S1 - Morphology > CARDIAC > Flashcards

CARDIAC Flashcards

(52 cards)

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1
Q

EMBRIOLOGY

Heart Tub: formation

A
  • week 3
  • splanchnic mesoderm (cardiogenic area) + neural crest cells = cardiogenic cells
  • cardiogenic cells → pair of primordial heart tubes → heart tube (single)
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2
Q

EMBRIOLOGY

Heart Tub: development

A

dextral looping + rotation

  • truncus arteriosus grows more → down + ventral movimentation to the right
  • atria + sinus venosus → up + dorsal movimentation to the left
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3
Q

EMBRIOLOGY

Heart Tub: dilatations

A
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4
Q

EMBRIOLOGY

Fetal Circulation: 3 major venous systems

A
  • Vitelline
    • deoxygenated blood
    • from yolk sac
    • will form veins of the liver and part of inferior vena cava
  • Umbilical
    • oxygenated blood
    • from placenta
  • Cardinal
    • deoxygenated blood
    • from fetal body
    • will form some of the major veins (cavas, azygo etc)
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5
Q

EMBRIOLOGY

Fetal Circulation: 3 shunts

A

umbilical vein → bypass lung and liver (shunts)

  1. Ductus Venous - bypass sinusoids of the liver
  2. Foramen Ovale bypass pulmonary circulation (right atrium to left atrium into systemic circulation)
  3. Ductus Arteriosus bypass pulmonary circulation (deoxygenated blood from pulmonary trunk to aorta)
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6
Q

EMBRIOLOGY

The shunting of blood through foramen ovale and ductus arteriosus occurs because of right-to-left pressure gradient.

TRUE OR FALSE

A

TRUE

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7
Q

EMBRIOLOGY

Pressure Gradients: Fetal vs Postnatal

A

Postnatal changes

  • umbilical vein closes
    • less pressure to right atrium
  • lungs expansion
    • increase venous return to left atrium
    • increase flow to pulmonary circulation
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8
Q

EMBRIOLOGY

Fetal Circulation: Closure of the shunts

A

Foramen Ovale

(left atrium >> right atrium)

Ductus Venous

(increase oxygen tensios + smooth muscles contration + after several hours)

Ductus Arteriosus

(same as ductus venous + bradykinin release + immediated drop of prostaglandin E)

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9
Q

EMBRIOLOGY

Fetal Circulation: Adult Vestiges

A
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10
Q

EMBRIOLOGY

Heart Tub: Septation

A

commom chamber

→

right and left horns

(ventricular, atrial and truncus venous - except sinus venous)

→

septation

(week 4 - week 8)

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11
Q

EMBRIOLOGY

Atrial Septation

A

2 septa

(septum primum and secundum)

+

2 foramina

(foramen primum and secundum)

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12
Q

EMBRIOLOGY

Atrial Septation: Septum Primum + Foramen Primum

A
  • Septum Primum
    • grows inferiorly (from the roof)
    • doesn’t fuse with endocardial cushions
  • Foramen Primum
    • betweem septum primum and endocardial cushions
    • closed when septum primum later fuses with endocardial cushions
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13
Q

EMBRIOLOGY

Atrial Septation: Septum Secundum and Foramen Secundum

A
  • Septum Secundum
    • after foramen primum closes
    • from the roof
    • right of the septum secundum
  • Foramen Secundum
    • from the upper part of septum primum
    • after foramen primum closes
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14
Q

EMBRIOLOGY

Foramen Ovale is the opening between septum secundum and septum primum

A

TRUE

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15
Q

EMBRIOLOGY

Endocardial Cushions receives the migrate cells from neural crest in order to form …

A

atrioventricular valves

+

membranous part of the intervertricular septum

+

aorticopulmonary septum

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16
Q

EMBRIOLOGY

Clinical Correlate: postnatal shunts

A

right-to-left shunts = cyanotic

left-to-right shuts = non-cyanotic

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17
Q

EMBRIOLOGY

Clinical Correlate: Atrial Septal Defect

A

female >> male

left-to-right shunt = non-cyanotic

primum vs secundum

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18
Q

EMBRIOLOGY

Clinical Correlate: Secundum Atrial Septal Defect

A

most commom ASD

excessive resorption of septum primum + underdevelopment of septum secundum

central part of septum

small

symptons at 30

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19
Q

EMBRIOLOGY

Clinical Correlate: Primum Atrial Septal Defect

A

less commom ASD

failure fusion between septum primum and endocardial cushion

lower atrial septum

may be associated with defects of endocardial cushion (valves)

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20
Q

EMBRIOLOGY

Ventricular Septation

A
  • week 4 - week 7 (usually completed)
  • close completely - without shunting
  • muscular component
    • large + most of the septum
    • from the floor of the ventricule (ascends)
    • leaving the IV foramen
  • membranous component
    • thin + superior part of the septum
    • closes the IV foramen
    • from the fusion of right and left conotruncal rigdes + endocardial cushions
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21
Q

EMBRIOLOGY

Clinical Correlate: Ventricular Septum Defect

Study These Flashcards
A

MOST COMMON CONGENITAL HEART DEFECT]

  • membranous VSD is the most commom
  • neural crest cells migration failure
  • IV foramen = left-to-right shunt = non-cyanotic
  • excessive fatigue upon exercise
  • pulmonary hypertension
    • ultimately: pulmonary resistence is higher than systemic resistence (Eisenmenger Complex)
    • shunt becomes right-to-left = cyanotic
22
Q

EMBRIOLOGY

Septation of the Truncus Arteriosus

Study These Flashcards
A
  • week 8
  • neural crest cells migration
  • fusion of conotruncal and bulbar ridges
    • spiral fashion
    • formation of aorticopulmonary septum
23
Q

EMBRIOLOGY

Clinical Correlate: Patent Ductus Arteriosus

Study These Flashcards
A
  • left-to-right shunt
    • aorta >> pulmonary trunk
    • non-cyanotic
    • machine-like murmur
  • ductus arteriosus fails to close after birth
    • low oxygen tension
    • prostaglandin E
  • premature infants + maternal rubella infection
  • prostaglandin can be used to keep the patency in transposition of great vessels
  • treatment
    • indomethacin (and others prostaglandin E inhibitors)
    • acetylcholine
    • histamine
    • catecholamine
24
Q

EMBRIOLOGY

Clinical Correlate: non-cyanotic congenital defects

Study These Flashcards
A

left-to-right shunting

  • ASD
  • VSD
  • Patent Ductus Arteriosus
25
EMBRIOLOGY Clinical Correlate: cyanotic congenital heart defects
right-to-left shunting * Tetralogy of Fallot * Transposition of Great Vessels * Persistent Truncus Arteriosus
26
EMBRIOLOGY Clinical Correlate: Tetralogy of Fallot (4 major defects)
pulmonary stenosis (most important) + membranous IV septal defect + right ventricle hypertrophy (secundary) + overriding aorta (receives blood from both ventricles)
27
EMBRIOLOGY Clinical Correlate: Tetralogy of Fallot (clinical informations)
* most commom cyanotic congenital heart defect * aorticopulmonary septum fails to close * right-to-left shunting = cyanotic * boot-shaped heart = enlarged right ventricle
28
EMBRIOLOGY Clinical Correlate: Transposition of the Great Vessels
* failure of the spiral fashion (aorticopulmonary septum) * right-to-left shunt = cyanotic * the most common cause of severe cyanosis immediately after birth * results in 2 closed circulation loops → usually associated with other defects (mixed blood) in order to survive
29
EMBRIOLOGY Clinical Correlate: Persistent Truncus Arteriosus
* partial development of the aorticopulmonary septum * right-to-left shunt * cyanotic * truncus arteriosus receives blood from both ventricles * Always accompanied by membranous VSD
30
HISTOLOGY Cardiac Muscle Cells
striated in the same manner as skeletal muscle cells, except... **smaller cells (fibers)** **only 1 or 2 nuclei per fiber** **nuclei → centrally** **less well developt T-tubule system**
31
HISTOLOGY Layers of the Heart Wall
Epicardium (outer) Myocardium (middle) Endocardium (inner)
32
HISTOLOGY Composition the Epicardium
* Pericardium * visceral layer of the serous pericardium * simple squamous epithelium (mesothelium) * Connective Tissue * fat cells * coronary vessels
33
HISTOLOGY Composition of the Myocardium
muscular wall + cardiac muscle cells
34
HISTOLOGY
Endothelium (simple squamous epithelium) + Connective Tissue
35
HISTOLOGY Intercalated Disc
special junctions complex between myocardial cells * gap junctions + adhering junctions * gap ⇒ eletrical * adhering ⇒ mechanical * dark and transverse lines
36
HISTOLOGY Purkinje Cells
* modified cardiac muscle cells * fewer contratile filaments * large content of glycogen * eletrical impulse conduction * run along → cardiac conduction system + endothelial surface
37
ANATOMY Heart: External Features
obliquely in the middle mediatinum + posteriorly to sternum + 3 main sulci (coronary + anterior and posterior interventricular)
38
ANATOMY Borders of the Heart
* Right Border → right atrium * Left Border → left ventricle * Superior Border → auricules (right and left) + conus arteriosus (right ventricle) * Inferior Border → right ventricle + apex (left ventricle)
39
ANATOMY Surfaces of the Heart
* Anterior (sternocostal) → right ventricle * Posterior → left atrium * Diaphragmatic → left ventricle
40
ANATOMY Heart: Projections
41
ANATOMY Heart: right atrium
* auricle → fetal atrium (pectinate muscles) * sinus venarum → from sinus venosus (smooth) * crista terminales → vertical ridge (separation of smooth and rough) + SA node (upper part) * fossa ovalis → from foramen ovale closure * tricuspide valve
42
ANATOMY Heart: left atrium
* 4 openings * bicuspid valve (mitral)
43
ANATOMY Heart: right ventricle
* trabeculae carneae → myocardium rigdes * papillary muscle + chordae tendineae * infundibulum → pulmonary trunk (smooth part) * septomarginal trabecula (moderator band)
44
ANATOMY Heart: left ventricle
* trabecula carneae * papillary muscles (2) + chordael tendineae * aortic vestibule
45
ANATOMY Heart: Auscultation
46
ANATOMY Clinical Correlate: Heart Murmurs
stenosis - orthograde direction insufficiency - retrograde direction + aortic and mitral valves are more commonly involved with heart diseases
47
ANATOMY Arterial Supply of the Heart
blood flow enters coronary ateries during diastole * Right Coronary → * SA nodal artery (first branch) * AV nodal artery (distal end) * marginal artery * posterior interventricular artery * Left Coronary * anterior interventricular or left anterior descending (diagonal artery) * circumflex artery (marginal branch)
48
ANATOMY Interventricular Arteries: posterior vs anterior
**Posterior Interventricular Artery** (right and left ventricles + posterior third of interventricular septum) **Anterior Interventricular Artery** (anterior 2/3 of interventricular septum + left ventricle + bundle of His + Apex)
49
ANATOMY Clinical Correlate: Obstruction in Myocardial Infarction
Left Anterior Descending - 50% Right Coronary - 30% Circumflex Artery - 20%
50
ANATOMY Venous Drainage of the Heart
* **Coronary Sinus** → from left sinus venosus (fetal) + lies in the posterior coronary sulcus + opening in the right atrium * **Great Cardiac Vein** → main tributary of the coronary sinus + lies in the anterior interventricular sulcus * **Middle Cardiac Vein** → lies in the posterior interventricular sulcus * **Small Cardiac Vein** → lies in the coronary sulcus (right) * **Venae Cordis Minimae (thebesiam veins) + Anterior Cardiac Veins** → opening directly to the chambers
51
ANATOMY Cardiac Conduction System
* SA node * pacemaker * crista terminalis (upper part) * arterial supply - right coronary * AV node * interatrial septum (near to the opening of coronary sinus) * arterial supply - right coronary * Bundle of HIS * LAD artery supplies * right ventricle - moderator band
52
ANATOMY Cardiac Innervation
SANS increase heart rate + pain in ischemia (T1-T5) PANS decrease heart rate + cardiac reflexes
S1 - Morphology
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