Heart Disorders 2 Flashcards
What is Acute Rheumatic Fever?
an acute, immunologically mediated, multi-system inflammatory disease
what is rheumatic heart disease?
valvular disease resulting from chronic valve damage as a result of acute rheumatic fever
aka rheumatic valve disease
what is the difference between rheumatic fever and rheumatic heart disease
rheumatic fever is an inflammatory disease
rheumatic heart disease is a result of rheumatic fever, leading to chronic valve damage
aetiology of rheumatic fever
commonly from group A streptococcal pharyngitis
pathogenesis of rheumatic fever
- a hypersensitive response - antibody and T cell
- antibody response against M proteins of streptococci
- CD4 + T cells specific to streptococcal peptides
what are the key clinical features of rheumatic fever (5)
- migratory polyarthritis of the large joints
- pancarditis
- skin lesions
- subcutaneous nodules
- CNS - cause Sydenham chorea = involuntary movements
- 10 days-6 weeks post infection
what is migratory polyarthiritis?
one large joint becomes painful and swollen for a period of days then subsides
- happens to another large joint
- repeats
what is Pancarditis or acute rheumatic carditis?
affecting all three layers of the heart
- can cause cardiac dilation or heart failure
what is acute rheumatic carditis? what is affected?
when acute rheumatic fever affects the heart
- can affect the three layers of the heart
= pericardium
= myocardium
= endocardium
what are the 3 layers of the heart.
pericardium
myocardium
endocardium
with the 3 layers of the heart, what can be a result of acute rheumatic carditis?
pericardium = pericarditis
myocardium = myocarditis
endocardium = endocarditis
what is a characteristic feature of myocarditis?
Aschoff bodies - clumps of macrophages recruited into the area of muscle damage due to autoimmune response
where can Aschoff bodies be found?
in all three cell layers of the heart
= pancarditis
what is the diagnostic criteria of rheumatic fever
using the Jones Criteria
- must have evidence of group A strep infection
patient symptoms
- 2 of the major criteria or
- one major and 2 minor
what comes under major diagnostic criteria for acute rheumatic fever? (5)
carditis
polyarthritis
chorea - abnormal movements
erythema marginatum
subcutaneous nodules
what comes under minor diagnostic criteria for acute rheumatic fever? (5)
fever
arthralgia
previous rheumatic fever or rheumatic heart disease
acute phase reactions
prolonged PR interval
pathogenesis of rheumatic heart disease (6)
- cardiac hypertrophy
- cardiac dilation
- heart failure
- arrhythmias
- veruccae aka vegetations
- mitral stenosis
what is mitral stenosis?
narrowing of the mitral valve, found on the left side
what is the most likely cause of mitral stenosis?
rheumatic heart disease
what are veruccae? - rheumatic heart disease
nodules found in areas of valve damage
what valves are involved in rheumatic heart disease?
mostly only mitral valve
25% aortic valve - usually wear and tear
tricuspid/pulomonary valves are uncommon
what are the key clinical features of rheumatic heart disease (2)
-permanent and cumulative valve damage
- mitral stenosis - looking like a fish mouth or buttonhole
what is the diagnostic criteria of rheumatic heart disease
relies on the Jones Criteria
what is endocarditis? how does it usually present?
inflammation of the endocardium
- usually get vegetation lesions on the valve