Rheumatic Heart Disease Flashcards
Definition of Acute RHD
inflammation of endocardium, myocardium, and epicardium (pancarditis) following group A beta-hemolytic streptococcal pharyngitis
ACUTE: Associated w/…
fever polyarthritis Sydenham's chorea (movement disorder) subcutaneous nodules erythema marginatum
erythema marginatum
skin rash w/ advancing edge and clearing center
Jones criteria for diagnosis of rheumatic fever
Evidence of Stretococcal infection AND
2 major OR 1 major and 2 minor criteria
ACUTE: Major criteria
carditis polyarthritis Sydenham's Chorea Erythemia Marginatum Subcutaneous Nodules
ACUTE: Minor criteria
fever
Migratory arthralgias
prolonged PR interval
High ESR or WBC count
ACUTE: Epidemiology
common in developing countries
rare in US
most common in children
How long usually after strep throat does pt get rheumatic fever?
3 wks
Pathogenesis
autoimmune disease in genetically susceptible individuals due to molecular mimicry b/w bacterial and heart antigens
ACUTE: Gross pathology
tiny (1-2mm) verrucous (wart-like) vegetations lined up on line of valve closure
fibrinous pericarditis
ACUTE: microscopic pathology
fibrin and platelet thrombi on valves
Aschoff bodies
Aschoff bodies
foci of fibrionoid necrosis w/ histiocytes and anitschkow cells
(w/ clumped chromatin resembling caterpillar)
ACUTE: Signs
various systolic and diastolic murmurs
pericardial friction rub
ACUTE: treatment
aspirin
penicillin
supportive care
ACUTE: Prognosis
Many cases will go on to Mitral stenosis
1/4 will go on to aortic regurgitation or stenosis too
CHRONIC: most common w/…
recurrent carditis
severe carditis
carditis at any age
CHRONIC: symptoms
usually occur an average of 20 yrs after carditis
but 50% have no Hx of it
Mitral stenosis is almot always due to…
rheumatic carditis
CHRONIC: epidemiology
female predominance?
CHRONIC: Pathology
- -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
MacCallum patches
maplike areas of atrial endocardial thickening and fibrosis
CHRONIC: common complications
left atrial HTN LA dilation atrial fibrillation LA thrombus formation Pulmonary HTN RV hypertrophy Right HF
