(P4) Cardiac: Rheumatic endocarditis

Question 1

Answer 1

Rheumatic endocarditis

• 1. fibrinoid necrosis
     
     2. deposition of small sterile vegetations on valvar leaflets*
• 3. Valvular deformation (mitral/aortic insufficiency/stenosis*
• 4. Mitral Valve*

Question 2

Identify slide:

This lesion is the most common manifestation of what….and a consequence of the progresson of what…which involves what?

Answer 2

Rheumatic endocarditis

• • Rheumatic endocarditis is the most common manifestation of rheumatic heart disease*
• • Rheumatic heart disease is a consequence of the progression of acute rheumatic fever*
• • Usually involves mitral valve (the only cause of mitral stenosis)*

Question 3

Rheumatic endocarditis

Macroscopic findings

Answer 3

The cardinal anatomic changes of the mitral valve in chronic RHD are:

– leaflet thickening
– commissural fusion
– shortening, thickening and fusion of the tendinous cords

• Mitral valve is always involved (in 2/3 of cases it is the only valve involved) and it leads to mitral stenosis
• With tight mitral stenosis* the *left atrium progressively dilates* and may *harbor mural thrombi

Question 4

identify slide

Describe the physiological involvement

and

location

Answer 4

• Rheumatic endocarditis*
• -Valvular involvement left sided valves*
• -Involvement of endocardium*
• and*

left-sided valves – mitral valve

• -Damage of endothelium promotes fibrinoid necrosis*
• -Formation of thrombi/emboli Perivascular region. -Inflammation concentrated near valve*

Question 5

Rheumatic endocarditis

describe what is found within the cusps or along the tendinous cords and at sites of erosion:

Answer 5

–Inflammatory foci’s fibrinoid necrosis within the cusps or along the tendinous cords–Nonspecific chronic inflammation

–Small vegetation nodules 1-2mm – precipitation fibrin at sites of erosion with inflammation and collagen degeneration

Question 6

Rheumatic endocarditis

leads to?

Answer 6

• Leads to stenosis or deformation of the valve
• Exudative & proliferation inflammation, valve involvement (left side)
• Fibrinoid necrosis
• Small thrombus (blood, platelets & fibrin) at the site of erosion w/inflammation
• Fibrous thickening of valve→stenosis or deformation of valve

Question 7

Rheumatic endocarditis

Microscopy?

Answer 7

Normal myocardium.

Valve w/ large foci of fibrinoid necrosis

Question 8

Name Slide:

Chronic direct consequence of this lesion is?

Answer 8

Rheumatic endocarditis

Valvular deformation (mitral/aortic insuficiency/stenosis)

Question 9

Anatomical structure of the presented organ

(not the histological layer indicated by the name of disease!)

typically affected by this lesion is?

Answer 9

Rheumatic endocarditis

Mitral valve (left-sided valve)

Question 10

Answer 10

Question 11

Answer 11

Question 12

identify structures

Answer 12

Question 13

identify structures and slide

Answer 13

Rheumatic endocarditis

Question 14

Answer 14

Rheumatic endocarditis