2009 Final Review Part 1 PDF

2009 FINAL REVIEW PART 1  BASIC EMBRYOLOGY  Basic Cardiac Embryology The heart is the first organ to function within an embryo. It forms from a pair of two heart tubes These tubes are composed of two layers of cells. Outer layer forms the myocardium Inner layer f...

2009 FINAL REVIEW PART 1  BASIC EMBRYOLOGY  Basic Cardiac Embryology The heart is the first organ to function within an embryo. It forms from a pair of two heart tubes These tubes are composed of two layers of cells. Outer layer forms the myocardium Inner layer forms the endocardium WEEK 3 1) sinus venosus  SVC, IVC, pulmonary veins, CS, posterior portion of RA & LA 2) primitive atrium  RA & LA 3) atrioventricular sulcus  divides primitive atrium & primitive ventricle 4) primitive ventricle  apical portion of LV & inlet portion of RV 5) interventricular sulcus  divides primitive ventricle & bulbus cordis 6) bulbus cordis  apical portion of RV, RVOT & LVOT, AO, main PA 7) AO sac will rise the aortic arch  QUESTIONS……. The heart is the first organ to function within an embryo. TRUE OR FALSE? Ultimately, the sinus venosus forms the __ _ a. superior and inferior vena cava b. pulmonary veins c. posterior portions of the atria d. all of the above  The sinus venosus has a right sinus horn and a left sinus horn The Left horn forms the coronary sinus The right horn becomes absorbed into the right atrium as the sinus venarum QUESTIONS……………… The growth of the __________ within the atrioventricular canal will eventually separate the canal into left and right sided orifices that will develop the mitral and tricuspid valve a. ventricular bulbar foramen b. sinus venosus c. endocardial cushions d. septum secundum  In the fetus, what structure is responsible for the exchange of oxygen, carbon dioxide, nutrients, and waste products? a. kidneys b. placenta c. lungs d. liver The right horn becomes absorbed into the right atrium as the_____ The Left horn forms the ______ STUDY THIS DIAGRAM NORMAL VARIANTS: CHIARI NETWORK EUSTACHIAN VALVE MODERATOR BAND FALSE TENDONS SIGMOID SEPTUM ATRIAL SEPTAL ANEURYSM LAMBL’S EXCRESCENCES  CHIARI NETWORK The Chiari network is an embryologic remnant of the valves of the sinus venosus. Chiari network occurs due to incomplete resorption of right valve of sinus venosus.  EUSTACHIAN VALVE Eustachian valve is an embryologic remnant of the inferior vena cava valve in the right atrium (also known as the "valve of the inferior vena cava").  QUESTIONS…………….. The Chiari network is an embryologic remnant of the valves that form from the a. Bundle branch b. sinus of Valsalva c. sinus venosus d. coronary sinus The Eustachian valve is an embryologic remnant of the inferior vena cava valve a. True b. False This is MODERATOR a band like structure BAND in the right ventricle passing from the interventricular septum to the free wall of the right ventricle. It transmits the right bundle branch from the Bundle of His to the right ventricle.  FALSE TENDONS False Tendons are thin string like structures in the left ventricle, extending from the interventricular septum to the papillary muscles near the lateral wall of the LV. SIGMOID SEPTUM The shape of the IVS and left ventricular outflow tract may change with age. The septum becomes “S”-shaped or “sigmoid” with bulging into the outflow tract.  QUESTIONS……………….. The Moderator band is a structure seen in the a. Right Atrium b. Left Atrium c. Left Ventricle d. Right Ventricle Thin string like structures seen in the LV from the papillary muscle to the IVS is a normal variant known as a. Moderator band b. False tendons c. Sigmoid Septum d. Chiari network  Fine filamentous strands originating from the aortic valve, commonly seen in the elderly is The shape of the IVS and the LV outflow a normal variant known as tract may change with age. a. Lambl’s Escrescences a. True b. Chiari network b. False c. Moderator band In the image below, the In reference to the above question, the arrow is pointing to a normal normal variant described is called a variant known as a. Moderator band b. False tendons c. Sigmoid Septum d. Chiari network a. Lambl’s Escrescences b. Chiari network c. Moderator band d. Atrial Septal Aneurysm  Coronar y Arteries Study this  LCA & RCA LEFT MAIN CORONARY ARTERY ARISES FROM THE SUPERIOR ASPECT OF THE LEFT CORONARY SINUS OF VALSALVA. THE RIGHT CORONARY ARTERY ARISES FROM THE SUPERIOR ASPECT OF THE RIGHT CORONARY SINUS OF VALSALVA. 23 ORDER OF FLOW OXYGENATED BLOOD IS PUMPED FROM THE LV THROUGH THE AORTIC VALVE, INTO THE ASCENDING AORTA (AAO) THE FIRST TWO BRANCHES OFF OF THE SINUS OF VALSALVA ASCENDING AORTA FORM THE CORONARY SYSTEM THE LCA & RCA ORIGINATE AT THE SINUSES OF VALSALVA AND TRAVEL DOWN THE OUTSIDE OF THE HEART MUSCLE 24  ORDER OF FLOW Study this diagram The branches off of the Aortic arch (AO arch) are the: Brachiocephalic or innominate artery right common carotid & right subclavian artery Left common carotid Left subclavian artery The Aortic isthmus is the area between the left subclavian artery and the ligamentum arteriosum These branches further divide into arteries, arterioles & capillaries to provide oxygen and nutrients to the upper extremities 25  ORDER OF FLOW The Descending thoracic aorta is distal of AO arch and travels inferiorly through the chest cavity The Descending abdominal aorta passes through the diaphragm and abdomen Numerous branches deliver oxygen and nutrients to the abdomen, organs an lower extremities 26  BLOOD VESSELS IN THE BODY ARTERIES ARTERIOLES VENULES VEINS CAPILLARIES 27 28  ARTERIES The arteries are the blood vessels that deliver oxygen-rich blood from the heart to the tissues of the body. Each artery is a muscular tube lined by smooth tissue and has three layers. 30 31 Venule A venule is a very small blood vessel in the microcirculatio n that allows blood to return from the capillary beds to drain into the larger 32 Veins are less muscular than arteries and are often closer to the skin 33 NETWORK OF VESSELS arteries arterioles capillarie s venules 34