The
following is the necropsy (autopsy) report of Myrna Loy after her death 8/19/15
of HCM.
The
report shows various physical changes and damage to the heart, kidneys, and
lungs due to HCM which were somewhat known, and most of which is to be expected
with heart disease. The report drills down the damage to the cellular level
which may be of interest.
Part of the problem of dealing with congestion was that the
damage to the thoracic duct allowed an acidic like fluid to flow from the duct
into the lungs. This opaque, milky-white fluid is called chylous or
chylothorax. It created pockets in the pleural cavity, pockets where fluid
formed and remained and was often difficult to remove. We tried to decrease it
by giving Myrna Rutin. Apparently, once chylous appears, the pet is not
expected to live for very long due to the damage chylous causes and because its
appearance means further left sided heart damage, which means a heart that is
failing. Myrna lived eight months after it first appeared in December 2014.
When we delivered her body to MSU for the necropsy, the receiving vet was
surprised to read that she had lived eight months with the condition and had
lived eight months with an almost constant need to have fluid removed from the
pleural cavity.
While the report notes signs of hypertension-or high blood
pressure-at no time at the end of her life did she have hypertension/high bp
noted by a vet or cardiologist. She had an occurrence in 2013 after her heart
attack but no further signs once it cleared up.
The report notes mild kidney disease. We worked really hard
to see that her kidneys retained as much function as possible. The various
vitamins, supplements, potassium, and iron that we gave her improved kidney
function and allowed te BUN and creatinine to remain stable. The numbers had
increased beginning in September 2014 but remained fairly stable to her death
(BUN 35, creatine 2.6.) The report's findings about the state of her
kidneys are proof that vitamins, supplements, potassium, and iron are necessary
for improving kidney support and that they work.
We were surprised to read that there were no gastro issues
noted because she had had many vomiting episodes for the last few weeks of her
life after her rear leg thrombosis in May. The vomiting was attributed to
a clot and her medicines. I suppose it was just the medicines, not to mention my
finger constantly in her mouth, that caused the upset stomach. While she
weighed about 10lbs. in late 2014, she did lose a lot of weight suddenly in the
last few weeks of her life, especially after being sick almost all of July
2015. But I hand fed her every time she was ill and refusing to eat and she
never went for very long without eating enough. (Methods can be found in the
blog History tab.) Her weight was still good at about 9.8lbs.
After the initial report, I have listed definitions for
various phrases used in the report.
------------------------------------------------------------------------------------
Report
processed at Michigan State University Veterinary College Diagnostic
Center for Population and Animal Health
Rcvd Date: 8/19/2015 11:23:00 AM
Gender: Female, MYRNA LOY, Feline, 6
years, Domestic Shorthair Cat
History
Gross Description
Received Date/Time: 8/19/2015 12:31:00 PM
Verified Date/Time: 8/20/2015 5:51:05 AM
REPORT OF LABORATORY EXAMINATION
Necropsy Preliminary Report
A 6 year old spayed DSH died on 8/19/15. The cat had a
history of clotting secondary to heart disease. Owner is concerned about
gastric and renal disease.
A 4.45 kg (9lbs. 8 oz approx) female spayed cat is necropsied
on 8/19/15. Autolysis is mild. There are adequate visceral fat
stores and the body condition score is 6/9. The
eyes are mildly sunken into the orbits, and mucous membranes are pale
pink. The thoracic cavity and pericardial sac respectively
contain 15-20 ml of red, clear, slightly opaque fluid, and
5 ml of dark red clear fluid. The parietal surfaces of the
pericardial sac and pleura are multifocally and loosely adhered to
the thoracic wall by numerous fibrinous adhesions. The edges of
the cranioventral lung lobes are collapsed and plumb
colored. All lung lobes float in formalin. The heart is
enlarged weighing 20.1 g (0.45% of total body weight), and the
right ventricular free wall and left ventricular free wall respectively measure
0.1 cm (RVF) and 0.8 cm (LVF). The left atrioventricular
valvular leaflets contain numerous, 0.2-0.3 mm in diameter, tan,
firm, smooth nodules. Lining the endocardial surface of the
left ventricle are ~10, thin, white-pink, string-like bands of
connective tissue (moderator bands) bridging the ventricular
septum and the left ventricular free wall. The liver has
slightly round edges and a prominent reticulated pattern.
The cortex of both kidneys is slightly granular. There
are no additional remarkable gross lesions.
Gross Diagnosis(es)
Heart:
Left ventricular concentric hypertrophy
Left atrioventricular endocardiosis
Excessive moderator bands
Liver: Mild hepatomegaly and centrilobular congestion
Pericardial sac: Pericardial effusion
Lung: locally extensive atelectasis and mild fibrinous pleuritis
The heart was overall large and the left ventricle
was markedly thickened, consistent with hypertrophic
cardiomyopathy which is a condition in which the muscle of the heart
thickens (especially on the left side) and compromises
the contractility and blood-pumping efficiency of the heart.
Left sided heart failure often presents clinically with
a thoracic/pleural effusion, as seen in this case; however, the slight
milky consistency suggest a chylous/lymph component which can
occur if there is damage to the thoracic duct. In addition,
the large liver and centrilobular congestion are common changes
seen in right sided heart failure. There was also evidence of endocardiosis
of the mitral valve, and excessive moderator bands, but the significance
of these changes in relation to the enlarged heart is unknown. Endocardiosis
is a common age related degenerative of the valvular leaflets. If
severe, these lesions can cause leaky valves and
eventually heart failure, but the changes were mild in this case.
Excessive moderator bands have been observed in normal cats and in
cats with hypertrophic cardiomyopathy, but the significance is unknown.
Microscopic Description
Representative sections of brain, eye, heart, lung, liver,
spleen, kidney, adrenal gland, thyroid gland with parathyroid gland, bone
marrow, stomach, esophagus, and intestine are examined. Within the heart there are severe
coalescing regions of myofiber disarray, multifocal myofiber degeneration,
and fibrosis. Disarrayed myofibers interweave and
are separated by increased loose fibrillar eosinophilic interstitial
fibrosis. Multifocal degenerative foci have variable
myofiber size and staining with flocculent and hypereosinophilic
sarcoplasm and loss of cross striations. There is moderate
medial thickening of small caliber vessels in the heart,
and kidney. In the kidney, there is mild to moderate,
multifocal, segmental, membranous glomerulonephritis and tubular proteinosis.
In addition, there is mild multifocal interstitial infiltrates
of lymphocytes, plasma cells, fewer neutrophils, and mild fibrosis. Hepatic (liver)
sinusoids have mild congestion, which is most prominent around
central veins. Within the lung there is severe
atelectasis and mild diffuse pulmonary edema characterized by
small quantities of pale proteinaceous material and low numbers of
macrophages in alveolar spaces. There are no additional
remarkable findings.
Morphologic Diagnosis(es)
Heart:
Severe myofiber disarray, degeneration, and fibrosis
Lung: Atelectasis, mild
edema, and alveolar histiocytosis
Liver:
Mild centrilobular congestion
Heart and kidney: Moderate arteriosclerosis
Kidney:
Mild to moderate, membranous glomerulonephritis and tubular proteinosis; Mild
multifocal lymphoplasmacytic interstitial nephritis and fibrosis
Final Diagnosis(es)
Severe hypertrophic cardiomyopathy with bicavitary effusion
and hypertension
Comments
Hypertrophic cardiomyopathy is the most common form of heart
disease in cats, and although the disease appears inherited in some breeds
(i.e., Maine Coon), the exact pathogenesis is unknown. In this case, diminished
cardiac function most likely resulted in fluid accumulation in the
thoracic cavity, lung, and pericardial sac. There was also evidence
of renal disease and thickening of small vessels which are likely
attributed to hypertension secondary to heart disease. Although there
was a concern of fibrin thrombi and gastric hemorrhage, these
changes were not evident during gross or histologic
examination. No further testing is currently pending.
________________________________________________________
Definitions of Words Found in the Necropsy
Severe coalescing (to come together to form a whole) regions of myofiber (myofiber is a multinucleated single muscle
cell) in disarray.
"Myofiber
disarray" defines a nonparallel arrangement of cardiac
myocytes (muscle cells of the heart). The presence of a sufficient quantity of
myocardial fibers showing this change is considered to be a specific
histological feature of hypertrophic cardiomyopathy.
Multifocal (multiple foci) myofiber-A cylindrical, multinucleate cell composed of numerous
myofibrils that contracts when stimulated.
Degeneration-decline
Fibrosis-thickening
and scarring
Fibrillar-Any of various threadlike fibers or filaments that are
constituent parts of a cell or larger structure. Fibrils make up the
contractile part of striated muscle fiber in the body.
Hypereosinophilic- It
occurs when an individual's blood has very high numbers of eosinophils.
Eosinophilic
-Eosinophils are a type of white blood cell. They help
fight off infections and play a role in your body's immune response. They can
also build up and cause inflammation...when the
body produces too many eosinophils, they can cause chronic inflammation
resulting in tissue damage.
Sarcoplasm is the cytoplasm of a myocyte (muscle fiber). The sarcoplasm of
a muscle fiber is comparable to the cytoplasm of other cells, but it contains unusually large amounts
of glycosomes (granules of stored glycogen) and significant amounts of myoglobin, an oxygen binding protein. The calcium concentration in
sarcoplasma is also a special element of the muscular fiber by means of which
the contractions take place and regulate.
It contains mostly myofibrils (which are composed of sarcomeres), but its contents are otherwise
comparable to those of the cytoplasm of other cells. It has a Golgi
apparatus, near the nucleus, mitochondria just on the inside of the
cytoplasmic membrane or sarcolemma, as well as
a smooth endoplasmic reticulum organized in
an extensive network.
Lymphocytes-a form
of small leukocyte (white blood cell) with a single round nucleus, occurring
especially in the lymphatic system.
Plasma cells, are white blood cells that
secrete large volumes of antibodies. They
are transported by the blood plasma and
the lymphatic system.
Neutrophil
granulocytes (also known as neutrophils or
occasionally neutrocytes) are the most abundant type of granulocytes and
the most abundant (40% to 75%) type of white blood cells in
most mammals. They form an essential part of the innate immune system.
Neutropenia-is an
abnormally low count of neutrophils, a type of white blood cell that helps
fight off infections. The lower your neutrophil count, the more vulnerable
you are to infectious diseases.
Proteinaceous material-relating to, resembling, or being protein
Macrophages-type of white blood cell that engulfs and digests cellular debris,
foreign substances, microbes, cancer cells, and anything else that does not
have the types of proteins specific to the surface of healthy body cells
Arteriosclerosis-thickening, hardening and loss
of elasticity of the walls of the arteries. This process gradually restricts the blood flow.
HEART:
Heart/Cardiology/Coronary
Hyptertension- Blood
pressure is determined both by the amount of blood your heart pumps and the
amount of resistance to blood flow in your arteries. The more blood your heart
pumps and the narrower your arteries, the higher your blood pressure.
Multifocally-Having to do with two or more foci or arising
from two or more places.
Fibrinous
adhesions-an adhesion that consists of fine threads of fibrin r from an exudate of plasma or lymph, or an extravasation of
blood.
Cranioventral is an anatomical description of a direction and means
directed "upwards" (cranial) and "to the
front" (ventral).
Autolysis- In biology, autolysis,
more commonly known as self-digestion, refers to the destruction of a cell
through the action of its own enzymes.
Thoracic
cavity - The thoracic
cavity (or chest cavity) is the chamber of the
body of vertebrates that is protected by the thoracic wall
(rib cage and associated skin, muscle, and fascia).
Parietal
pericardium-The
outer layer of the pericardium which is a conical sac of fibrous tissue that
surrounds the heart and the roots of the great blood vessels.
Pericardial
sac-The pericardium (from
the Greek περί, "around" and κάρδιον, "heart") is a
double-walled sac containing the heart and the roots of the
great vessels. The pericardial sac has two layers, a serous
layer and a fibrous layer. It encloses the pericardial cavity
which contains pericardial fluid.
Thoracic
duct-thoracic duct is the largest lymphatic vessel of the lymphatic system.
Chylothoracic-Chylothorax is a relatively rare condition in the cat
in which lymphatic fluid or chyle accumulates in the pleural
cavity. It
results from lymph formed in the digestive system called chyle accumulating
in the pleural
cavity due to
either disruption or obstruction of the thoracic duct.
Atrioventricular- Pertaining to the atria (the upper chambers of the heart) and
the ventricles (the lower chambers of the heart).
Mitral valve (not to be confused with the
congenital bicuspid aortic valve) and the tricuspid valve are
known collectively as the atrioventricular valves because they lie between the
atria and the ventricles of the heart and control the flow of blood.
Endocardial surface of the left ventricle-endocardium is
the innermost layer of tissue that lines the chambers of the heart.
Ventricular septum -The interventricular
septum (IVS) is the stout wall separating the lower chambers (the ventricles) of the heart from one another. The ventricular septum is
directed obliquely backward to the right, and curved with the convexity toward
the right ventricle; its margins correspond with the anterior and posterior longitudinal sulci (coronary groove which contains the
trunks of the nutrient vessels of the heart, and is deficient in front, where
it is crossed by the root of the pulmonary trunk. On the posterior surface of the heart,
the coronary sulcus contains the coronary sinus.)
Excessive
moderator bands-
The moderator
band is a muscular band of heart tissue found in the
right ventricle of
the heart...frequently extends from the base of the anterior papillary muscle to
the ventricular septum. While normal, if
excessive, they impair heart function.
Left ventricular concentric hypertrophy-Left ventricular hypertrophy is enlargement
and thickening (hypertrophy) of the walls of your heart's main pumping chamber
(left ventricle).
Left
atrioventricular endocardiosis-Mitral valve disease
is a serious heart condition caused by the abnormal function of the valve that
separates the upper and lower chamber of the left side of the heart.
Endocardiosis is a valvular insufficiency. The most
commonly affected site is the mitral valve. The condition results in slowly
developing heart failure as the valves become swollen and shortened/misshapen,
so the heart cannot pump blood effectively from the left ventricle to the
circulation.
Leaky valves-The valves consist of flaps
that open to let blood flow in one direction as it moves through the chambers
of the heart. Then the valves close to keep blood from flowing backwards into the
chamber it just left. Each valve typically has three flaps, except for the
mitral valve, which has two. means that just after the heart squeezes and
pumps blood forward, some blood will leak backward through the valve. Leaking
through the valve is also called valve regurgitation.
LUNGS:
Lungs/Pulmonary/Respiratory
Pleura-each of a pair of serous membranes lining the
thorax and enveloping the lungs in humans and other mammals.
Pleural cavity is the thin fluid-filled space between
the two pulmonary pleurae (visceral
and parietal) of each lung.
Pulmonary pleurae are the two pleurae of the invaginated sac surrounding each lung and attaching to the thoracic cavity. The visceral pleura is the delicate serous
membrane that covers the surface of each lung and dips into the fissures
between the lobes. The parietal pleura is the outer membrane
which is attached to the inner surface of the thoracic cavity. It also
separates the pleural cavity from the mediastinum. The
parietal pleura is innervated by the intercostal nerves and the phrenic nerve.
Lung lobes- parts of the lung.
Pleurisy (also known as pleuritis) is an inflammation of the pleura.
Fibrinous
pleuritis-fibroid
tissue, damage in the pleural cavity.
Pulonary edema-excess
fluid in the lungs.
Pleural effusion-fluid around the lung.
Atelectasis-a complete or partial collapse of a lung or lobe of a
lung. Atelectasis can make
breathing difficult and lower oxygen particularly if lung disease is already
present. It is a condition where the alveoli are
deflated down to little or no volume.
Interstitial
fibrosis -group of lung diseases affecting the interstitium (the tissue and
space around the air sacs of the
lungs)
Alveolar histiocytosis-Histiocytosis is a general name for a group
of disorders or "syndromes" that involve an abnormal
increase in the number of immune cells that are called histiocytes.
LIVER:
Liver:
Liver-slightly
round edges and a prominent reticulated pattern (as if threads woven like a
net)
About Liver disease and heart failure -Damage
done to a liver is due to right sided heart failure.
Hepatomegaly is
the condition of having an enlarged liver.
Congestive
hepatopathy of the liver-also known as nutmeg liver and chronic passive
congestion of the liver, is liver dysfunction due to venous congestion, usually due
to congestive heart
failure. The gross pathological appearance
of a liver affected by chronic passive congestion is "speckled" like
a grated nutmeg kernel; the dark spots represent
the dilated and congested hepatic venules and small hepatic veins.
(Liver) sinusoids -A sinusoid is
a small blood vessel that is a type of capillary similar to a fenestrated
endothelium.
KIDNEYS:
Kidneys/Renal/Nephrology
Kidneys have a somewhat granular
outer section (the cortex), containing the glomeruli and
convoluted tubules, and a smooth, somewhat striated inner section (the
medulla), containing the loops of Henle and the collecting tubules.
Granular- A granular surface of the kidney may be present in both benign
and malignant hypertension and is indicative of atrophy and fibrosis of the
cortex due to the destruction of the small blood vessels. The degree of the
granulation depends on the duration of the hypertension.
Renal cortex -is the
outer portion of the kidney between the renal capsule and the renal medulla.
Glomerulonephritis -acute inflammation of the kidney of tiny filters in your kidneys (glomeruli). Glomeruli remove excess
fluid, electrolytes and waste from your bloodstream and pass them into your
urine.
Tubular proteinosis. -the accumulation of excess protein in the tissues. These proteins are normally filtered by the glomerulus and
are almost completely reabsorbed in the proximal tubule. Diseases that
interfere with proximal tubular function, such as tubulointerstitial nephritis,
reduce reabsorption of these proteins and lead to tubular proteinuria. High concentrations of protein cause frothy or sudsy urine.
No comments:
Post a Comment