Pathology of the Cardiovascular System

Alfonso López
Professor of Anatomic Pathology
Dept. Pathology and Microbiology
Atlantic Veterinary College
University of Prince Edward Island
Canada

Jan 23, 2013
Module 1 Structure and Function
 Heart: Structure and Function

• The heart is the first organ to form in 
the embryo. 

• In mammalians and birds it consists of 
4 chambers (2 atria and 2 ventricles). 

• There are four cardiac valves:

1. Right atrio‐ventricular (Tricuspid)
2. Left  atrio‐ventricular (Mitral)
3. Aortic (semilunar)
4. Pulmonic 

Source: Wikipedia

In the adult animal the left ventricle is thicker than the right
 Heart: Structure and Function

• The systemic circulation returns non‐
oxygenated blood from the body to the 
right atrium via the vena cava.

• From the right atrium the blood passes 
through the right AV valve into the right 
ventricle.

• From the right ventricle the blood is   
pumped into the lungs via the pulmonary 
(pulmonic) arteries.

• From the lung, oxygenated blood returns 
to the left atrium via the pulmonary vein.

• The blood then passes from the left 
atrium to the left ventricle through the 
mitral valve.  Source: Wikipedia
 Heart: Structure and Function

The heart is composed of three layers: 

1. Pericardium (Epicardium).
2. Myocardium (Heart muscle).
3. Endocardium (atria, ventricles and 
valves).

2‐ Myocardium

3‐ Endocardium
1‐ Epicardium
 Pericardium and Epicardium

Pericardium and Epicardium:
• The pericardium is  a double layered serosal membrane that 
covers the heart and the proximal part of the great vessels.

• The most external and thicker layer of the sac is the parietal 
pericardium while the most internal and thinner layer which 
intimately covers the myocardium, is the visceral pericardium 
called epicardium.

* • These two serosal membranes are composed of a thin layer 
of mesothelium and connective tissue which supports blood 
vessels, lymphatic vessels, nerves and adipose tissue.  

• The epicardial fat (asterisk) generally follows the coronary 
grooves. 

• The pericardial space ,present between the epicardium and 
pericardium, contains small amounts of clear lubricant fluid.

Note:  The pericardial sac (pericardium) was removed to expose the epicardium
Epicardial surface

Epicardial fat

Epicardium Artery

Nerve

Myocardium
 Myocardium

Myocardium
• The myocardium constitutes the  
muscle of the heart.

• Through contraction (systole) and 
relaxation (diastole) the heart 
pumps the blood to the lungs and 
systemic circulation. 

• The myocardial muscle is 
histologically similar but not 
identical to skeletal muscle.
Myocardium

• Involuntary striated muscle.

• Branched fibres that connect with each

other through the Intercalated disks (white
arrows).

• Fibres contain abundant mitochondria but

these sre only seen by electron
microscopy.
 Endocardium

• Thin layer lining the internal

surface of the heart.

• Endocardium in the heart is the

Endocardium equivalent to the tunica intima of
blood vessels.

• It is close contact with blood.

• Endocardium is microscopically
composed of three layers:
1. Endothelium (superficial)
2. Basal lamina
3. Sub-endothelial connective
tissue (elastin and collagen).

• Endocardium also contains part

of the conductive system and
Purkinje fibres.
Purkinje Fibers • Specialized myocardial cells (arrow)
• Responsible for electrical impulse conduction
• Not to be confused with Purkinje cells in the cerebellum

Endocardium

Myocardium
 Normal Heart Valves

The heart has four valves which allow 
for unidirectional blood flow: 
1. Tricuspid valve (right AV valve)
2. Bicuspid or mitral valve (left AV 
valve)
3. Aortic (semi‐lunar) valve
4. Pulmonic valve (pulmonary artery.

The normal valvular leaflets (cusps) are thin, smooth, partially translucent and are lined by 
endothelium.
 Normal Heart Valves

Atrium

Endocardium

Valve
Chordae tendinae

AV valves attach to the papillary 
muscles of the ventricular myocardium 
by the chordae tendinae. Papillary muscle
 Postmortem Examination of the Heart

Silhouette in situ Shape Size Weight (total and ratios)

Color Pericardial fluid Fat deposits Post‐mortem changes
Wall thickness Valves Endocardium Blood vessels
 Postmortem Examination

Equine Thorax • Always check the heart 

in situ paying attention 
to the relative size of the 
cardiac silhouette 
(dotted lines).

• Before cutting the 
pericardium (arrow), 
check for the presence 
of effusions or exudate.

Enlarged cardiac silhouette occurs in: cardiac dilation or hypertrophy, pericarditis, tumor 
or cardiac effusions.
Note an enlarged cardiac silhouette with marked cardiac dilation which in this 
lamb  is secondary to  heart defect.
Note severe hydropericardium which is secondary to a right heart failure
 Postmortem Examination of the Heart

There is no universal method to open a heart.  In  neonatal and young animals it 
is important to carefully check for congenital heart defects.
 Postmortem Examination

Before you open the heart, check the epicardium, pericardial fat and great vessels 

Left Atrium
The  atrial epicardium is 
slightly thicker which gives 
it a whiter appearance
Epicardial fat
It follows the coronary groove
Epicardium
Thin and transparent serosal
membrane through which the 
underlying myocardium is 
visible.
 Opening the Right Heart

Pulmonic artery

Right ventricle
The most frequent technique to examine 
the heart, is to cut the right ventricle in a 
“U” shape starting in the pulmonary artery 
and ending to the base of the right atrium 
(yellow lines). 
 Opening the Left Heart

The left ventricle  is opened with a 
single straight  cut extending from the 
apex to the left atrium (yellow lines) 
 The Left Heart

Finally, open the aortic outflow tract by inserting a knife or cutting through the mitral 
valve with scissors (white arrow).  Once the aortic outflow is visible carefully check the 
semilunar valves  (black arrows).
 LV

Septum

RV

Some pathologists like to make a  transverse section of the heart to evaluate the wall 
thickness of the ventricles and septum (arrows).  Typically  the left ventricle (LV) is 2‐3 times 
thicker than the right ventricle (RV).
Caution: Do not mistake lymphatic vessels in the epicardium (arrows) with heart 
lesions.  This mistake is particularly common when examining the hearts of emaciated 
animals.   
 Samples for Histopathology

Take representative samples of atrium, ventricles, and septum in a routine post‐mortem,  
and valves if you suspect valvular problems.   For better fixation,  wash away excess blood 
before putting tissues in the formalin and use a tissue:fixative volume ratio of 1:10.
 Thanks to all AVC pathologists for contributing case materials

 Some images were acquired from veterinary colleges of

Canada, United States and Mexico and the names of some
contributing pathologists are unknown. Their valuable
contribution is sincerely acknowledged.

 I would like to thank Dr. Shannon Martinson, Atlantic

Veterinary College, for critically reviewing these modules.
 Module 1: Structure and Function

THE END

If you have any comments or criticisms about tutorials or

quizzes please let me know. Also, if you find any errors or
typos please let me know

lopez@upei.ca