Rheumatic Heart Disease Flashcards
Rheumatic Fever (RF) is a (local or systemic?) , post-__________ , (suppurative or non-suppurative?) inflammatory disease, principally affecting the _____,____,____,____,______
Systemic
streptococcal
non-suppurative
heart, joints, CNS, skin , subcut.tissues
The (acute or chronic?) stage of RF involves _____ layers of the heart ( _______ ) causing major cardiac sequelae referred to as Rheumatic Heart Disease (RHD).
Chronic
all three
pancarditis
RHD
Most commonly seen in (children or adults?) _____ years
When ________ infection is most frequent and intense
Children; 5-15
streptococcal
Streptococcus pharyngitis is seen (more or less?) commonly in poor socioeconomic strata of people living in damp and crowded places which promotes interpersonal spread of strep.infection
•Its incidence has declined in _______ countries.
More
developed
Both sexes are nearly equally affected in RHD
T/F
T
AETIOPATHOGENESIS of RHD
• It is generally accepted that there is a preceding _______ with ________ streptococcus of group ____ in RF
throat infection
beta- haemolytic
A
AETIOPATHOGENESIS of RHD
• the mechanism of lesions in the heart, joints and other tissues is by direct infection
T/F
If T , why
If F, then by how?
F
not by direct infection but by induction of hypersensitivity or autoimmunity
AETIOPATHOGENESIS of RHD
• However, the mechanism of lesions in the heart, joints and other tissues is not by ____ but by ___________________________
• 2 evidences support this concept.
_________ and _________
direct infection
induction of hypersensitivity or autoimmunity
EPIDEMIOLOGIC EVIDENCE
IMMUNOLOGICAL EVIDENCE
AETIOPATHOGENESIS of RHD
A. EPIDEMIOLOGIC EVIDENCE
• 1. a preceeding history of _____infection & _____ infection with this micro-organism, ___________ prior to the attack of RF.
pharyngeal ; URT
2 or 3 weeks
AETIOPATHOGENESIS • A. EPIDEMIOLOGIC EVIDENCE
• 2. Subsequent attack is generally associated with ________ of ______
• 3. administration of antibiotics leads to ____________ as well as _____ of RF and its _______
exacerbation of RF
lowering of the incidence
severity; recurrence
the latent period required for sensitization to the bacteria( streptococcus pyogenes) is??
2-3 weeks
AETIOPATHOGENESIS of A. EPIDEMIOLOGIC EVIDENCE
• 4) Patients with RF have elevated titres of _____ to the ______ of ______-haemolytic strep of group ____ such as ___________ O (ASO) & S, _______, ________ and ___________
Abs to the Ags
beta; A
antistreptolysin; antistreptokinase
antistreptohyaluronidase
anti-DNAase B.
AETIOPATHOGENESIS of RHD• A. EPIDEMIOLOGIC EVIDENCE
• 5.________ factors
• 6. _________ distribution
Socioeconomic
Geographic
AETIOPATHOGENESIS of RHD
A. EPIDEMIOLOGIC EVIDENCE
• 7. Climate: its role has been desribed by some workers. Incidence of the dx is higher in _____ and _____ regions with (cold or hot?) , damp climate near the rivers and water ways which favour the spread of the infection
subtropical and tropical
Cold
AETIOPATHOGENESIS of RHD A. EPIDEMIOLOGIC EVIDENCE
• Despite all these evidences, only a (small or large?) proportion of patients of ________ infection develop RF- the attack rate is _____%.
Small
strep. pharyngeal
<3
AETIOPATHOGENESIS of RHD: B. IMMUNOLOGIC EVIDENCE
RF appears ____ weeks after throat infection
2-3
AETIOPATHOGENESIS of RHD B. IMMUNOLOGIC EVIDENCE
• The org can not be ______ from _____ in the target tissues
• This has led to the concept that lesions are produced as a result of ______ by formation of ______ against ______
grown from lesions
immune response
autoAntibodies
bacteria
A number of components of streptococcus identify or cross- react with target human tissues in RHD
T/F
T
AETIOPATHOGENESIS of RHD: immunological evidence
• One such important component is _____ identified as ______ of streptococcus which has various antigenic types, and hence corresponding antibodies in humans which target different tissues.
M-protein; surface protein
AETIOPATHOGENESIS of RHD: immunological evidence
• 1._________ of grp A strep forms antibodies which are reactive against ______
Cell wall polysaccharide
cardiac valves
AETIOPATHOGENESIS of RHD: immunological evidence
• 2._________ capsule of grp. A streptococcus is identical to _______ present in _____ tissues and thus these tissues are target of attack.
hyaluronate
human hyaluronate
joint
AETIOPATHOGENESIS of RHD: immunological evidence
• 3. ____ Antigens of group. A streptococcus react with ______ of _________ muscle , dermal _____ and neurons of _______
Membrane
sarcolemma
smooth and cardiac
fibroblasts; caudate nucleus.
PATHOLOGIC CHANGES of RHD
• A.______ LESIONS
• B. _______ LESIONS
CARDIAC
EXTRACARDIAC
PATHOLOGIC CHANGES • A. CARDIAC LESIONS
• The cardiac manifestations of RF are in the form of (focal or diffuse?) inflammatory involvement of the ______ tissues of the ____ layers of the heart, the so called (_______).
Focal
interstitial
3; Pancarditis
• The pathognomonic features of pancarditis in RF is the presence of distinctive __________ or ________
Aschoff nodules or Aschoff bodies.
PATHOLOGIC CHANGES :A. CARDIAC LESIONS
• Aschoff bodies are _______ or ________ shaped distinct (tiny or large?) structures 1-2mm in size occuring in the interstitium of the heart in RF
spheroidal or fusiform
Tiny
PATHOLOGIC CHANGES • A. CARDIAC LESIONS
•Aschoff bodies : They are especially found in the vicinity of __________ in the _________ and __________ and occasionally in the _______ and the ________ of the (proximal or distal?) part of the _______.
small blood vessels
myocardium and endocardium
pericardium & the adventitia
Proximal ; aorta
Aschoff bodies may be visible to naked eye.
T/F
T
cardiac histiocytes (__________ cells)
modified multinucleate cardiac histiocytes ( _______ cells)
Anitschkow
Aschoff
PATHOLOGIC CHANGES • A. CARDIAC LESIONS
• It consists of ________, plasma cells, few ________, cardiac _______ and modified ______________
lymphocytes
neutrophils
histiocytes
• Aschoff contain ___-___ cells.
1 to 4
RHEUMATIC PANCARDITIS
• all the 3 layers of the heart are affected in RF, with equal intensity in terms of their involvement
T/F
F
Although all the 3 layers of the heart are affected in RF, the intensity of their involvement is variable
RHEUMATIC ENDOCARDITIS
•______ lesions of RF may involve the ______ and _______ endocardium causing _________ and _______, respectively
Endocardial
valvular and mural
rheumatic valvulitis and mural endocarditis