39. endocarditis, endocardiosis and their consequences. Organic heart changes Flashcards
2 types of vegetative endocarditis
valvular (mitral -> aortic -> tricuspid -> pulomnary)
mural (parietal)
cause of vegetative endocarditis
systemic bacterial infection
lesions of vegetative endocarditis
adhering, friable, yellow-grey masses of fibrin, platelets and inflammatory cells
rough and granular surface
how are fibrin depositis organised in chronic vegetative endocarditis
by fibrous CT to produce irregular nodular masses - “verrucae”
consequence of vegetative endocarditis
death due to cardiac failure from valvular dysfunction
risk of septic thromboembolism
ulcerative/ uremic endocarditis
DOGS
left atrium
healing by fibrosis
+/- mineralisation
chronically dilated atria
white-red wrinkled area
Subendocardial fibrosis in cases of
- in chronically dilated hearts
– in dogs with healed lesions of left atrial ulcerative endocarditis
– in cattle, in a variety of chronic debilitating diseases (e. Johne’s disease
– in valvular insufficiencies ((„jet lesions” focal fibrosis)
–with or without mineralization
Subendocardial mineralization
occurs with fibrosis
left atrium
cause of Subendocardial mineralization
*Secondary: on the basis of previous lesions (uraemia!)
* Vitamin E/Selenium deficiency (lamb)
* Vitamin D intoxication (iatrogenic, alimentary)
* Primary: problems of mineral metabolism (hypercalcaemia)
lesions of subendocardial mineralisation
diffuse, severe mineralisation and fibrosis of left arium
endocariosis
degeneration
most common cardiac disease in dogs
mitral > mitral + tricuspid > tricsupid
organic heart disease
vitium cordia
chronic lesions of valves and orifices of heart
stenosis of orifices
mitral stenosis
valvular insufficiency
chronic lesions of valves and orifices of heart
can be developmental errors
after endocarditis
can be consequence of endocardiosis or space occupying lesion
stenosis of orifices
either pulmonic/ (sub)aortic
Ventricular outflow obstruction ––> increase in intraventricular pressure (pressure overload) ––> concentric ventricular hypertrophy (increase in wall thickness, decrease in chamber size)
– Poststenotic dilation of the pulmonary artery /aorta with irregular intimal thickenings ( jet lesions
mitral stenosis
–Valvular stenosis = narrowing, failure to open
– Increased left atrial pressure ( (––> pulmonary hypertension ––> right venticular dilation)
– Left ventricular atrophy
valvular insufficiency
failure to close
– The valve structure is distorted ––> it becomes insufficient and cannot prevent backflow of blood
– Regurgitation ––> volume overload ––> atrial dilation and eccentric ventricular hypertrophy (approx. normal wall thickness, increase in chamber size)
– +/- atrial “jet lesions” (focal endocardial fibrosis resulting from long term trauma by a jet of blood leaking through the damaged valve
consequence of organic heart disease
congestive heart failure
right sided failure lesions
right atrioventricular (AV)
valvular insufficiency
pulmonic stenosis
pulmonary hypertension
result of right sided lesions
excessive right atrial pressure and systemic venous congestion
hepatic and splenic enlargement
nutmeg liver
ascites - dogs
hydrothorax - cats
subcutaneous oedema - ru, eq
histopath of right sided heart failure
dilated congested hepatic sinusiods
parenchymal atrophy
hemosiderin laden (Prussian blue positive) macrophages
cor pulmonale is defined as
right heart failure secondary to pulmonary disease, such as chronic obstructive pulmonary disease, dirofilariasis, or pulmonary thromboembolism
left sided lesions
left AV
aortic valvular insufficiency
results of left sided lesions
pulmonary venous congestion
pulmonary oedema
heavy, wet, mottled lungs, white froth in airways
histopath of left sided heart failure
pulmonary venous congestion
alveolar edema
hemosiderin laden (Prussian blue alveolar macrophages (“heart failure cells” or siderophages)
