RHEUMATIC HEART DISEASE:

ACUTE RHEUMATIC FEVER: A hypersensitivity disease typically caused by an abnormal immune response to Strep-A antigens.

PATHOGENESIS: Immune mechanism involves both B and T cells.

CLINICAL: Patient must have at least one of the major symptoms, and two of the minor symptoms of the JONES'S CRITERIA:

MAJOR JONES'S SYMPTOMS:

Carditis: Found in 35% of patients.

Polyarthritis: found in 75% of patients.

Chorea: Rapid jerky, dyskinetic involuntary movements.

Erythema Marginatum

Subcutaneous nodules

MINOR JONES'S SYMPTOMS:

Fever

Arthralgia

History of Rheumatic Fever or Rheumatic Heart Disease

Acute-Phase Reactants: high sed-rate, or positive C-Reactive Protein, which are evidence of inflammation.

Prolonged PR interval by ECG.

RISK-FACTORS: The more severe the initial Streptococcal infection, the more likely it is for patients to develop Rheumatic Fever.

 

 

CHRONIC RHEUMATIC HEART DISEASE:

PANCARDITIS: Rheumatic heart disease is typically a pancarditis, affecting all three layers of the heart.

VALVULITIS: Endocarditis affecting Mitral and Aortic Valves.

MITRAL VALVE is most common: Chordae Tendineae get fused together, resulting in MITRAL STENOSIS. Rheumatic Fever is the most common cause of mitral stenosis.

Stenosis has a fishmouth appearance.

You may also at the same time see mitral insufficiency in the same patient.

AORTIC VALVE is second most common, which can lead to AORTIC STENOSIS.

PERICARDITIS: Often seen, but described as Bread-and-Butter Pericarditis. This is an inflammatory process, but it is not Constrictive Pericarditis.

HISTOPATHOLOGY: It is aseptic so no bacteria are present.

ASCHOFF BODY is the characteristic finding. A granuloma composed of a central triangular area of fibrinoid necrosis surrounded by histocytes. They heal by scarring.

ANITCHKOFF CELLS: Found around the perimeter of the Aschoff bodies. They are also called Caterpillar cells. Round-to-ovoid nuclei have chromatin disposed in a wavy ribbon resembling a caterpillar.

General Medicine

Cardiovascular System

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