Cardiopathology Lecture 2 Flashcards
List the layers of the heart from outer to inner
- Fibrous pericardium
- Parietal pericardium
- Parietal cavity
- Visceral layer of pericardium (epicardium)
- Myocardium
- Endocardium
What is pericardial effusion
Build of up fluid in pericardial sac
What is cardiac tamponade? What is happening to heart
Result from pericardial effusion—> increase presssure on the heart, reduced ventricular filling, backflow of blood—> right and left heart failure and ultimately cardiogenic shock
What kind of shock is cardiac tamponade
Cardiogeneic shock
What are the two types of pericardial effusion
- Hydropericardium
- Hemopericardium
What is hydropericardium and what causes it
Fluid accumulation in pericardial sac
1. Increased hydrostatic pressure (CHF)
2. Decreased oncotic pressure (hypoproteinemia)
3. Lymphatic obstruction (heart base mass)
4. Increased vascular permeability (pericarditis)
What is hemopericardium and what can cause it
Bleeding into pericardial sac
1. Cardiac hemangiosarcoma
2. Trauma: rupture of atria, aorta, or pulmonary artery
What are some causes pericarditis
Bacterial infection, traumatic reticulopericarditis (hardware dz), idiopathic
What are some causes of epicardial hemorrhage
Anoxia, sepsis, endotoxemia, DIC, coagulopathy, trauma, electrocution
Can be agonal change (at death increase BP-hemorrhage)
What does serous atrophied fat on the heart look like
Fat is gelatinous and clear to serous, lymphatics may be prominent
What are some causes of serous atrophy of fat on the heart
Chronic prolonged negative energy balance- emactiation
Ex: cancer patients
what is wrong with heart
Serous atrophy of fat
What is traumatic reticulopericarditis/ hardware disease
Migration of metal object from reticulum directly puncturing pericardial sac
Direct introduction of bacteria from gut
What does the heart look like in acute traumatic reticulopericarditis/ hardware diseae
Fibrinosuppurative pericarditis
“Bread and butter” appearance
What cell type is most common with bacterial infections
Neutrophils
What is wrong with heart
fibrinosuppurative pericarditis
What does chronic reticulopericarditis/ hardware disease look like
Constrictive pericarditis, fibrosis of epicardium to pericardium, reduced contraction of ventricles
Selenium and Vitamin E are key components in protecting cells from ___
Oxidative damage
Activity and high oxygen demand leave myocardial cells sensitivity to ___
Oxidative damage
Selenium and vitamin E deficiencies lead to _____
Myocardial degeneration and necrosis
What age group are nutritional deficiencies associated with myocardial disease seen in
Young animals
Patient has selenium and vitamin E deficiencies- what did it do to heart/what disease? What species is it common in
White muscle disease- necrosis and mineralization
Species: sheep’s and cows
What is wrong with this heart? What caused it? What species is it common in
Mulberry heart disease due to selenium and vitamin
E deficiencies
Species: pig
What important role does copper serve with the heart
Promotes cross linking of collagen in vessels
What can copper deficiency lead to
Weakened vascular integrity, predisposing to vascular aneurysmal dilations or tears
What are some ways in which toxins damage the heart
Depress myocardial function, directly injury cardiac cells- degeneration and necrosis, hypersensitivity reactions
What species do ionospheres, coccidiostats, monesin and lasalocid cause toxicity in and what is the result
Causes myocardial degeneration and necrosis in horses
What toxicities are associated with anthracycline (doxorubicin, adriamycin)? And what are the drugs used for
Uses: chemo drug to tx lymphosarcoma in dogs
Causes acute myocardial necrosis through oxidative damage, cytokine release, and inhibition of protein synthesis
What toxicities is gossypol associated with and in what species
Swine>goats>ruminants and horses fed cottonseed products
Causes myocardial necrosis and degeneration
What toxicities can occur due to plants with excess vitamin D and calcinogenic plants
Epidcardial deposits of minerals- necrosis and mineralization due to shoving Ca2+ into heart
How can uremia be toxic to the heart
Deposit of urate crystals following acute or repeated episodes of uremia from chronic renal disease that cause ulcerative lesions that are resolved with fibrosis and mineralization
What are some downstream effects of infectious and inflammatory cardiovascular disease
Infarcts, ischemia, hypertension, cor pulmonale (pulmonary vascular disease that leads to right heart enlargement)
What are some gross lesions associated with infectious and inflammatory cardiovascular disease
- Hemorrhage- petechiae and ecchymosis on epidcardium and endocardium of LV
- Areas of tan discoloration (necrosis, inflammation, or fibrosis)
- Roughened or irregular areas (fibrosis, inflammation)
- Irregularly thickened “vegetative” valves
What are 3 important inflammatory routes to heart
- Hematogenous or embolic dissemination/septicemia (most common)
- Direct extension from pleural or mediastinal infections
- Foreign body penetration or trauma
what is wrong here
Endocardial hemorrhage secondary to acute bacterial septicemia
What are some outcomes of infection, inflammation, +/- necrosis of myocardium
- Complete resolution
- Poor myocardial regeneration capacity
- Granulation tissue—> scarring (fibrosis) +/-mineralization
- Progressive myocardial damage- DCM
What cell type is dominant in pyogenic bacteria myocarditis lesions
Suppurative- neutrophils
What cell type is dominant in viral infections (WNV) and immune mediated
Lymphocytic
What histo changes are associated with canine parvovirus, foot and mouth disease
Necrotizing
What cell type is associated with idiopathic or parasitic myocarditis lesions
Eosinophilic
What disease are know to manifest as dilation and cause DCM
- Taurine deficiency in cats
- Cobalt toxicity
- Myocarditis
- Doxorubicin
DCM is an important cause of ___ in dogs
CHF
What species/breeds and age tend to be affected in DCM
Young to middle aged giant and large breed dogs
What is the boxer specific DCM
Arrhythmogenic right ventricular cardiomyopathy
What cell type/ myocarditis lesion is this and what diseases would it be affiliated with
Eosinophilic myocarditis- idiopathic or parasitic
What cell type/ myocarditis lesion is this and what diseases are associated with it
Lymphocytic myocarditis- viral infections (WNV) and immune mediated
Based on gross image what is wrong
DCM
What does the gross heart of DCM patients look like
Rounded, can have double apex, all chambers of heart may be dilated, ventricles are flabby and thin
What is wrong
DCM
What is wrong
DCM
Left: loss of cardiomyocytes, fat, fibrosis
Right: thin and wavy with fibrosis
What are the histological changes seen in DCM
Fibrosis, fat
What species is HCM common in and what age
Young adult-middle aged cats
What are some causes of HCM
Idiopathic or autosomal inheritance in several breeds- especially Maine coons
What species and age is thyrotoxic cardiomyopathy common in
Older cats
What causes thyrotoxic cardiomyopathy
Functional adenomatous hyperplasia or adenoma of thyroid (hyperthyroid)
What is the weight of the heart if hypertrophic and thyrotoxic cardiomyopathy
> 20 grams
What is the gross appearance of heart in HCM or thyrotoxic cardiomyopathy
Thickening of left ventricle and interventricular septum
LA may be dilated
What does the histology look like in HCM
Myocyte disarray, hypertrophy of myocytes, and fibrosis
___ develops over time with HCM and TCM
CHF
What is a major sequelae of HCM or TCM
Left atrial thrombosis and caudal abdominal aorta thromboembolism in 10-20% (saddle thrombi)
What is wrong
HCM or TCM
what is wrong
HCM or TCM- giant cardiomyocytes and not all going same direction
What is wrong here and what caused it
saddle thrombi caused by HCM or TCM
What is the primary cause of endocarditis
Bacterial
What is the main bacterial agent causing endocarditis in pigs
Erysipelothrix rhusiopathiae
What is the main bacterial agent causing endocarditis in cattle
Trueperella pyogenes
What are the main bacterial agents that can cause endocarditis in many species
Streptococcus, E. Coli, staphylococcus
What is the pathogens is of endocarditis
- Infection
- Multiple bouts of bacteremia/sepsis + factors affected virchow ‘s triad
- Fibrin and bacteria adhere to disrupted valve surface
- Mass of fibrin, bacteria, inflammatory cells, and granulation tissue grow +/- portions of mass dislodge
- Septic emboli in distant sites causing infarcts and new abscess formation
- Valve dysfunction and or septic shock
- Death
What is wrong
Endocarditis
What is wrong
endocarditis
Grossly what does endocarditis look like
Friable grey/black/tan masses adhered to the surface of valves (vegetative), margins of valves are rough and irregular (eroded and necrotic)
Where is the most common site of endocarditis
Mitral valve then aortic valve (left side)
In cattle where is the most common site for endocarditis
Tricuspid valve
What is endocardiosis
Myxomatous valvular degeneration, valvular insufficiency
What age and breeds tend to get endocardiosis
Middle to old age toy to medium sized dogs
What is the most common cause of CHF in old dogs
Endocardiosis
What is the most common cause of new murmur in older dogs
Endocardiosis
What is wrong
Endocardiosis
What is wrong
endocardiosis
What valve is endocardiosis most common in
Mitral valve
What are some associated lesions/sequelae of endocardiosis
- Atrial dilation and rupture
- Jet lesions- endocardial fibrosis caused by turbulence- white tissue above valves
3.rupture of chordae tendineae
What is wrong here
endocardiosis
What are group is feline endomyocarditis/ endocardial fibrosis most common in
Young cats <4yrs
When does feline endomyocarditis/ endocardial fibrosis most commonly occur
After stressful events
What happens in feline endomyocarditis/ endocardial fibrosis
Inflammation of left ventricular outflow tract
What do cats with feline endomyocarditis/ endocardial fibrosis typically present with
Interstitial pneumonia
What does the gross heart look like in cats with feline endomyocarditis/ endocardial fibrosis
Nothing or enlarged heart with white to grey discoloration of left ventricular endocardium and aortic outflow tract
What does histology look like in cat with feline endomyocarditis/ endocardial fibrosis. Acute and chronic
Acute: mixed inflammation in endocardium and adjacent myocardium
Chronic: marked fibroplasia and/or granulation tissue
What is wrong here
feline endomyocarditis/ endocardial fibrosis
