Fetal Heart Development

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Questions and Answers

Failure of the ductus arteriosus to close after birth is most commonly observed in which population?

  • Infants with chromosomal abnormalities
  • Premature infants (correct)
  • Full-term infants
  • Infants with congenital heart defects

Which of the following structures is responsible for directing blood from the umbilical vein to the inferior vena cava (IVC) in fetal circulation?

  • Ductus venosus (correct)
  • Umbilical artery
  • Foramen ovale
  • Ductus arteriosus

In fetal circulation, what is the primary function of the foramen ovale?

  • To bypass the ventricles
  • To direct blood from the umbilical vein to the inferior vena cava
  • To allow blood to flow from the right atrium to the left atrium (correct)
  • To shunt blood from the pulmonary artery to the aorta

Which of the following cardiac events occurs earliest during embryonic development?

<p>Appearance of the heart (B)</p> Signup and view all the answers

During which week of embryonic development does the heartbeat typically begin?

<p>Week 3 (C)</p> Signup and view all the answers

Which of the following best describes the direction of cardiac looping during embryonic development?

<p>To the right in a counterclockwise direction (D)</p> Signup and view all the answers

What is the origin of the heart tissue during embryonic development?

<p>Mesoderm (A)</p> Signup and view all the answers

Which of the following best describes the function of the endocardial cushions in heart development?

<p>Separation of the atria and ventricles and formation of the heart valves (C)</p> Signup and view all the answers

A newborn is diagnosed with persistent fetal circulation. Which fetal shunt failed to close properly?

<p>Ductus arteriosus (B)</p> Signup and view all the answers

A baby is born with only one umbilical artery. This condition raises concern for:

<p>Chromosomal abnormalities and other congenital defects (B)</p> Signup and view all the answers

A child is diagnosed with Tetralogy of Fallot (TOF). Which of the following is NOT a component of TOF?

<p>Atrial Septal Defect (ASD) (A)</p> Signup and view all the answers

Which heart sound correlates with the closure of the mitral and tricuspid valves?

<p>S1 (B)</p> Signup and view all the answers

In which area of the chest is S1 typically heard best?

<p>Lower left sternal border or apex (A)</p> Signup and view all the answers

What causes cyanosis in right-to-left shunting?

<p>Blood bypassing the lungs and returning to the body (C)</p> Signup and view all the answers

What physiological process leads to pulmonary hypertension in left-to-right shunting?

<p>Back leak of blood from systemic to pulmonary circulation (D)</p> Signup and view all the answers

Which of the following terms best describes the sound produced by turbulent blood flow in the heart?

<p>Murmur (B)</p> Signup and view all the answers

Which of the following is NOT a cause of heart murmurs?

<p>Laminar blood flow (B)</p> Signup and view all the answers

Which of the following is a category of cyanotic heart diseases?

<p>Transposition of the Great Arteries (TGA) (D)</p> Signup and view all the answers

A patient is diagnosed with tricuspid atresia. What does this condition entail?

<p>Complete absence of the tricuspid valve (A)</p> Signup and view all the answers

A Still's murmur is most commonly heard in children of what age range?

<p>2-8 years (A)</p> Signup and view all the answers

When auscultating a Still's murmur, what action typically makes the murmur disappear or soften?

<p>Bearing down (Valsalva maneuver) (A)</p> Signup and view all the answers

What is a key characteristic of a venous hum that distinguishes it from other murmurs?

<p>It is a continuous murmur (D)</p> Signup and view all the answers

What physical action typically makes a venous hum disappear?

<p>Lying supine or neck extension (B)</p> Signup and view all the answers

A peripheral pulmonic stenosis murmur in a newborn is characterized by radiation to which areas?

<p>Axilla and back (D)</p> Signup and view all the answers

What is the typical cause of pulmonary and aortic flow murmurs?

<p>Turbulent flow across pulmonary arteries (B)</p> Signup and view all the answers

Under what conditions are pulmonary and aortic flow murmurs most likely to be heard?

<p>During febrile illnesses or dehydration (A)</p> Signup and view all the answers

A clinician detects a heart murmur described as 'sensitive, short duration, soft, single, small, sweet, and systolic'. Which of the following is the most likely type of murmur?

<p>Innocent murmur such as Still's murmur (C)</p> Signup and view all the answers

A newborn presents with cyanosis shortly after birth. The echocardiogram reveals a single vessel leaving the heart. Which cyanotic heart defect is most likely?

<p>Truncus Arteriosus (A)</p> Signup and view all the answers

A newborn presents with cyanosis. Upon examination, it is determined that the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. Which congenital heart defect is most likely?

<p>Transposition of the Great Arteries (TGA) (C)</p> Signup and view all the answers

Which of the following is a cyanotic heart defect characterized by the absence of a tricuspid valve, resulting in no direct communication between the right atrium and right ventricle?

<p>Tricuspid Atresia (C)</p> Signup and view all the answers

During an examination of a child, a physician identifies the classic components of Tetralogy of Fallot (TOF). Which of the following defects is included in this tetralogy?

<p>Overriding Aorta (C)</p> Signup and view all the answers

A neonate is diagnosed with Total Anomalous Pulmonary Venous Return (TAPVR). What is the key characteristic of this condition?

<p>Pulmonary veins fail to connect normally to the left atrium (C)</p> Signup and view all the answers

Which of the following defects is associated with the abnormal movement of blood from the aorta to the pulmonary artery?

<p>Patent ductus arteriosus (B)</p> Signup and view all the answers

In Coarctation of the Aorta, where is the aorta narrowed?

<p>In the descending aorta, typically near the ductus arteriosus (A)</p> Signup and view all the answers

What condition is defined by the presence of two aortic arches surrounding the trachea and esophagus?

<p>Double aortic arch (D)</p> Signup and view all the answers

What abnormality is indicated by the terms double or absent IVC (Inferior Vena Cava) or SVC ( Superior Vena Cava)?

<p>Venous defect (B)</p> Signup and view all the answers

What does PFO stand for, in the context of circulatory system defects?

<p>Persistent Foramen Ovale (D)</p> Signup and view all the answers

Where might you find a click, when listening to heart sounds?

<p>In association with valvular disease (B)</p> Signup and view all the answers

What does S2 correlate with?

<p>Closure of the semilunar valves (B)</p> Signup and view all the answers

Flashcards

Heart Origin

Develops from mesoderm and is the first functional organ.

Endocardial Cushions

Divide to form the left/right AV canals and develop into valves.

Day 18-20

Heart appears.

Day 20

Two separate heart tubes form.

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Day 21

Heart tubes fuse.

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Day 22

Fused heart tubes with primitive chambers.

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Day 22-23

Heartbeat begins.

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Day 23-28

Cardiac looping occurs to the right.

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Week 4

Blood circulation begins.

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Week 4

Atrial and ventricular septation occurs.

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Week 5

Truncus swelling occurs.

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Umbilical Cord (Week 5)

Contains 2 umbilical arteries and 1 umbilical vein.

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Week 8

Final heart formation is complete and fully functioning.

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Foramen Ovale

Shunts blood from the R atrium to L atrium.

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Ductus Arteriosus

Shunts blood from the pulmonary artery to the aorta.

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Ductus Venosus

Shunts blood from the umbilical vein to IVC.

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Endocardial cushion/septal defects

ASD, VSD, TOF, Transposition

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One Umbilical Artery

Associated with chromosomal abnormalities and congenital defects.

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Arterial Defects

PDA, Coarctation, Double Arch

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Venous Defects

Double or absent IVC or SVC.

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S1 Heart Sound

Closure of mitral/tricuspid valves.

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S2 Heart Sound

Closure of semilunar valves.

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Heart Clicks

May indicate valvular disease.

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Right-to-Left Shunt

Blood bypasses the lungs.

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Left-to-Right Shunt

Blood leaks from systemic to pulmonary circulation.

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Heart Murmur

Increased, obstructed, regurgitant, or turbulent blood flow.

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Cyanotic Heart Diseases

Truncus arteriosus, TGA, Tricuspid atresia, TOF, TAPVR.

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Still's Murmur

Loud in supine position, disappears with bearing down.

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Venous Hum

Soft continuous murmur, disappears in supine/neck extension.

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Peripheral Pulmonic Stenosis

Turbulent flow across pulmonary arteries.

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Pulmonary and Aortic Flow Murmur

Can happen with fever, dehydration, anemia.

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Study Notes

  • The heart is the first organ to functionally develop, originating from the mesoderm.
  • Endocardial cushions develop to separate the heart into left, right, upper, and lower chambers.
  • These cushions divide into left and right atrioventricular canals and thin to form the valves.
  • Heart development timeline:
    • 18-20 days: Heart appears.
    • 20 days: Two separate heart tubes.
    • 21 days: Fused heart tubes.
    • 22 days: Fused heart tubes with primitive atrium and ventricles.
    • 22-23 days: Heartbeat starts.
    • 23-28 days: Cardiac looping (to the right, out counterclockwise).
    • 28 days (4th week): Blood circulation begins.
    • Week 4: Atrial septation, ventricular septation.
    • Week 5: Truncus swelling, umbilical cord development.
    • Week 8: Fully functioning, fully formed heart.

Umbilical Cord Composition

  • Two umbilical arteries carry depleted blood from fetus to mother.
  • One umbilical vein carries oxygenated blood from mother to fetus.
  • Wharton's jelly surrounds and protects these vessels.

Fetal Shunts

  • Foramen ovale: Shunts blood from right atrium to left atrium, bypassing the right ventricle.
  • Ductus arteriosus: Shunts blood from pulmonary artery to aorta. Failure to close is common in premature infants.
  • Ductus venosus: Shunts blood from umbilical vein to inferior vena cava (IVC) and right atrium.

Endocardial Cushion/Septal Defects

  • Atrial Septal Defect (ASD).
  • Ventricular Septal Defect (VSD).
  • Tetralogy of Fallot (TOF).
  • Transposition of the Great Vessels (TGA).

Circulatory System Defects

  • One umbilical artery is linked to chromosomal abnormalities and congenital defects.
  • Arterial defects include:
    • Patent Ductus Arteriosus (PDA).
    • Coarctation of the aorta.
    • Double aortic arch.
  • Venous defects include double or absent IVC or SVC.
  • Patent Foramen Ovale (PFO).

Heart Sounds

  • S1: Closure of mitral and tricuspid valves; heard at the lower left sternal border or apex.
  • S2: Closure of semilunar valves.
  • Clicks: Associated with valvular disease.

Shunting

  • Right-to-left shunting: Causes cyanosis because blood bypasses the lungs.
  • Left-to-right shunting: Causes back leak of blood from systemic to pulmonary circulation, leading to pulmonary hypertension.

Murmurs

  • Whooshing or swishing sounds caused by:
    • Increased flow.
    • Obstructed flow.
    • Regurgitant flow.
    • Turbulent flow of blood.
  • The "seven S's" of murmurs: Sensitive, Short duration, Soft, Single, Small, Sweet, Systolic.

Cyanotic Diseases

  • Truncus arteriosus: One vessel leaves the heart instead of two.
  • Transposition of the Great Arteries (TGA): Great vessels are transposed.
  • Tricuspid atresia: Tricuspid valve fails to form.
  • Tetralogy of Fallot (TOF): Four heart defects occur together.
  • Total Anomalous Pulmonary Venous Return (TAPVR): No pulmonary artery.

Murmur Characteristics by Type

  • Stills murmur:
    • Age range: 2-8 years old.
    • Grade 1-3 murmur.
    • Loud in supine position.
    • Most common innocent murmur.
    • Goes away with bearing down.
  • Venous hum:
    • Age range: 2-5 years old.
    • Grade 1-3 murmur.
    • Soft, continuous sound.
    • Heard while sitting down.
    • Disappears in supine position or with neck extension.
  • Peripheral pulmonic stenosis:
    • Newborns to 6 months.
    • Grade 1-3 murmur.
    • Radiation to axilla and back.
    • Turbulent flow across pulmonary arteries.
  • Pulmonary and aortic flow murmur:
    • Any age.
    • Grade 1-2 murmur.
    • Can happen with fever, dehydration, or anemia.
    • Occurs after illness.

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