39. endocarditis, endocardiosis and their consequences. Organic heart changes

Question 1

2 types of vegetative endocarditis

Answer 1

valvular (mitral -> aortic -> tricuspid -> pulomnary)
mural (parietal)

Question 2

cause of vegetative endocarditis

Answer 2

systemic bacterial infection

Question 3

lesions of vegetative endocarditis

Answer 3

adhering, friable, yellow-grey masses of fibrin, platelets and inflammatory cells
rough and granular surface

Question 4

how are fibrin depositis organised in chronic vegetative endocarditis

Answer 4

by fibrous CT to produce irregular nodular masses - “verrucae”

Question 5

consequence of vegetative endocarditis

Answer 5

death due to cardiac failure from valvular dysfunction
risk of septic thromboembolism

Question 6

ulcerative/ uremic endocarditis

Answer 6

DOGS
left atrium
healing by fibrosis
+/- mineralisation
chronically dilated atria
white-red wrinkled area

Question 7

Subendocardial fibrosis in cases of

Answer 7

• 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

Question 8

Subendocardial mineralization

Answer 8

occurs with fibrosis
left atrium

Question 9

cause of Subendocardial mineralization

Answer 9

*Secondary: on the basis of previous lesions (uraemia!)
* Vitamin E/Selenium deficiency (lamb)
* Vitamin D intoxication (iatrogenic, alimentary)
* Primary: problems of mineral metabolism (hypercalcaemia)

Question 10

lesions of subendocardial mineralisation

Answer 10

diffuse, severe mineralisation and fibrosis of left arium

Question 11

endocariosis

Answer 11

degeneration
most common cardiac disease in dogs
mitral > mitral + tricuspid > tricsupid

Question 12

organic heart disease

Answer 12

vitium cordia
chronic lesions of valves and orifices of heart
stenosis of orifices
mitral stenosis
valvular insufficiency

Question 13

chronic lesions of valves and orifices of heart

Answer 13

can be developmental errors
after endocarditis
can be consequence of endocardiosis or space occupying lesion

Question 14

stenosis of orifices

Answer 14

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

Question 15

mitral stenosis

Answer 15

–Valvular stenosis = narrowing, failure to open
– Increased left atrial pressure ( (––> pulmonary hypertension ––> right venticular dilation)
– Left ventricular atrophy

Question 16

valvular insufficiency

Answer 16

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

Question 17

consequence of organic heart disease

Answer 17

congestive heart failure

Question 18

right sided failure lesions

Answer 18

right atrioventricular (AV)
valvular insufficiency
pulmonic stenosis
pulmonary hypertension

Question 19

result of right sided lesions

Answer 19

excessive right atrial pressure and systemic venous congestion
hepatic and splenic enlargement
nutmeg liver
ascites - dogs
hydrothorax - cats
subcutaneous oedema - ru, eq

Question 20

histopath of right sided heart failure

Answer 20

dilated congested hepatic sinusiods
parenchymal atrophy
hemosiderin laden (Prussian blue positive) macrophages

Question 21

cor pulmonale is defined as

Answer 21

right heart failure secondary to pulmonary disease, such as chronic obstructive pulmonary disease, dirofilariasis, or pulmonary thromboembolism

Question 22

left sided lesions

Answer 22

left AV
aortic valvular insufficiency

Question 23

results of left sided lesions

Answer 23

pulmonary venous congestion
pulmonary oedema
heavy, wet, mottled lungs, white froth in airways

Question 24

histopath of left sided heart failure

Answer 24

pulmonary venous congestion
alveolar edema
hemosiderin laden (Prussian blue alveolar macrophages (“heart failure cells” or siderophages)

Question 25

biventricular failure

Answer 25

due to closed cardiovascular system - failure of one side leads to failure of the other