ISSN 2398-2969      

Heart: left atrial tear

icanis
Contributor(s):

Chris Little

Mark Oyama

Synonym(s): Left atrial rupture


Introduction

  • Left atrial tear is an uncommon sequel to severe left atrial enlargement. Most cases of left atrial tear result in pericardial effusion and acute death.

Pathogenesis

Etiology

  • Most cases of complete (full-thickness) atrial tears occur in aged small breed dogs with advanced left atrial enlargement due to mitral valve disease Heart: mitral valve degenerative disease. The tear results in acute hemorrhage into the pericardial space and acute pericardial effusion Pericardial disease , cardiac tamponade, and death. Partial thickness tears (endocardial splitting) of the left atrium is very common in dogs with advanced mitral valve disease, but no clinical signs specifically relating to this pathology are evident unless the tear becomes full thickness.

Predisposing factors

General

Specific

  • Advanced mitral valve disease and left atrial enlargement.

Pathophysiology

  • Full-thickness tears result in acute hemorrhage into the pericardial space Pericardium: idiopathic hemorrhage , pericardial effusion, and acute cardiac tamponade. Cardiac output is markedly reduced and profound low-output heart failure occurs.
  • Many cases of acute tears likely die suddenly and are never definitively diagnosed.
  • At necropsy, partial thickness tears in the left atrial endocardial surface are quite commonly noted in dogs with advanced disease. These partial tears may predispose dogs to atrial thrombus formation and/or to atrial arrhythmias, but no overt clinical signs are thought to be associated with partial tears.

Timecourse

  • Most cases present acutely with collapse, lethargy, and cardiac tamponade. Many cases likely die suddenly without ever being definitively diagnosed.

Epidemiology

  • Older small breed dogs with advanced mitral valve disease.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Reineke E L, Burkett D E & Drobatz K J (2008) Left atrial rupture in dogs: 14 cases (1990-2005). J Vet Emerg Crit Care 18 (2), 158-164 VetMedResource.
  • Prosek R, Sisson D D & Oyama M A (2003) What is your diagnosis? Pericardial effusion with a clot in the pericardial space likely caused by left atrial rupture secondary to mitral regurgitation. JAVMA 222 (4), 441-442 PubMed.
  • Sadanaga K K et al (1990) Echocardiography and surgery in a dog with left atrial rupture and hemopericardium. J Vet Intern Med (4), 216-221 PubMed.

Other sources of information

  • Komitor D A (1976)Left atrial rupture. Infrequent sequel to chronic valvular insufficiency.Vet Med Small Anim Clin71(5), 620-621.

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