Rheumatic Heart Disease Flashcards
What is rheumatic fever?
Disease of disordered immunity
Who is usually affected by rheumatic fever?
Children 5-15 years, boys>girls
What are some of the presenting symptoms of rheumatic heart disease?
“Flitting” (painful) polyarthritis of large joints (wrists, elbows, knees, ankles) Plus skin rashes and fever
What does rheumatic fever cause?
Inflammatory changes in the heart and joints, sometimes neurological symptoms
What else do you get with rheumatic fever?
Pancarditis (inflammation affecting endocardium, myocardium, pericardium)
How does rheumatic fever affect the heart?
Most patients have usually had a sore throat due to a group A beta-haemolytic streptococcal infection.
Strong antibody reaction to the strep which may cross react with other antigens in CT.
Damage to heart tissue may be caused by combination of antibody-mediated and T cell-mediated reactions
Which structure do you see in histology of the heart in someone with rheumatic fever?
Aschoff body
Pathological problems relating to valvular heart disease can arise from what?
Valvular stenosis
Valvular incompetence/regurgitation/incompetency
Vegetations
What is valvular stenosis?
Valve thickened/calcified and obstructs normal blood flow into chamber/vessel
What is valve incompetence?
Valve loses normal function and fails to prevent reflux of blood after contraction of cardiac chamber
What is meant by vegetations?
Infective or thrombotic nodules develop on valve leaflets impairing normal valve mobility; may embolise
What can pancarditis in acute rheumatic fever develop into?
Chronic rheumatic heart disease
What does inflammation of the endocardium and left sided valves result in?
Fibrinoid necrosis of the valve cusps/chordae tendineae, over which (and along line of closure) form small vegetations
What is rheumatic HD characterised by?
Deforming fibrotic valvular disease, particularly involving the mitral valve: typically leaflet thickening, commissural fusion and shortening, thickening and fusion of chordae tendineae
What is rheumatic heart disease on of the only causes of?
Mitral stenosis
