Post on 05-Jan-2016
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Rheumatic fever
ByDr. Ali Abdel-Wahab
Lecture specs
At the end of lecture students should be able toClassify disorders of the heart, especially inflammatory diseasesDefine endocarditis and enumerate its causes and pathological subtypesDefine rheumatic fever and enumerate organs affected by this disorderDescribe Aschoff body (rheumatic granuloma)Enumerate possible complications of rheumatic fever
Diseases of heart
Heart failure Congenital heart Valve diseases Hypertensive heart diseases Ischemic heart disease Cardiomyopathy Cardiac transplantation
Pericardiac diseases Myocardiac diseases Endocardiac diseases Pancarditis
Endocarditis
Usually associated with vegetations (thrombosis on cardiac valve) that may leads to
– Emboli– Fibrosis and valve diseases
Non-infective endocarditis– Rheumatic fever(part of pancarditis)– Rheumatoid disease
Infective endocarditis
Rheumatic fever
It is an non-infective immune disorder A systemic autoimmune disease affecting
mainly the heart, joints, subcutaneous tissue and CNS.
Incidence
Children between 5-15 years. Developing countries. Familial Low socioeconomic standards
– Poor nutrition– Overcrowding– Poor ventilation– Bad habits
Rheumatic feverPathogenesis
Certain susceptible individuals
An upper respiratory tract infection by Group A β hemolytic streptococci.
After 1-4 weeks start immune reaction
Streptococcal antigen stimulates antibody production
High anti-streptolysin O (ASO) indicate recent streptococcal infection
The antistreptococcal antibody cross-react with host cardiac antigen starting
the disease.
Manifestations of rheumatic fever Cardiac; pancarditis Extra cardiac manifestations
Skin rash Arthritis Brain
Extra-cardiac manifestations
Fever, malaise and increased ESR. Joint: arthralgia and migratory
polyarthritis that usually heals without residual effect.
Subcutaneous nodules over bony prominences.
Sydenham’s chorea (chorea minor); involuntary semi-purposeful movements associated with emotional liability
Rheumatic feverPancarditis
- Inflammation of the 3 heart layers= Pancarditis
1. Pericarditis
2. Myocarditis
3. Endocarditis
Rheumatic fever serious lesions
- During the acute stage, rheumatic myocarditis is more dangerous
- With chronic disease, endocarditis leads to valve lesions
Rheumatic pericarditis
It produces serofibrinous pericarditis. Pericarditis heals by organization (fibrosis)
Rheumatic Myocarditis
Aschoff’s nodules (granuloma) developing in the myocardium
Rarely acute left ventricular failure
Aschoff’s nodules (granuloma)
Site: myocardium, skin nodules Paravascuar collections of monocular cells Caterpillar cells
Rheumatic endocarditis
Mural endocardium Valvular endocarditis
Inflammation of the cardiac cusps commonly affected
The mitral and aortic valves– Mitral ˃mitral with aortic˃ aortic ˃ tricuspid
Edema of the leaflets of the cusps make the endocardium liable to injury during closure of the valve
This leads to small thrombosis on the valve
(vegetations)
Rheumatic feverComplications
Mitral stenosis Mitral incompetence Double mitral valve
disease Stenosis
thrombu
s
Rheumatic feverComplications
Aortic stenosis Aortic incompetence Double aortic valve
disease
Rheumatic feverComplications
Pulmonary and tricuspid valves are rarely affected.
Diagnosis of Rheumatic FeverJones criteria
– Major criteria1. Carditis2. Polyarthritis3. Chorea4. Skin rash5. Skin nodules.
Two major or Two minors +one major
– Minor criteria1. Fever2. Arthralgia3. increased ESR 4. CRP5. Previous rheumatic fever.6. ECG changes