Pathology of the Cardiovascular system – Part One Flashcards
Normal Cardiac Function
* Maintenance of adequate blood flow (cardiac output)
* Delivery of Oxygen, nutrients and hormones to
peripheral tissues
* Removal of Carbon Dioxide (CO2) and other metabolic
waste products
* Maintenance of normal thermoregulation and glomerular
filtration rate (GFR) urine output
Compensatory mechanisms available to
maintain cardiac function:
- Cardiac dilatation (stretching of cardiac muscle
–> ↑ in contractile force –> ↑stroke volume ->maintain normal cardiac output) - Myocardial hypertrophy
- ↑in heart rate
- ↑in peripheral resistance
- Redistribution of blood flow
Label the Image accordingly.
*Important
Deoxgenated blood to lungs via pulmonary artery. blood is oxygenated and get rid of CO2. Left ventricle is more powerful b/c delivers blood to every single tissue in the body. Sends oxygenated blood through aorta to body.
Write out steps of blood flow
Based on this histological image, what muscle type is this?
Myocardium, Left ventricle, pig
Nuclei are located in the middle of the cell rather than periphery (Skeletal muscle).
Sarcomeres present with contractile proteins (myosin, actin, etc).
Label the image accordingly.
_____ changes are reversible or irreversible.
Which of the changes below are reversible? irreversible?
Double arrow = reversible, single = irreversible.
Fatty produces some degree of atrophy to ?
Lipofuscin = older (common) or cachectic animals (rare)
Cardiomyocyte undergoes neoplastic transformation = irreversible.
Label the image accordingly.
Satellite cells surrounding skeletal muscle cells. Can differentiate into new muscle cells (myoblasts). Disruption of BM in case of injury, satellite cells regenerate.
Cardiomyocytes: undergo severe injury leading to necrosis -> that cell is replaced by fibrous CT. Necrotic cardiomocyte is infiltrated by MQ –> intiate repair –> scar formation.
Label the image accordingly.
- Identify this organ.
- Label accordingly.
Heart, normal
Left ventricle (L), Right ventricle (R)
Ratio is 1:3/4 = difference in thickness between left and right ventricle.
Follow the blood pathway from placenta (umbilical vein) to umbilical arteries. Note the coloration of the different mixes of fetal blood,depending on where one looks at the system.
If bypasses remain after birth = congenital anomaly; ductus venosis bypasses the liver (hepatic encephalopahy), foramen ovale, ductus arteriosis (forms ligament of arterosis after birth - within first week of life).
In the developing heart, communication between different chamberws (R and L Ventricle; R and L atrium b/c the lungs in the fetus are nonfunctional, hance do not play role in oxygenation; only req a small amt of blood.
What can be seen in this image?
Serous atrophy of heart - cow
Gellatinous, yellow appearance of corony groove which is characteristic of serous atrophy (poor nutritional state due to starvation, GI, or dental issues –> deposition of fat in inappropriate regions of the body).
What can be seen in this image?
Circulatory disturbances: Hemorrhage
Epicardial hemorrhage (petechia, ecchymosis),
endotoxemia – cow.
Hypoxia, sometimes terminal, can result in pettichia that are small foci of hemorrhage. If not hypoxic, animal could have been in septic state.
Example - Slaughterhouse: stun animals to feel no pain, cut spinal chord, takes animal awhile to die –> terminal hypoxia.
Cardiac Failure
- Cardiac syncope is an _____ onset of cardiac failure causing _____ and _______ (abnormal heart rhythm, defective heart valves etc.). Usually associated with severe ______ or ______ valves.
- Congestive heart failure (CHF): Develops slowly from _____ loss of cardiac output due to ______ or ____ overload or myocardial injury.
acute, collapse, unconsciousness, arrythemias, defective, gradual, pressure, volume
What can be seen here?
This condition is common in which species?
Brisket edema,
bull, CHF
Present in cattle with high altitude/high mountain disease (Colorado, Utah).
RS of heart –> pumping ? into lungs –> pulomanary hypertension –> eventually leads to increase hydrostaic pressure in lungs, venous system –> increased resistance?
High altitude air is very light/ very little o2, to compensate, heart has to work harder and pump more blood into lungs to be oxygenated and causes pulmonary hypertension, which leads to congestion/ heart failure ( from increased vascular resistance)
What can be seen in this image?
Heifer, idiopathic (pathogenesis unknown) pulmonary hypertension leading to CHF, AVC
Covered from severe bouts of pneumonia; areas of the lung may have died and were replaced by CT. All of this CT can produce compression of pulmonary BV –> pulmonary HT. Increased hydrostatic pressure in lungs –> presence of pulmonary edema, fluid in thoracic cavity, ?, Lesions associated with RSCHF b/c RS has a hard time pumping blood into lungs due to hypertension so heart is trying to push blood in there and isn’t happening. RS compensate in beginning with hypertrophy and dilatation, but if myocardium increases in thickness to certain level –> ischemic injury. BV in coronary vasculature will not be enough to supply hypertrophic muscle —> progressive damage to cardio myocytes –> scarring in heart –> CHF.
Increased venous blood in liver –> chronic damage –> nutmeg liver
Ascites (hydroperitoneum), dog
Main differentials : Heart failure, Protein losing enteropathy –> hypoproteinemia due to chronic GI, Renal disease.
Post-mortem examination of the heart: what are
we looking for?
- Thickness of R and L Side
- No areas of inflammtion of the valves. Endocarditis = usually bacteria; see dry type of material attached to valves that represent septic thrombi.
- No communication between ventricals or atria.
- Size of aorta and pulmonary artery (no narrowing of the pulmonary artery or aorta in the case of pulomonic or aortic stenosis).
What can be seen here?
Normal valve; transluscent.
What can be seen here?
Cordi tendinae
Rupture in car accidents for people/ chest trauma in non-human animals –> no proper sealing of the valve during systoli.
Congenital anomalies
* May involve the _____ or blood _____
* Animals may die in ____ or present clinical signs after ____ (_____ born or _____).
* Clinical manifestations may include?
heart, vessels, utero, birth, still, aborted, exercise intolerance, cyanosis and stunted body growth.
Congenital valvular anomalies
Valvular hematocyst, mitral valve-Calf
- There are 4 defects found in Tetralogy of Fallot. Name each of them.
- This condition is most common in which species?
- See Below:
- Ventricular septal defect
- Pulmonary stenosis
- Misplaced aorta
- Thickening of right ventricular wall (right ventricular hypertrophy).
Overriding aorta (dextroposition of the aorta),
pulmonic stenosis,
–> right ventricle
hypertrophy.
- One of the most common cardiac abnormalities in human beings: “blue babies.” In veterinary medicine:
Inherited in Keeshonds,
also common in English
bulldogs
Keeshond, prone to Tetralogy of Fallot.
Dog, right ventricular hypertrophy secondary to pulmonic stenosis
- Name the condition associated with this image.
- What are the blue arrows pointing to?
- What are the green arrows pointing to?
- This condition is most commonly seen in which species?
- What does this condition result in?
- Aortic stenosis (subvalvular).
- Blue arrows: aortic valve
- Green arrows: fibrous band.
- This is among the most frequently encountered anomalies in dogs.
- Results in compensatory concentric hypertrophy of the left ventricle and post-stenotic dilation of the aorta (narrowing at base of aorta and then because of increase pressure in that area, post-stenotic dilatation so blood goes with more force into the wall of the aorta —> immediate dilatation due to restriction).
At root of aorta, in some cases, you may see a band of CT that is producing constriction of the aorta.
Most frequently encountered, especially in dogs.
Pressure overload in left ventricle –> concentric hypertrophy of LV.
Tricuspid dysplasia, dorsal view from the
atrium. Most common in cats
Valve will not close during systole.
Ventricular septal defect
More common
Left Ventricle here
High ventricular septal defect.
Some animals may not present clinical signs for awhile.
B.c LV is more powerful, movement of blood from left to right so the blood that is O2 willl go into right side. That is why animals may not present any clinical signs but later on you will have ventricaular overload on the right side, so too much blood going into RV, and animals present compensatory hypertrophy of RV and eventually develop Rsided congestive heart failure. Blood can then start to go from right to left, can see cyanosis.
VSD, calf, UCVM, OI, 2010, view from the right
ventricle
Ventricular septal defect.
VSD, calf, UCVM, OI, 2010, view from the right
ventricle
Around this area the endocardium is thickened and whitish/grey in color due to the presence of endocardial fibrosis
A jet lesion
Turbulence present with some congenital anomalies
Chronic pounding on endocardium –> endocardial fibrosis
VSD, calf, UCVM, OI, 2010. “Jet lesions”
(endocardial fibrosis) within the right ventricular free
wall
VSD, calf, UCVM, OI, 2010. “Jet lesions”
(endocardial fibrosis) within the right ventricular free
wall
- Name the condition associated with this image.
- Which species are most affected by this condition?
- Describe this condition.
- Patent Ductus Arteriosus
- One of the more common defects – recorded in all species
- O2 blood from right side of heart should go straight into the aorta during fetal life. After birth, DA needs to be replaced with FCT –> ligamentum arteriosum.
In some cases, this does not happen and DA remains patent and then we may have a problem. Could be subclinical if PDA is small but if it is relatively big –> clinical disease
Blood goes from aorta into the pulmonary artery
Pressure overload on RS of the heart b/c too much blood entering; pulmonary hypertension too because too much blood going into the lungs. Eventually leads to RS congestive heart failure.
Normally ?
Persistent right aortic arch (PRAA). Results in dysphagia and
megaesophagus. Affected animals often die of aspiration
pneumonia
There are two aortic arteries on the right and left side. Eventually, the right aortic artery should disappear, leaving the left one behind. But in some cases, the right one does not disappear and we end up with thoracic aorta coming on the right side of the esophagus so the ligametnum arteriosis, aorta, pulmonary artery form a ring –>compression of the esophagus and the trachea.
Trachea has cartilaginous rings and is firm so not a big issue, esophagus is soft –> constriction -> megaesophagus –> animals may not present any clinical signs b/c drinking milk so no problem. Solid food –> problem. ore and more dilatation of esophagus. Eventually animals die of aspiration pneumonia. Losing weight, not gaining any weight.
Swallow some regurgitated material –> die
- Name the condition associated with this disease.
- What breeds are most commonly affected?
- What complications are associated with this disease?
- Describe what can be seen in this image.
- Calf, persistent right aortic arch (PRAA). Most common in dogs.
- German Shepherds, Irish Setters and Great Danes are predisposed. BUT Can happen in any animal, technically.
- Complications: megasophagus, aspiration pneumonia.
- Head to left
Aorta is on right side here = abnormal, should be on the left.
- Name the condition associated with this disease. What species are most commonly affected?
- Describe what can be seen in this image.
- What complications are associated with this disease?
- Hemopericardium –ruptured atrial hemangiosarcoma, dog
- Presence of blood in pericardial sac.
pericardium is normally translucent, dark.
Seen in trauma cases such as HBC.
In dogs can be idiopathic, unknown cause.
Common malignant tumor in dogs = hemangiosarcoma (endothelial cells affected). One of the sites is the RA –> producing cystic blood filled cysts in the RA that can rupture –> collapse and die.
- heart can not expand –> acute heart failure (cardiac tamponade)
if related to hemangiosarcoma = older dogs
Some don’t die from tamponade? So no impairment in proper contraction of heart.
- Name the condition associated with this image.
- Name and explain the etiology.
- Pericardial effusion – “mulberry heart disease”- pig
important condition in pigs - Etiology: Vitamin E/Selenium Deficiency
different than in other animals because produces hepatica diotetica lesions
Strands of fibrin
Vitamin E produces a necrotizing vasculities affecting branches of coronary arteries.
Pig: Myocardial degeneration/necrosis and hemorrhage;
pericardial effusion, pulmonary edema. Vitamin E/
Selenium deficiency.
Fibrinous pericarditis, Calf, “black leg”
Epicardial surface looks roughened, granular.
See air bubbles characteristic of this clostridium infection.
Fibrinous pericarditis, “black leg”, steer
Surface is roughened because of presence of fibrin and emphysema
Hardware disease, cow, TAMU
Cattle can not discriminate very well from what they are eating.
Enters reticulum after ingestion –> pushes it nto wall –> diaphragm –> perforate diaphragm and enter pericardial sac –> pinch heart –> myocarditis.
Reluctant to walk. Lordosis, difficulty walking and breathing.
Fibrous adhesion between reticulum a nd diaphragm -> stuck?
Cow, Hardware disease, Dr. King’s Cornell
files
Lesions in chronic cases can be significant
Foreign bodies, hardware disease,cow, Cornell files
A piece of wire had perforated the cranial wall of the
reticulum, OI, UCVM.
The piece of wire penetrated both, the reticulum and the adjacent diaphragm resulting in leakage
of ingesta into the peritoneum. Fibrin admixed with suppurative exudate was present in the
affected area (fibrino-suppurative peritonitis). N08-B9, UCVM, OI
Atony?
Chronic (constricted) pericarditis —> Chronic cardiac tamponade, cow
Visceral layer and peritoneal layer?
CT constircting movement of the heart so animals die of hert failure
Top: Dog, valvular endocardiosis,
UCVM, OI
Valves become shorter and nodular. Hooding of the valve that is also characteristic
Valves are flapping (valvuoar insuffiency) due to nodules and/or rupture of cordinae tendinae –> more severe cllincal signs
Valvular endocardiosis: cusp (leaflet) of right
atrioventricular (tricuspid) valve, dog. This is the most
common cause of CHF in old dogs.
What can be seen in this image?
Dog, TAMU,
Valvular endocardiosis, note endocardial fibroelastosis within the atrium (“jet lesions”).
Very common. some breeds more susceptible , although older animals can have lesions assocaited with valvular endocardiosis.
Classical nodular lesisons in the valve and significatn jet lesions on the inside of the left atrium.
Describe what you can see?
What condition is this?
Dog, TAMU. Valvular endocarditis and endocardial fibro-elastosis
Friable, whitish/yellow material attached to valves representing septic thrombi in the valves.
Lesions –> valvular insufficiency (open or close properly) –> blood turbulence/volume overload in this area –> jet lesions, dilatation of the ventricles/atria –> endocardial fibrosis
Describe what you can see?
What condition is this?
Dog, TAMU, Endocarditis, aortic valve
Looks very different from valvular endocardisosis (endocardiosis = septic thrombi).
Describe what you can see?
What condition is this?
Dog, TAMU, Endocarditis, aortic valve. Chronic lesions like this are
often referred to as “vegetative” or “verrucous” (wart-like) valvular
endocarditis
Aortic valve/right arteric valve.
Describe what you can see?
What condition is this?
Valvular bacterial endocarditis, cow, right AV valve,
H&E
Fibrin abundant (pale pink)
Eosinophils abundant
Bacterial colonies (dark purple)
Describe what you can see?
What condition is this?
Pig, Erysipelas, valvular endocarditis, Noah’s
arkive
Etiologic Agent of endocarditis in pigs = Erysipelas
Streptococcus can also –> endocarditis
Describe what you can see?
What condition is this?
Verrucous valvular endocarditis, aortic valve, pig
Etiology: Erysipelothrix rhusiopathiae
Dry, friable material attached to aorta
Look at kidney too because lesions produce septic emboli in kidney –> inflammation and infarction in kidney
Describe what you can see?
What condition is this?
Dog, chronic ulcerative mural endocarditis, left atrium – uremia,
renal failure. Chronic lesions like these are characterized by raised
white plaques of fibrous and mineralized tissue.
Seen occasionally, not common.
Left atrium: nodular, reddish areas of congestion. Primarily in dogs, rarely in cats ad other species. Related to renal failure and uremia. Produces vasculitis in different places too, such as GI –> uremic gastritis, left atrium (why? don’t know).
Dystrophic mineralization present too.
Describe what you can see?
What condition is this?
Uremic (ulcerative) endocarditis, dog
Pale, white lesions
Renal failure, uremia, uremic gastritis
Describe what you can see?
What condition is this?
Dirofilariasis, dog (Dirofilaria immitis). The parasites are usually found in the pulmonary arteries and right ventricle. Also in the R atrium and cranial and caudal vena cava in heavy infestations. May lead to CHF and result in endocarditis, endarteritis (crawl to pulmonary artery –> inflammation of intima –> endarteritis) and pulmonary thrombosis. Can let
What can be seen here?
Calf, “white muscle disease”, Cornell Files. Lesions are “chalky” and have a “gritty” consistency.If you see fat, it would be along coronary groove, not on the actually heart muscle. Easy to make this mistake!
Left side = cattle
What can be seen here?
Lamb, Nutritional myopathy – “white paint brush strokes”, Dr. King’s Show & Tell
Sheep = right side
What can be seen here?
Calf, 2 days-old, heart, nutritional myopathy – AVC, OI,
Von Kossa stain. Extensive mineralization of degenerated/
necrotic muscle fibres.
What can be seen here?
Calf, 2 days-old, heart, nutritional myopathy – AVC, OI, Von Kossa stain. Extensive mineralization of degenerated/ necrotic muscle fibres.
Pig, “mulberry heart disease”
What can be seen here?
Pig, “mulberry heart disease”
Lumen of small artery
Tunica media is hard to recognize because there is fibrinous necrosis of the wall.
What can be seen here?
Cow, monensin toxicity, AVC
Antibiotic toxicity
Farmer used monensin as a growth promoter.
Added too much.. cattle susceptible to this… animals presented with respiratory distress, exercise intolerance.
In a matter of 1 to 2 months, farmer lost all of the cows.
