Valvular Heart Disease Flashcards
Describe the main causes of valvular heart disease
- Rheumatic heart disease
- Calcific aortic disease – most common in Western countries
- Valve ring dilation and leaflet degeneration
- Infective endocarditis
- Congenital heart disease
- Acquired stenoses of the aortic and mitral valves account for approximately two-thirds of all valve disease and virtually always a chronic process
Rheumatic fever
“Licks the joint, but bites the whole heart”
William Boyd
A sore throat can lead to a broken heart
RF is a
It is a systemic, post streptococcal, non suppurative inflammatory disease affecting the heart and extra- cardiac sites (joints, brain, skin etc.)
RF epidemiology
The incidence of RF is still high in developing countries
The disease affects children and young adults (5-15years)
The disease follows 10 days to 6 weeks after upper respiratory infection or via skin infection with Group A Beta hemolytic streptococci
RF caused by _____________
Group A Beta hemolytic streptococci
GABHS
Presence of GABHS is shown by
streptolysin O and DNAse B, in sera of most patients
Theories of Pathogenesis of RF
Induction of hypersensitivity & autoimmunity
Toxic products of streptococci
Sensitized T-lymphocytes may lead to cardiac injury
Note: Not by direct infection of Streptococci.
It is thought that antibodies directed against the M proteins of certain strains of streptococci cross-react with glycoprotein antigens in the heart, joints, and other tissues.
Migratory (Poly)Arthritis
Most common (75%) – and earliest manifestation
Involves larger joints: knees, ankles, wrists and elbows in a fleeting way
The pain can precede and appear to be disproportionate to the other findings
An inverse relationship between the severity of arthritis and the severity of cardiac involvement
Sydenham’s Chorea
St Vitus’ dance – jerky, involuntary movements
Often in prepubertal girls (8-12 years old)
Neuropsychiatric disorder
emotional lability and other personality changes.
Choreiform movements can affect the whole body, or just one side
Chorea disappears with sleep and is made more pronounced by purposeful movements
Subcutaneous Nodules
Firm, painless lumps, mainly on the hands, feet, occiput and back
Usually 0.5 to 2 cm in diameter and often found in crops of about three
Appearing two to three weeks after the onset of fever
Erythema Marginatum
Not itchy
Redness which gradually spreads out and the skin in the center of lesions returns to normal
Usually on the front of the abdomen and chest/back – it can develop on the limbs but almost never on the face
Tends to come and go lasting from one or two days to months or years
Carditis
Most serious manifestation
Accounts for essentially all of the associated morbidity and mortality
Isolated mitral valvular disease (90%) or combined aortic and mitral valvular disease
ASCHOFF’s BODIES formed in RHD – inflammation –foci of heart disease
Chronic Rheumatic Valvular Disease
Mitral & Aortic Valves pathology:
Thickening of valve leaflet, especially along the lines of closure
Fusion of commissures
Result is mitral or aortic stenosis, insufficiency, or both
Usually no clinical manifestations even for decades after Rheumatic fever
Small vegetations are formed at injured parts
2 types of endocarditis
infective = acute + subacute
non infective = rheumatic + non-bacterial thrombotic + Libman-Sacks
What is Infective Endocarditis?
An infection involving the inner layer of the heart – typically the heart valves
All of which can either have an acute presentation or a subacute presentation
