?
- Cause?
- Symptoms?
A
- Communication between the right and left atria
- Ostium secundum atrial septal defect (80% prevalence)
- Septum secundum is too short to cover forament secundum completely or foramen secundum is too large.
- Many are asymptomatic. Can cause cryptogenic stroke if embolism present in systemic circulation.
18
Q
Ventricular Septal Defect (VSD)
- What is it?
- Causes?
- Symptoms?
A
- Persistent communication between right and left ventricles
- It is the MOST common congenital heart disease
- Caused by:
- Deficient development of bulbar ridges
- Failure of dorsal and ventral endocardial cushions to fuse
- Deficient development of interventricular muscular septum.
- LOUD MURMUR at birth or shortly after
- if left untreated, Eisenmenger’s syndrome (cyanosis) can occur
19
Q
Atrioventricular Canal (AVC)
- What is it?
- Causes
- Correlations
A
- Open canal between right and left atria and right and left ventricles. Atria and ventricles separated by common valve.
- Results from faulty endocardial cushion development
- Correlated with trisomy, more specifically trisomy 21 (Down’s syndrome)
20
Q
Truncus Arteriosus (TA)
- What is it?
- Causes?
- Correlations?
- Symptoms?
A
- Single arterial trunk arises from heart and supplies systemic, pulmonary, and coronary circulations
- Caused by abnormal migration of neural crest cells - failure of the truncal ridges and aorticopulmonary septum to develop normally
- There is always a VSD present with TA
- Correlated with DiGeorge syndrome (CATCH22)
- Cardiac abnormality
- Abnormal facies
- Thymic aplasia
- Cleft palate
- Hypoparathyroidism
- Symptoms include cyanosis, congestive heart failure, murmr, and pulmonary hypertension early on.
21
Q
Transposition of the Great Arteries (TGA)
- What is it?
- Causes?
- Symptoms?
A
- Aorta arises from right ventricle and pulmonary trunk arises from left ventricle
- most common cyanotic lesion in newborns
- Systemic and pulmonary circulations are parallel
- Caused by failure of the AP septum to spiral
- Interatrial connection (ASD or PFO) is most often present
- Severe cyanosis occurs since birth, “egg on a string” appearance of heart on chest Xray
22
Q
Tetralogy of Fallot (TOF)
- What is it?
- Causes?
- Symptoms?
A
- Pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy present
- most common cyanotic lesion beyond neonatal period
- Caused by abnormal neural crst migration into truncal and bulbar ridges
- causes misalignment of the aortopulmonary septum
- Symptoms include murmur from pulmonary stenosis, hypoxic cyanotic spell during crying or feeding, boot shaped heart seen in chest xray
23
Q
Ebstein’s Anomaly
- What is it?
- Causes?
- Symptoms?
A
- RA becomes enlarged and part of RV becomes atrialized
- Caused by abnormally developed and positioned tricuspid valve (anterior cusp in enlarged)
- Symptoms include ASD (in 80% of cases)
- cyanosis
- decreased pulmonary blood flow
- CHF
- cardiomegaly that can cause airway obstruction and lung compression
- Arrhythmias
24
Q
Coarcation of the Aorta (CoA)
- What is it?
- Causes?
- Symptoms?
A
- Aortic constriction of variable length and location
- Common association with Turner syndrom
- Caused by:
- abnormal migration of cells into aortic wall next to DA
- abnormal hemodynamics resulting in abnormal growth of left 4th aortic arch
- Post-ductal CoA is usually diagnosed later in life. It shows signs and symptoms of decreased perfusion in distal vascular territories, difference in BP b/w upper and lower extremities, rib notching shown on chest xray
- Pre-ductal CoA shows differential diagnosis (upper part of body pink, lower part blue), difference in BP and pulses
25
Patent Ductus Arteriosus (PDA)
* What is it?
* Correlations?
* Symptoms?
* Persistence of ductus arteriosus
* Correlated with maternal rubella infection
* Symptoms include decreased lung compliance, worsening respiratory status
26
Total anomalous pulmonary venous return (TAPVR)
* What is it?
* Causes?
* Symptoms?
* All pulmonary veins return via various pathways to RA intead of LA
* Blood keeps circulating withing pulmonary circuit (increased PBF, pulmonary edema)
* Caused by defect in formation of pulmonary veins in LA wall
* Symptoms include respiratory distress and cyanosis
* ASD/VSD needed for systemic blood flow
27
The five cyanotic diseases are:
1. Truncus arteriosus
2. Transposition of the great vessels
3. Tricuspid atresia
4. Tetralogy of Fallot
5. TAPVR
28
Tracheoesophageal fistula (TEF)
* What is it?
* Causes?
* VACTERL
* Symptoms
* Abnormal connection between trachea and esophagus that often results in a blind esophagus as well.
* Caused by incomplete fusion of tracheoesophageal folds that prevents foregut to separate completely into trachea and esophagus
* **VACTERL**: **V**ertebral anomalies, **A**nal atresia, **C**ardiac defects, **T**racheoesophageal fistula/**E**sophageal atresia, **R**enal anomalies, **L**imb anomalies
* Symptoms include inability to swallow, frequent drooling, immediately regurgitate milk when fed, choking/aspiration due to reflux from stomach
* Associated with polyhydramnios, coiled tube will show up on CXR
29
Types of TEF
* Most common
* Least symptomatic
* Most common: Type C - upper portion of esophagus ending in blind pouch and lower segment forming fistula with trachea
* Least symptomatic: Type H - TEF without esophageal atresia; often diagnosed later in life
30
Respiratory Distress Syndrome
* What is it?
* Symptoms?
* Caused by inadequate production of surfactant
* Severe labored breathing and cyanosis shortly after birth
* CXR shows ground glass (diffuse fine granular pattern)
31
Hereditary Surfactant Protein B Deficiency
* Autosomal recessive disease that causes complete absence of one of genes encoding surfactant protein B
* Fatal disease
32
33
Pulmonary Hypoplasia
* What is it?
* Causes?
* Potter's sequence
* Lung underdevelopment
* Caused by oligohydramnios and/or congenital diaphragmatic hernia
* Often associated with renal agenesis or amniotic sac rupture
* Potter's sequence: deformed limbs; wrinkly, dry skin; abnormal facies (wide-set eyes and infraorbital skin creases, beak nose, recessed chin, low-set ears)
* caused by oligohydramnios from bilateral renal agenesis
34
Congenital Diaphragmatic Hernia
* What is it?
* Symptoms
* Herniation of abdominal contents into thoracic cavity
* Causes defective formation and/or fusion of pleuroperitoneal membranes with other three parts of diaphragm
* Causes lung hypoplasia due to compression by abdominal viscera
* Also pushes heart anteriorly and to the right
* Immediately after birth, babies present with respiratory distress, cyanosis, decreased breath sounds on hernia side, and **scaphoid abdomen**
35
The primitive atrium in the embryo becomes...
the auricles of the right and left atria in the adult.
36
The right horn of the sinus venosus in the embryo becomes...
the sinus venarum in the adult.
37
The left horn of sinus venosus in the embryo becomes...
the coronary sinus in the adult.
38
The primitive pulmonary veins in the embryo become...
the smooth part of the left atrium.
39
The conus cordis (upper bulbis cordis) in the embryo becomes...
the conus arteriosus in the right ventricle and the aortic vestibule in the left ventricle in the adult.
40
41
The bulbis cordis in the embryo becomes...
the trabeculated right ventricle in the adult.
42
The primitive ventricle in the embryo becomes...
the trabeculated left ventricle.
43
The truncus arteriosus in the embryo becomes...
the ascending aorta and pulmonary trunk in the adult.
44
The division of the AV canal in the embryo heart occurs by the...
endocardial cushions (create R and L AV canals)
45
The atrial septum is formed by what? (and where do these septa form from?)
1. Septum primum: grows from roof of common atrium
1. Foramen primum closes as septum primum fuses with endcardial cushions
2. Foramen secundum forms in septum primum following cell death
2. Sepum secundum: grows from roof of atrium *immediately* to right of septum primum
46
The aorticopulmonary septum is formed from...
What is the origin of these cells?
truncal ridges from the walls of the truncus arteriosus and bulbar ridges from the bulbis cordis.
These ridges contain neural crest cells
47
/What structures does the right coronary artery supply?
Right coronary artery branches and structures it supplies.
* The right coronary artery supplies the right atrium and right ventricle
* Posterior interventricular artery
* Supplies left and right ventricles and interventricular septum
* Right marginal artery
* Supplies right ventricle
48
What structures does the left coronary artery supply?
Branches of left coronary artery and what structures do they supply?
* Left coronary artery supplies the left atrium and ventricle
* Anterior interventricular artery
* Supplies left and right ventricles and interventricular septum
* Circumflex artery
* Suppies left ventricle posteriorly
* Diagonal artery
* Supplies left ventricle anteriorly
* Left marginal artery
* Supplies left ventricle anteriorly
49
The veins that run with the right coronary artery are...
* Small cardiac vein
* Anterior cardiac vein (drapes over right coronary artery)
50
The vein that runs with the circumflex artery and the anterior interventricular artery is...
the great cardiac vein
51
The vein that runs with the anterior interventricular artery is...
middle cardiac vein.
52
What structure do all the cardiac veins drain into before draining into the right atrium?
What is the exception?
The coronary sinus
The anterior cardiac veins drain directly into the right atrium
