Rheumatic Heart Disease

Question 1

Definition of Acute RHD

Answer 1

inflammation of endocardium, myocardium, and epicardium (pancarditis) following group A beta-hemolytic streptococcal pharyngitis

Question 2

ACUTE: Associated w/…

Answer 2

fever
polyarthritis
Sydenham's chorea (movement disorder)
subcutaneous nodules
erythema marginatum

Question 3

erythema marginatum

Answer 3

skin rash w/ advancing edge and clearing center

Question 4

Jones criteria for diagnosis of rheumatic fever

Answer 4

Evidence of Stretococcal infection AND

2 major OR 1 major and 2 minor criteria

Question 5

ACUTE: Major criteria

Answer 5

carditis
polyarthritis
Sydenham's Chorea
Erythemia Marginatum
Subcutaneous Nodules

Question 6

ACUTE: Minor criteria

Answer 6

fever
Migratory arthralgias
prolonged PR interval
High ESR or WBC count

Question 7

ACUTE: Epidemiology

Answer 7

common in developing countries
rare in US
most common in children

Question 8

How long usually after strep throat does pt get rheumatic fever?

Answer 8

3 wks

Question 9

Pathogenesis

Answer 9

autoimmune disease in genetically susceptible individuals due to molecular mimicry b/w bacterial and heart antigens

Question 10

ACUTE: Gross pathology

Answer 10

tiny (1-2mm) verrucous (wart-like) vegetations lined up on line of valve closure
fibrinous pericarditis

Question 11

ACUTE: microscopic pathology

Answer 11

fibrin and platelet thrombi on valves

Aschoff bodies

Question 12

Aschoff bodies

Answer 12

foci of fibrionoid necrosis w/ histiocytes and anitschkow cells
(w/ clumped chromatin resembling caterpillar)

Question 13

ACUTE: Signs

Answer 13

various systolic and diastolic murmurs

pericardial friction rub

Question 14

ACUTE: treatment

Answer 14

aspirin
penicillin
supportive care

Question 15

ACUTE: Prognosis

Answer 15

Many cases will go on to Mitral stenosis

1/4 will go on to aortic regurgitation or stenosis too

Question 16

CHRONIC: most common w/…

Answer 16

recurrent carditis
severe carditis
carditis at any age

Question 17

CHRONIC: symptoms

Answer 17

usually occur an average of 20 yrs after carditis

but 50% have no Hx of it

Question 18

Mitral stenosis is almot always due to…

Answer 18

rheumatic carditis

Question 19

CHRONIC: epidemiology

Answer 19

female predominance?

Question 20

CHRONIC: Pathology

Answer 20

• -slitlike fishmouth
• -round buttonhole stenosis w/ fibrous thickening and rigidity of valves w/ or w/out calcification
• -fusion of commissures
• -thickening, retraction, fusion of chordae
• -sometimes MacCallum patches

Question 21

MacCallum patches

Answer 21

maplike areas of atrial endocardial thickening and fibrosis

Question 22

CHRONIC: common complications

Answer 22

left atrial HTN
LA dilation
atrial fibrillation
LA thrombus formation
Pulmonary HTN
RV hypertrophy
Right HF