Rheumatic Heart Disease

Question 1

What is rheumatic fever?

Answer 1

A complication of untreated strep throat, can damage body tissue by causing them to swell

Question 2

What is a complication of untreated strep throat that can damage body tissue by causing them to swell?

Answer 2

Rheumatic fever

Question 3

Where is rheumatic fever common?

Answer 3

India

Middle East

Central Africa

(rare in Europe and North America)

Question 4

Who does rheumatic fever commonly affect?

Answer 4

Children 5-15 years

Question 5

Does rheumatic fever affect more boys or girls?

Answer 5

Boys

Question 6

What does rheumatic fever lead to?

Answer 6

Inflammatory changes in the heart and joints, sometimes neurological symptoms

Question 7

What are the presenting features of rheumatic fever?

Answer 7

Flitting (painful)

Polyarthritis of large joints (wrist, elbows, knees, ankles)

Skin rashes

Fever

Pancarditis in the acute phase

Heart murmurs are common

Question 8

What is pancarditis?

Answer 8

Inflammation affecting endocardium, myocardium and pericardium

Question 9

What have most patients who have rheumatic fever recently had?

Answer 9

Sore throat usually due to group A beta-haemolytic streptococcal infection

Question 10

Why does the untreated strep lead to rheumatic fever?

Answer 10

Strong antibody reaction to strep may cross react with unknown antigens in connective tissue leading to damage to heart tissue caused by antibody and T cell mediated reactions)

Question 11

Histologically, what is seen in the heart in rheumatic fever?

Answer 11

Aschoff body

Question 12

What is valvular heart disease characterised by?

Answer 12

Damage to or a defect in one of the four heart valves

Question 13

What are examples of valvular heart disease?

Answer 13

Valvular stenosis

Valvular incompetence

Vegetations

Question 14

What is valvular stenosis?

Answer 14

Valve thickened/calcified and obstructs normal blood flow into chamber/vessel

Question 15

What is it called when valve is thicken/calcified and obstructs the normal blood flow into chamber/vessel?

Answer 15

Valvular stenosis

Question 16

What is valvular incompetence?

Answer 16

Valve loses normal function and fails to prevent reflux of blood after contraction of cardiac chamber

Question 17

What is it called when valve loses normal function and fails to prevent reflux of blood after contraction of cardiac chamber?

Answer 17

Valvular incompetence

Question 18

What is valvular vegetations?

Answer 18

Infective or thrombotic nodules develop on valve leaflets impairing normal valve mobility, they may embolism

Question 19

What are infective or thrombotic nodules develop on valve leaflets impairing normal valve mobility that may embolise called?

Answer 19

Valvular vegetations

Question 20

What is rheumatic heart disease?

Answer 20

A complication of rheumatic fever in which the heart valves are damaged

Question 21

How does rheumatic fever become rheumatic heart disease?

Answer 21

Pancarditis in acute rheumatic fever can progress over time to chronic rheumatic heart disease where it mainly manifests as valvular abnormalities

Question 22

Why does rheumatic heart disease manifest as valcular abnormaliies?

Answer 22

Inflammation of the endocardium and left sided valves results in fibrinoid necrosis of the valve cusps/chordae tendinae over which form small vegetations

Question 23

What is rheumatic heart disease characterised by?

Answer 23

Fibrotic valvular disease, particularly involving the mitral valve

Question 24

What is virtually the only cause of mitral stenosis?

Answer 24

Rheumatic heart disease

Question 25

Can rheumatic heart disease cause aortic stenosis?

Answer 25

Rarely, mostly due to calcific aortic valve disease

Question 26

How common is the tricuspid and pulmonary valve involvement in rheumatic heart disease?

Answer 26

Tricuspid is infrequent Pulmonary is rare