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C & R II - wk1 > cardiovascular pathology - pt 1 > Flashcards

cardiovascular pathology - pt 1 Flashcards

1
Q

what is the function of the heart

A

pump sufficient volumes of blood to all organs to meet the varying metabolic needs of the animal

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2
Q

what are the 3 layers of the heart wall

A
  1. endocardium
  2. myocardium
  3. pericardium, visceral layer (epicardium)
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3
Q

what is the blood supply to the heart

A
  • left & right coronary arteries & their branches in epicardium -> intramural arteries that penetrate myocardium
  • venules & veins collect blood from heart wall & return it to right atrium via coronary sinus
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4
Q

what are the 3 specific characteristics to cardiac myocytes

A
  1. central nuclei
  2. intercalated discs
  3. cross-striations
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5
Q

what are sarcomeres

A

the contractile units composed of actin & myosin filaments

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6
Q

what are intercalated discs

A

specialized junctions between myocytes that allow myocardium to function as a unit

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7
Q

what is the cardiac conduction system composed of

A

modified cardiac myocytes that initate & conduct an electrical impulse -> coordinate cardiac muscle contraction

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8
Q

what is the function of the cardiac valves

A

allow unimpeded unidirectional blood flow

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9
Q

what are atrioventricular (AV) valves

A
  • supported by tendinous cords (chordae tendinae) & ventricular papillary muscles
  • allow flow from atria into ventricles, prevent backflow into atria
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10
Q

what are semilunar valves

A

allow flow into pulmonary artery & aorta, prevent backflow into ventricles

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11
Q

what is heart failure

A

heart is unable to meet the metabolic needs of the animal

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12
Q

loss of pumping efficiency due to cardiac disease or increased cardiac workload can lead to ____ & _____

A

ischemia and congestion

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13
Q

what is ischemia

A

decreased blood flow to the tissues

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14
Q

what is congestion

A

pooling of blood behind the failing chambers

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15
Q

what are gross findings of right-sided CHF

A
  • subcutaneous edema
  • ascities
  • chronic hepatic congestion (nutmeg liver)
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16
Q

what are gross findings of left-sided CHF

A

pulmonary congestion & edema

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17
Q

what are the gross findings of right/left-sided CHF

A
  • pleural effusion
  • common in cats
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18
Q

what are myocardial diseases

A

cardiac responses to increased workload or dysfunction

  • hypertrophy
  • dilation
  • cardiomegaly
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19
Q

what is hypertrophy

A

increase in myocardial mass due to increase myocyte size

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20
Q

what is dilation

A

increase in chamber volume due to stretching and/or hypertrophy of myocytes

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21
Q

what is cardiomegaly

A

increase in external dimensions of heart due to hypertrophy and/or dilation

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22
Q

what is concentric hypertrophy

A
  • due to pressure overload
  • sarcomeres added in parallel
  • increase wall thickness
  • decrease chamber volume
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23
Q

what is eccentric hypertrophy

A
  • due to volume overload
  • sarcomeres added in series
  • increase chamber volume (dilation)
  • normal to decreased wall thickness
24
Q

what is cardiomyopathies

A
  • diseases of the myocardium
  • primary (genetic or idiopathic)
  • secondary (known cause other than genetic)
25
what are the 3 main types of cardiomyopathies
* hypertrophic * dilated * restrictive
26
what is hypertrophic cardiomyopathy (HCM)
* **common in cats** (esp. young to middle-aged adult males) * **PRIMARY** (heritable) in some cat breeds (known mutation in Maine coon & ragdoll, idiopathic in others)
27
what are the gross findings of hypertrophic cardiomyopathy (HCM)
* englarged heart **(cardiomegaly)** * thick LV wall, decreased LV volume **(concentric hypertrophy)** * +/- LA dilation, thrombosis
28
what is thyrotoxic cardiomegaly | DDX for HCM
* **common in cats** * **SECONDARY** to hyperthyroidism * thyroid gland hyperplasia -> increase thyroid hormone production -> increase production of myocardial contractile proteins -> **myocardial hypertrophy** * **potentially reversible** on return to euthroidism
29
what are the gross findings of thyrotoxic cardiomegaly
* heart looks similar to HCM * enlarged nodular thyroid glands
30
what is dilated cardiomyopathy (DCM)
* **most common type in dogs** (esp. young to middle-aged giant & large breed) * **PRIMARY** (hertible) in some breeds (doberman, juvenile portuguese water dogs) * **SECONDARY** (acquired) form due to nutritional imbalances **(taurine deficiency in dogs & cats)**
31
what are the gross findings of DCM
* enlarged rounded heart * dilated chambers, thin walls **(eccentric hypertrophy)**, atrophied papillary muscles
32
what is restrictive cardiomyopathy (RCM)
* second most common type of cardiomyopathy in cats * endomyocardial fibrosis -> **impaired ventricular filling** * sequela of **ENDOMYOCARDITIS** (idiopathic inflammation that often follows a stressful event)
33
what are the gross findings of RCM
* **thick opaque endocardium** (usually involving LV outflow tract) * thick LV wall, decreased LV volume **(concentric hypertrophy)** * LA dilation
34
what are cardiomyopathy sequelae (may include)
* **arrhythmia** (syncope, sudden death) * **cardiac thrombosis -> thromboembolism** * **aortic ("saddle") thromboembolism** -> hind limb ischemia, paresis * thromboemboli to other organs -> ischemia, infarcts * **congestive heart failure**
35
what is myocardial necrosis
* death of cardiac myocytes * myocytes have minimal capacity to regenerate * irreversible injury -> myocyte **necrosis** -> **inflammation & healing by fibrosis** * clinical significance determined by location and extent of injury * may be subclinical or clinical -> arrhythmias, sudden death, CHF
36
what does acute myocardial necrosis look like grossly
myocardial pallor, dry +/- gritty texture **(dystrophic mineralization)**
37
what does chronic myocardial necrosis look like grossly
firm depressed myocardial scar **(fibrosis)**
38
what are the causes of myocardial necrosis
* nutritional (VE, selenium deficiency) * toxic (ionophores) * ischemic (coronary vasopasm, thrombosis) * genetic (X-linked muscular dystrophy in goldens) * traumatic
39
what is nutritional myopathy
* **VE/selenium deficiency** -> decreased antioxidant activity -> oxidative membrane damage -> cardiac & skeletal myocyte necrosis * **"white muscle disease"** in ruminants & horses * **"mulberry heart disease"** in pigs; accompanies by multiprgan vascular necrosis/thrombosis +/- hepatic necrosis * tan foci of myocardial necrosis & mineralization
40
what is myocarditis
inflammation of myocardium
41
what are the gross and histological findings of myocarditis
* similar to myocardial necrosis (which may be present) * myocytes separated/replaced by **inflammatory cells**
42
what are the causes of myocarditis
often hematogenous infection of local extension from endocardium & pericardium * viral * bacterial * fungal * parasitic
43
what are endocardial diseases
most clinically significant lesions affect the valves rather than the mural endocardium
44
what is valvular stenosis
failure to open completely
45
what is valvular insufficiency
failure to close completely
46
what is degenerative valve disease ("endocardiosis")
* **most common cardiovascular lesion in dogs** * **idiopathic degeneration** of valvular collagen with replacement by myxomatous matrix * most common in smaller breeds, prevalance increases with age. earlier onset with cavalier king charles spaniel * **mitral** > tricuspid >> aortic & pulmonic
47
what are the gross findings of degenerative valve disease
white, opaque, thickened/nodular valve leaflets with a **smooth, glistening surface**
48
what is myxomatous valvular degeneration
* valves thickened by loose fibroblastic tissue & wispy blue-gray matrix rich in mucopolysaccharides * **not an inflammatory lesion**
49
what may happen with degenerative valve disease
* valvular insufficiancy: **regurgiation** (heart murmur) * atrial volume overload: **eccentric hypertrophy** +/- CHF * atrial subendocardial fibrosis: **"jet lesion"** * **atrial thrombosis**: thromboembolism +/- infarcts * **chordae tendinae rupture** * **atrial tear**: hemopericardium
50
what is endocarditis
* inflammation of endocardium * **bacterial** >> fungal or parasitic causes * **tricuspid** lesions most common in **cattle** * **mitral** lesions most common in **others**
51
what is the pathogenesis of endocarditis
* sustained or recurrent **bacteremia** & minor **endocardial injury** at lines of valve apposition * bacterial adhesion & proliferation * inflammation & further endocardial injury * **thrombosis**
52
what are the gross findings of endocarditis
rough, friable, red-tan thrombi **("vegetations")** on valvular endocardium
53
what is vegetative valvular endocarditis
septic thombi composed of **fibrin, bacteria, neutrophils** +/- granulation tissue/fibrosis
54
what may happen with vegetative endocarditis
* death may result from **valvular insufficiency** (leading to CHF) or effects of **bacteremia** * **septic thromboemboli** to heart, kidneys, brain, other organs causing: ischemia **(infarcts)** & infection **(inflammation)**
55
what is uremic endocarditis
* due to **renal failure in dogs** * endocardial necrosis: **mineralization & inflammation** of LA endocardium * pathogenesis is poorly understood * **DDX for endocardial mineralization: VD intoxication**

C & R II - wk1 (13 decks)

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