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Year 3 Pathology > Cardiovascular 1, 2 and 3 > Flashcards

Cardiovascular 1, 2 and 3 Flashcards

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1
Q

Describe CV embyrology?

A
  • Heart develops from splanchnic mesenchyme in cardiogenic area
  • Single heart tube- surrounding mesenchyme thickens to from myoepicardial mantle- dilations and constrictions forms 4 chambers
  • Cardiac looping- heart converted from tube to C-shaped structure
  • Cardiac septation- atrial septum primordia and ventricular septum primordia divide left and right
  • Atria partitioned by septum primum and secundum (incomplete until afer birth)
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2
Q

What is the foramen ovale?

A

Incomplete septum secundum allows blood to pass from left to right

After birth forms the fossa ovalis

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3
Q

What do the left and right 4th aortic arches form?

A

Left- proximal part of arch or aorta

Right- proximal part of subclavian artery

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4
Q

Describe foetal circulation from the placenta to the placenta?

A
  • Placenta to umbilical veins- liver/ductus venosus
  • Liver to vena cava to the right atrium
  • Right atrium through foramen ovale to left atrium
  • Left atrium to aorta- systemic arteries
  • Systemic arteries to umbilical arteries to placenta
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5
Q

What is the pericardium, epicardium, endocardium and myocardium?

A

Pericardium (sack)- one layer of the mesothelium with central layer of connective and adipose tissue

Epicardium- one layer of mesothelium on connective tissue and adipose tissue fused to the myocardium

Endocardium- endothelium identical to arterial with connective tissue and purkinje fibres in ventricle

Myocardium- muscle layer

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6
Q

Describe the histology of the myocardium

A

Centrally placed nuclei

Sarcomeric cross-striations

Ratio muscle fibre : capillaries 1:1

Purkinje fibres

Arranged in bundles

Connective tissue

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7
Q

What are the PM alterations of the the heart?

A

Blood clotting- red clots- atria, RV

Rigor mortis- occurs in left myocardium
Animals with prolonged heart disease may lack aquate glycogen for rigor mortis

Chicken fat clots- sedimentation of erythrocytes, closts of colourless fibrin

Haemoglobin imbibition- PM lysis of erythrocytes released Hb- red staining

Barbituate crystals- from phenobarbitone injection

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8
Q

What are the different pathological mechanisms of cardiovascular dysfunction?

A

Pump failure- weak contractility, myocardial disease

Obstruction of flow- valvular stenosis, vascular narrowing

Regurgitant flow- valvular dysfunction

Shunted flow- congenital defects

Ruptures- heart wall/ major vessels

Conduction disorders

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9
Q

What is cardiac syncope?

How is is characterised?

What can cause it?

A

Fainting/loss of conscious

Characterised clinically by collapse, loss of consciousness and extreme changes in HR and blood pressure

Myocardial necrosis, ventricular fibrillation, arrythmias, cardiac inhibition

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10
Q

What is congestive heart failure and the responses?

A

CHF- slow or gradual loss of puming efficiency, associated with pressure overload, volume overload, progressive myocardial damage
Reduced renal blood stimulated RAAS- sodium and water retention causing hypertension and increased workload on heart

Responses-
Cardiac dilation
Hypertrophy
Decompensation
Death

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11
Q

What does subacute and chronic Left/Right sided heart failure cause?

What are the causes of Right/Left sided heart failure?

A

Left-
Subacute- pulmonary congestion and oedema
Chronic- pulmonary congestion and oedema, fibrosis and hemosiderosis (iron deposits from erythropoesis)
Causes- left sided cardiomyopathies, dysfunction of aortic/mitral valve

Right-
Subacute- passive systemic congestion, hepatomegaly and splenomegaly
Chronic- systemic oedema (ascites), nutmeg liver
Causes- right sided cardiomyopathy, pulmonary hypertension, dysfunction of tricupsid and pulmonary valves

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12
Q

How can congenital defects of the heart present differently?

A

Extreme defects- animals do not survive in utero

Mildest defects- could have no clinical signs

Defects with immediate severity
Clinical signs- cardiac failure- cyanosis, excercise intolerance

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13
Q

What can cause congenital defects of the heart and pericardium?

A

Single or multiple gene defects

Toxins- thalidomide

Physical agents

Nutritional deficiencies

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14
Q

What does this image show?

What is acardia?

A

Amorphus globosus- acardiac monster attached to placenta

Acardia- agenesis of the heart

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15
Q

What is ectopia cordis?

A

Congenital development of the heart outside the thoracic cavity

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16
Q

What is patent ductus arteriosus?

A

Vascular channel between the pulmonary artery and aorta- allows blood to bypass the lung during foetal life- should convert to ligamentum ateriosum

Remains and therefore blood shunted from left to right causing:
Pulmonary hypertension therefore RV pressure overload, concentric hypertrophy, volume overload then eccentric hypertrophy

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17
Q

What are the two types of atrial septal defects?

A

Failure of foramen ovale to close

True septal defect- faulty development of interatrial septum

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18
Q

What does a ventricular septal defect cause?

A

Failure of inteventricular septum- bull dog, springer, Westie

Shunts blood left to right- equal pressures, pressure hypertrophy of right ventricle, volume hypertrophy of left

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19
Q

What are the three types of semilunar valve stenoses?

A

Supravalvular

Valvular

Subvalvular

Circumferential band of fibrous or musculat tissue of the valvular tissue- above or at level of tissue

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20
Q

What is a pulmonic stenosis?

What does it cause?

What species are affected?

A

Narrowing of pulmonart artery- usually valvular lesions

Causes pressure overload- right concentric hypertrophy- leads to roughening, deformatino and dilation of the surface of the pulmonary artery

Species- beagle, bulldog, Chihuahua

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21
Q

What causes subaortic stenosis?

What does it lead to?

A

Subvalvular lesions- thick zone of endocardial fibrous tissue that encircles the left ventricular outflow below the valve

Microscopically- endocardial mesenchymal necrosis and fibrosis

Pressure overload in LV- concentric hypertrophy

Pigs, dogs- boxer/GSH

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22
Q

What tetralogy of fallot?

A

Anomaly of four lesions

Ventricular septal defect

Pulmonic stenosis

Dextroposition of the Aorta

Secondarily- hypertrophy of the RV

Bulldogs and Keeshond

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23
Q

What are valvular haemotomas?

A

Haematocyst or lymphocysts frequently observes on the atrioventricular valves in ruminants

Generally regress spontaneously

Haematocyst- bulging, blood filled cysts
Lymphocyts- bulging, ywlloe serum-filled cyst

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24
Q

How does a persistent right aortic arch cause megaoesophagus?

A

Right 4th aortic arch- not left- develops and ascends in the right midline

Ligamentum arteriosum forms a vascular ring over the oesophagus and trachea

Oesophageal obstruction and dilation- megaoeosphagus

GSH, irish setter, great dane

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25
What is valvular agenesis/hypoplasia?
Failure of valves to develop
26
What causes peritoneopericardial diaphragmatic hernia?
Dogs- with incomplete development of diaphragm Abdominal viscera can be located in pericardial sac
27
What circulatory disturbances can there be of CV?
Haemorrhages Frequent lesion in endocardium, myocardium, pericardium Petechiae, ecchymoses- septicaemia Mulberry heart disease
28
What is the normal appearance and ammount of pericardial fluid?
Clear, viscous fluid Horse/cow- 100ml Dog/cat- 10ml
29
What is hydropericardium? What are the different causes of it and associated agents? How do acute and chronic cases appear differently? What are the consequences?
Hydropericardium- accumulation of clear to light yellow, watery serous fluid in the pericardial sac Associated with vascular injury- generalised oedema: * Increased vascular permeability- virus (influenza) , bacteria (clostridium), III hypersensitivity, toxins (paraquat) * Increased IV hydrostatic pressure- pulmonary hypertension (LCHF, high altitude disease) * Decreased IV osmosotic pressure- decreases albumin (malnutrition) * Decreased lymphatic drainage- obstruction Consequences- cardiac tamponade or compression, which impairs cardiac filling and venous return
30
What is haemorrhagic pericardial effusion? What breed of dog does it affect?
Deposits of small amounts of blood, chronically Great Dane, St Bernard, GSH
31
What is haemopericardium? What can cause it?
Accumulation of large amount of blood in pericardium causing cardiac tamponade, leading to compression and interfereing with cardiac filling and empyting Atrial rupture due to haemagiosarcoma of right atrium in dogs Rupture of intrapericardial aorta in horses Complications of intracardiac injection
32
What is a pneumopericardium and a cyclopericardium and what can cause them?
Pneumopericardium- air filled Pulmonary ruptures, perforations of oesophagus/stomach Cyclopericardium- specific gravity \>1.015 Rupture of thoracic duct, often gelatinous and white
33
What can be found incidentally with the pericardium in sheep? What can cause serous atrophy of epicardial adipose tissue?
Pigmentations- melanosis Anorexia, starvation, cachexia- fat catabolised to maintain energy Important for cases of emaciation (neglect) Grossly- white/yellow fat to grey gellatinous material Microscopically- lipocytes are atrophic and oedema present in interstitial tissue
34
What is the name for inflammation of pericardium/epicardium? What are the different portals of entry for inflammation?
Pericarditis and epicarditis Foreign body penetration- reticulum cattle Local extension- local extension of severe inflammatory processes for adjactent structures Haematogenous- virus/bacteria
35
What are the different categories of inflammation based of exudate?
Serous Fibrinous Purulent Sero-purulent Fibrino-purulent Proliferative fibrosing Granulomatous
36
What is the normal specific gravity of transudate and exudate?
Transudate \< 1.015 Exudate \>1.015
37
What causes mineralisation of the endocardium? How does it appear grossly and histologically?
Intake of excessibe amounts of vitamin D and intoxication by calcinogenic plants in cows or Hyperparathyroidism, Renal failure, Johne's disease Gross- multiple, large, white, rough, firm plaques or mineralised fibroelastic tissue within the endocardium and intima or large elastic arteries Histology- deep purple angular appearance
38
What causes endocardium fibrosis? What causes pigmentation of the endocardium in sheep?
Fibrosis- ``` Occurs in chronically dilated hearts Healed ulcerative endocarditis in dog (uraemia) jet lesions (valvular stenosis/regurgitation) ``` Pigmentation- Melanosis, aortic valves, no clinical significance
39
What is valvular endocarditis? What happens to the affected valves? How does it appear microscopically?
Age-related cardiac disease of small and toy breeds (CKCS) Associated with degeneration of valvular collagen Polygenic basis Affected valves are shortened and thickened and appear smooth and shiny These lesions results in vulvar insufficiency and CHF Development of jet lesions and rupture of chordae tendinae are common Microscopically- increased fibroblastic proliferation and deposition of mucopolysaccharides
40
What is left ventricular endocardial fibroelastic disease? What breed of cat does it affect? How can it lead to CHF, left bundle branch block?
Defect in myocardial lymph drainage, leading to chronic oedema and fibroelastic proliferation Siamese and Burmese cats Restricted myocardial motion produces a reduction in output and may lead to CHF May incarcerate subendocardial purkinje fibres which leading to left bundle branch block
41
What can cause endocarditis? How does it appear grossly and microcropically?
Often endothelial injury and other elements of Virchow's triad involved Prexisiting extracardiac infections leading to Haematogenous disseminations- bacteria\> parasites\>fungi Grossly- the surface is rough and granular with large, adhering, friable, yellow to grey masses Microscopically- Fibrin, platelets, bacteria, leukocytes, erythrocytes In chronic lesions- fibrin deposits are organised by fibrous connective tissue (nodules) which can become mineralised
42
Describe the pathogenesis of endocarditis What results in death from endocarditis? What differs between left and right?
Extracardiac infection, injured valve, bacteria adhere, proliferate and initiate inflammatory reaction More often in cows right, left usually every other Death- cardiac failure from valvular dysfunction, bacteraemia, septic emboli leading to infacrction or abscess formation in other organs Septic emboli disseminate- 'embolic showers' Right- chronic hepatic congesion and pulmonary embolism Left- Chronic pulmonary congestion, systemic embolism (kidney)
43
What causes ulcerative endocarditis? How does it appear after healing?
Uraemia induce endocardial ulceration in dogs The area is replaced by raised, white plaques of fibrous and mineralised tissue
44
How does fibrinous pericarditis appear grossly? How does it appear microscopically?
Grossly- pericardial surfaces are covered by variable amounts of yellow fibrin deposits, adherence between parietal and visceral layers When pericardial sac is opened upon necropsy attachments are torn away Microscopically- An eosinophilic layer of fibrin admixed with few neutrophils lies over a congested pericardium
45
What are the 2 outcomes of fibrinous pericarditis?
Early death by septicaemia Constrictuve pericarditis- proliferative fibrosing * When survival ir prolonged, there is a fibrinous organization of the exudate forming fibrous adhesions between the surfaces * This constricts the heart with fibrous tissue interfering with filling and output * Hypertrophy- CHF
46
What diseases casue fibrinous pericarditis in the following species?: Cats Cattle Pigs Horses Birds
Cats- FIP Cattle- pasturella, blackleg Pigs- glassers disease, streptococcus sp, salmonella Horses- step Birds- clamydia psittaci
47
What is the common name for porcine polyserositis? What is its aetiology? What age of pigs does it affect? What are the subacute/chronic lesions? What are the predisposing factors?
Glassers disease Aet- Haemophilus parasuis Young pigs- weaning to 4mo Acute- pleuritis, **pericarditis**, peritonitis, polyarthritis, meningoencephalitis Chronic- proliferating fibrosing- CHF Predisposing factors- stress (weaning/transport)
48
How does fibrinosuppurative pericarditis grossly appear? What are the outcomes?
Pericardial surfaces are thickened by white often rough appearing masses of fibrin with purulent exudate- neutrophils Outcomes Early death by septicaemia Constrictive pericarditis- when the survival is prolonged, there is a fibrous organization of the exudate forming fibrosis adhesions between the surface- affects output- hypertrophy- CHF
49
What is the pathologically correct term for wire of hardware disease in cattle? What causes this disease? Describe is pathology?
Traumatic reticuloperitonitis Due to foreign bodies, oftensharp/pointed that accumulat in the reticulum Contraction of the reticulorumen caused the foreign body to penetrate the reticular wall and diaphragm and enters the adjactent pericardial sac Bacteria are transferred with foreign body to establish infection
50
What is viceral gout? What can cause visceral gout? How does it appear histologically?
Catabolism of nucleic acids which is usually converted to uric acid and excreted through the kidney Imbalence between production and excretions causes increased levels and deposits to form Renal diseases- nephritis, tubular damages, urolithiasis Dehydration Enzyme defiencies Diet Increased catabolism- diseases, tumours Histo- has a star appearance
51
What are the two types of myocardium ruptures and what can cause them?
Traumatic- shot/RTA Spontaneous- weakness, dilation, necrosis, neoplasm
52
What are the three types of cardiomegaly causes?
Hypertrophy Dilation Cardiomyopathy
53
What causes ventriculat hypertrophy? What are the different types of ventricular hypertrophy and whar can cause them?
Compensatory mechanism- physiological response to maintain adequate cardiac output Secondary- reversible to increased workload, Primary- irreversible idiopathic Eccentric- heary with normal but enlarged ventricles, normal/decreased thickness- **volume overload** (valve/septal defects) Concentric- increased wall thickness- **pressure overload**- valvular stenosis, hypertension, pulmonary disease Cor pulmonae- an alteration in RV structure and function from primary disorder of respiratory system
54
What are the DDXs of cor pulmonae?
Dirofilaris and congenital pulmonic stenosis in dogs High altitude disease Chronic alveolar emphysema in horses (heaves)
55
What can cause ventricular dilation and why does it occur? Why not hypertrophy?
Same causes as hypertrophy- compensatory response to achieve cardiac output- dilation allows stretching of cardiac muscle cells to increase contractile force Myocardium cannot undergo hypertrophy due to insufficient time, inadequate nutrition or diseases
56
What is a cardiomyopathy? What are the classifications?
Disease of the heart If pathogenesis unknown effect is described- 'Primary' Dilated cardiomyopthy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Known pathogenesis- Toxic, Nutritional, Genetic
57
What species can be affected by hypertrophic cardiomyopathy? How does it grossly and histologically appear?
Common in young adult to middle aged cats Cats die from left atrial thrombosis and caudal aorta thromboembolism- saddle thrombosis Uncommon in dogs Grossly- heart enlarged, prominent hypertrophy of LV, ventricular septum, dilation of LA Histologically- Prominent disarrays of hypertrophic degenerated myocytes, interweaving arrangment of fibres and interstitial fibrosis
58
What animals can develop DCM- dilated cardiomyopathy? How does it appear grossly? How does it appear histologically?
Middle aged dogs- idiopathic or autosomal inheritance Cats with low tissue concentrations of taurine Grossly- biventricular dilation, white thickened endocardium, increased heart weight \>1%- *big round heart* Histo- may see no lesion, alternatively- interstitial fibrosis, fatty infiltration and myocyte degeneration
59
What breed is affected by bovine DCM? What are the symptoms? How does it appear PM?
Well grown 2-3 yo Holstein cattle- genetic component Peripheral oedema, jugular distension, fluid accumulation in body cavities Enlargment of heart with a 'globose' shape- globe
60
What is restrictive cardiomyopathy? Why can it be difficult to diagnose? What can cause it?
Walls are rigid and the heart is restricted from stretching and filling with blood properly Rhythmicity and contractility may be normal * Cats with endocrdial lesions that impair ventricular flow * Short/irregular chordae tendinae * Abnormal crossbar like muscle/connective tissue in LV- 'crista saliens' dog, pig, cat
61
What is myocardial necrosis?- come on if you don't get that... What can be the different causes?
Necrosis of the myocardium- acute cardiac failure, necrosis related arrythmias from condution disruption, CHF, dilation * Nutritional deficiencies- Vit E/selenium deficiencies, mulberry heart disease (seem to love this one) * Ischaemia- hypoxia * Ionophore toxicity- monensin intoxication * Plant intoxication- heart glycosides (avocado) * Doxirubin- treatment of lymphosarcoma in dogs * Secondary to myocarditis
62
How does myocardial necrosis appear grossly- what is the most affected area? How does it appear microscopically initially and after 24-48 houts, then weeks?
Grossly- affected areas are pale, yellow to white and dry- can become gritty due to dystrophic calcification Most affeted areas are the papillary muscles and subendocardial myocardium Microscopically initially- Fibres swollen, hypereosinophilic, striations are indistinct, nuclei are pyknotic, scattered basophilic granules Shredded appearance because of hypercontraction and formation of multiple transverse oriented bars of disrupted material (contraction band necrosis) 24-48h- infiltrationby inflammatory cells (macrophages, neutrophils) to phagocytose and lyse Weeks- persistent stromal tissue (fibroblast, collagen and capillaries) Pyknotic- irriversible condensation of DNA
63
Using the following images which shows Myocardial necrosis histologically after the following periods? Initially 24-48h Weeks another of one of the above
A- Weeks B- Intially C- 24-48h D- Initially
64
What is the aetiology and pathology of mulberry heart disease in pigs? What does it cause primarily and secondarily?
Vitamin E/ Selenium deficiency (antioxidant deficiency) Leads to peroxidation of cell membranes Primarily- Vascular fibrinous necrosis, endothelial damage, fibrin thrombi Secondary- Necrosis, hypdropericardium, haemorrhages
65
What causes equine myocardial degeneration? *Horses with chickens* How does it present actuely? How does it appear PM?
Monensin intoxication- coccidiostat for poultry Acute- arrythmic heart beat, ventricular fibrillation Petechial pericoronal haemorrhages, necrosis/hyalinosis of myocytes
66
Can you grossly describe this histological picture of myocytes? What could have caused this?
Chronic cardiotoxicity characterized pale myocardium, hyaline necrosis, hydropic degeneration of the myocytes Chemotherapeutic agents- Doxorubicin- prevents synthesis of DNA, RNA and proteins
67
What is myocarditis? What are the portals of entry and therefore potential aetiologies? What are the types?
Inflammation of the myocardium Portal of entry- haematogenous dissemination, embolic dissemination from vegetative endocarditis Aet- infectious agents- Virus/Bacteria/Fungi/parasitic * Purulent- vegetative endocarditis * Necrotising- toxoplasmosis * Haemorrhagic- black leg * lymphocytic- parvoviral * Eosinophilic- sarcocystosis * Granulomatous- fungi
68
What viruses can produce acute necrosis with little of moderate lymphocytic inflammatory response?
* Canine parvovirus * West nile * FMD * Distemper in young puppies * Blue tongue in sheep * Newcastle disease * Avian encephalomyelitis
69
How does myocarditis septicaemic grossly appear? What causes purulent myocarditis? What inflammatory cell dominates it?
Multi focal or focal, purulent necrotizing Bacterial causes- * Direct extension of pericarditis (hardware disease) * Direct extension of endocarditis * Any septicaemia: Lyme disease/ Listeria monocytogenes/ Black leg- clostridium chauvei Dominated by neutrophils
70
This image shows a horse heart Give a morphological diagnosis? What is a likely aetiology?
Equine disseminated granulomatous myocarditis *Macrophages!* Mycosis/aspergillosis
71
What parasites can effect the heart? Give the families and genuses
Protozoan- Sarcocystis sp Toxoplasma sp Neospora sp Metazoan- Cestodes- cysts Nematodes- Dirofilaria immitis, Angiostrongylus vasorum
72
What cardiac parasite is this What is the significance of this finding?
Protozoan- sarcocystis sp Incidental finding- harmless Host specific
73
How are more likely to develop toxoplasmosis? Describe its pathogenesis?
Immunosupressed and young animals Tachyzoites spread systemically and cause intersitial pneumonia, myocarditis, hepatic necrosis Heart- casues necrosis and chronic pyogranulomatous myocarditis Causes abortion and still birth in sheep and goats
74
What are the problems of Neospora caninum?
Dogs- Puppies- CNS/neuronal symtom, dermatitis, hepatitis, pneumonia and myocarditis can occur Adult dogs- sporadically develop neosporosis Cattle- oral or transplacental- causes abortion in cattle, adults asymptomatic
75
What parasites would cause the following presentations?
Left- cysticercus Right- Hyatid cyst- Ecinococcus granulosus
76
What parasite is this? Where are the adults and larvae found?
Dirofilaria immitis Adults- RV/ pulmonary arteries Larvae- microfilariae in peripheral circulation
77
Describe the pathology of Angiostrongylus vasorum
* Adults live in pulmonary artery and RV- larvae in lung parenchyma * Enlarged RV, rounded cardiac silhouette * Right sided heart failure * Eosinophilic vasculitis * Multifocal granulomatous and eosinophilic pneumonia * Bleeding disorder
78
What are the different neoplasms of endothelial cells of the heart and pericardium? How do they appear grossly and histologically?
Haemangioma- benign- arising from the endothelial cells in vessels Grossly- red-black blood containing masses that protrude into lumen or epicardial surface Histologically- well differentiated vascular spaces lined by endothelial cells Haemangiosarcoma- malignant- RA/spleen in dogs- metastastic Gross- similar to haemangioma Histologically- scattered, elongaget plumb endothelial cells
79
What neoplasms can arise from the myocardium, Intersitium and Epi/pericardium?
Myocardium- rare- rhabdomyoma (dog, sheep, cattle, pig), rhabdomyosarcoma (dog) Intersitium- fibroma, myxoma Epi/pericardium- mesothelioma- focally invasive
80
What are the three types of heart base tumours and what are their neoplastic names?
Aortic body tumours- Chemodectoma (chemoreceptor) Carotid body tumour- chemodectoma, paranglioma Arise and produce vascular obstruction and failure- surround and compress great vessels and atria Ectopic thyroid- adenoma/carcinoma Metastases- sarcoma, carcinoma, melanoma

Year 3 Pathology (21 decks)

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