RHEUMATIC HEART DISEASE AND RHEUMATIC FEVER

RHEUMATIC FEVER
Acute, immunologically mediated inflammatory
disease
Mainly children (ages 5-15)
Occurs 1-5 weeks following episode of
Group A Streptococcal Pharyngitis

MINOR MANIFESTATIONS
Fever
Arthralgia
Increase acute phase reactants
o Antistreptolysin O (ASO)
o C reactive protein (CRP)

PATHOGENESIS
Suspected as Hypersensitivity Reaction induced by
Group A Streptococci
Evidence suggests it is secondary to host
antistreptococcal antibodies cross-reactive to
cardiac antigens

MORPHOLOGY

CLINICAL FEATURES:
Diagnosis established by JONES CRITERIA
2 major criteria + recent strep infection or
1 major and 2 minor criteria + recent strep
infection
MAJOR MANIFESTATIONS:
Migratory Polyarthritis
90% in adults
Less common in children
Carditis

50-75% in children, 35% in adults

Pericardial friction rubs, weak heart sounds,
tachycardia, and arrhythmias

Subcutaneous nodules
Erythema marginatum of skin
Macular skin lesions with erythematous
rims & central clearing
Sydenhams Chorea
Neurologic disorder with involuntary
purposeless, rapid movements

Aschoff bodies

Pathognomonic focal inflammatory nodules

Most characteristic in the heart
Constitute foci of fibrinoid necrosis
macrophages called Anitschkow cells
abundant cytoplasm
round to ovoid nuclei possessing
chromatin disposed in slender
wavy ribbon
Surrounded by lymphocytes

MacCallum plaques
Subendochardial collection of aschoff
nodules in the left atrium
Irregular thickening
Exacerbated by regurgitant jets
Inflammatory valvulitis
Formation of 1-2 mm beady
fibrinousvegetations (Verrucae) along the
lines of closure

CHRONIC RHEUMATIC HEART DISEASE

Deforming fibrotic valvular disease particularly
stenosis
Mitral involvement in 65-75% of cases
Combined aortic/ mitral in 20-25% of cases
Tricuspid and pulmonic valves are less frequently
affected

Cardinal changes of the valve:

1. Fibrous thickening of leaflets
2. Commisural fusion bridging fibrosis exhibiting
fish-mouth or buttonhole stenosis
3. Thickening and fusion of chordae