Rheumatic Fever

Question 1

Acute rheumatic fever

Answer 1

Acute often recurrent ,non-suppurative, Immunologically mediated , multi system inflammatory systemic disease due to beta hemolytic streptococcal pharyngitis

Question 2

Population most affected by rheumatic fever

Answer 2

Children (5-15)

Question 3

Structures involved in rheumatic fever

Answer 3

Joints 
tendons 
and
 muscles
 subcutaneous tissues 
arteries 
serous membranes
 lungs 
brain 
heart

Question 4

Clinical features of rheumatic fever

Answer 4

Major :
Flitting or migratory polyarthritis of large joints 
pan carditis 
Sydenham Chorea
 subcutaneous nodules 
skin rashes (erythema  marginatum)

Minor : 
Fever 
Long PR interval on ECG
Arthralgia 
High ESR  
Leucocytosis
C reactive proteins present

Question 5

Duckett Jones criteria

Answer 5

To confirm diagnosis of rheumatic fever in the patients after streptococcal sore throat’s you should have either two major manifestations of rheumatic fever or one major and 2 minor manifestations

Question 6

Rheumatic fever pathogenesis

Answer 6

Not really known
Immune mediated hypersensitivity reaction
2 mechanisms
Molecular mimicry (Sharing of human tissue antigens with the components of the bacterial wall)

MM protein of streptococcal wall invokes antibodies that’s cross reacts with tissue glycoproteins in the heart the joints and the other tissues

Streptococcal infection cause an auto immune response against self antigens due to cross reacting antigens

Question 7

Lesions in rheumatic fever

Answer 7

Sterile and that’s directly related to the bacterial and vision and do not contain bacterial antigens

Question 8

Morphology of rheumatic fever

Answer 8

ASCHOFF BODY :

Focal inflammatory lesions in the tissues

Fibrinoid necrosis with elliptic fusiforme or globular nodules

Plump macrophages with abundant cytoplasm and single clear nucleus with central wavy bar of chromatin
Anitschkow myocytes or cells (caterpillar cells)
t lymphocytes
Multinucleates giant cells ( aschoff giant cells )

Question 9

Cardiac conditions in rheumatic fever morphology

Answer 9

Aschoff bodies in any of the three cardiac layers
Pancarditis
Endocarditis ( diffuse edema in mural endocardium, cellular infiltration)

Mccallums patch ( numerous Aschoff bodies in posterior wall of left atrium just above insertion of posterior mitral cusp ) => can form mccallums plaque ( healing leading to gray white wrinkled plaque)

Loss of transparency of valve leaflets

Small sessile thrombi on apposition lines of valve=> gives verrucous endocarditis ( warty appearance of valve )

Vascularisation of avascular valve

Mitral regurgitation

Moderate to severe fibrosis

Myocarditis ( with conduction disturbances and heart failure) => flabby myocardium, dilated ventricles, Aschoff bodies , Infiltration, myocyte necrosis

Pericarditis => exudative ( fibrin in pericardial layers => bread and butter pericarditis , shaggy heart x, cor villosum => organization of fibrin => thickening of pericardium => adhesion of 2 layers with sac obliteration

Question 10

Must come involved involved in the rheumatic fever

Answer 10

Mitral valve most common

Mitral and aortic valve together

aortic fall

Question 11

Let’s come involved involved in rheumatic fever

Answer 11

Tricuspid and pulmonary valve

Question 12

Extra cardiac lesions of rheumatic fever

Answer 12

Subcutaneous nodules ( over bony prominence and extensor tendons , painless, 1-2cm) => fibrinoid necrosis , granulons with histiocytes, fibroblasts, edematous connective tissue, non specific chronic inflammation

Polyarthritis => hyperemia and edema of synoviale membrane and periarticular connective tissue => neutrophil infiltration, fibrinoid necrosis, granulation , focal aschoff like body

Lungs and pleura => pleuritis with pleural effusion, fibrinous deposit => interstitial pneumonitis

Brain => sydenhams chorea of St. Vitus’ dance => involuntary movements

Question 13

Must life-threatening problem in acute attack of your Mattick fever

Answer 13

Myocarditis Which can lead to arrhythmias and cardiac failure

Question 14

Chronic rheumatic heart disease

Answer 14

Sequelae of a cute rheumatic fever

Endocarditis where fibrosis and irregular shrinkage of valves leads to deformities which produce permanent valvular dysfunction years later

Question 15

Pathogenesis of Chronic rheumatic heart m disease

Answer 15

Lesions from healing of acute rheumatic endocarditis
fibrosis of previously inflamed sites

Leads to fusion of the Cusps so to permanent stenosis

Leads to thickening and retraction of valve cusps preventing closure and causing valvular incompetence

Compensatory dilatation and hyper trophy of chambers

Question 16

Sites must be affected by lesions leading to chronic rheumatic heart disease

Answer 16

Mitral aortic tricuspid valves

And their chordae tendinae ( thickened and shortened)

Question 17

Complication of chronic rheumatic heart disease

Answer 17

Cardiac failure -major cause of death

Miral thrombi -major cause of death

angina pectoris

cardiac arrhythmias

infective endocarditis- major cause of death