(P4) Cardiac: Rheumatic Myocarditis Flashcards
- identify slide*
- Define the cause;*
Rheumatic myocarditis
Rheumatic fever is an acute, immunologically mediated, multisystem inflammatory disease that occurs after group A β‐hemolytic streptococcal infections (usually pharyngitis, but also occasionally infections at other sites, such as skin)
Identify Slide
Cardiac manifestation is called?
Rheumatic myocarditis
rheumatic heart disease
Morphological presentation of
Rheumatic myocarditis is?
– Pericarditis – Myocarditis – Endocarditis
Rheumatic myocarditis
The diagnosis of acute rheumatic fever is made based on serologic evidence of?
previous streptococcal infection in conjunction with two or more of the Jones criteria:
– carditis
– migratory polyarthritis of large joints
– subcutaneous nodules
– erythematous annular rash (erythema marginatum) in the skin
– Sydenham chorea
Sydenham chorea (SC) is a neurological disorder of childhood resulting from infection via Group A beta-hemolytic streptococcus (GABHS), the bacterium that causes rheumatic fever. SC is characterized by rapid, irregular, and aimless involuntary movements of the arms and legs, trunk, and facial muscles
- Rheumatic myocarditis*
- Minor criteria* such as?
fever, arthralgias, EKG changes,
or
elevated acute phase reactants
Rheumatic myocarditis
Micro:
– Nonspecific myocarditis, in which lymphocytes and macrophages dominate, although a few neutrophils and eosinophils may be evident.
– The Aschoff’s body is the typical lesion of r_heumatic myocarditis_, the structure initially consists of perivascular focus of fibrinous necrosis surrounded by lymphocytes, plasma cells and plump macrophages (Anitschkow bodies)
identify slide and structure
Rheumatic myocarditis
identify slide and structure
Rheumatic myocarditis
Rheumatic myocarditis
1. Aschoff bodies: nodule in RF with macrophages, giant cells, Anitschkow cells*
2. Anitschkow cells: enlarged macrophages characteristic of RF*
3. lipofuscin*
4. joints, skin, CNS
Rheumatic myocarditis
Cause?
Infection by bacteria Strep A:
laryngitis, pharyngitis, upper respiratory infection
Rheumatic myocarditis
Which organs are affected in teh course of this disease apart form that seen on the slide:
3 Examples?
joints
skin
CNS
Rheumatic myocarditis
Is a cross reaction between what?
Cross reaction between streptococci’s protein M and glycoprotein in the heart, joints and other tissues
define
Aschoff bodies
Small granules surrounding blood vessels (accumulation of cells around vessel)
-with time completely obliterate vessel and develop foci of necrosis
Antischkow cells are?
Antischkow cells
are
enlarged macrophages found within granulomas (Aschoff bodies)
Identify slide
Rheumatic myocarditis
identify slide
Rheumatic myocarditis
identify slide
Rheumatic myocarditis
identify slide and parts
Rheumatic Myocarditis
Microscopically:
Aschoff bodies appear
Microscopically:
Aschoff bodies are areas of inflammation of the connective tissue of the heart, or focal interstitial inflammation.
Fully developed Aschoff bodies are granulomatous structures consisting of fibrinoid change, lymphocytic infiltration, occasional plasma cells, and characteristically abnormal macrophages surrounding necrotic centres. Some of these macrophages may fuse to form multinucleated giant cells. Others may become Anitschkow cells or “caterpillar cells,” so named because of the appearance of their chromatin.
Aschoff body
Presence in cardiac lesions:
The cardiac manifestations of rheumatic fever are in the form of focal inflammatory involvement of the interstitial tissue in all 3 layers of the heart, a pathological change named pancarditis.
The pathognomonic feature of pancarditis in the case of rheumatic heart disease is the presence of Aschoff nodules or Aschoff bodies.
