Professional Documents
Culture Documents
Adobe Scan Sep 06 2022
Adobe Scan Sep 06 2022
Adobe Scan Sep 06 2022
HD
Fibrin-platelet thrombus
ANITSCHKOw CELL
Congestion Mitral
valve
Left
ventricle
Oedema
Mononuclear cells
similar but 2. PC
It may be mentioned here that histologically
3. C
clinically different subcutaneous lesions appear in rheumatoid
arthritis; they are larger, painful and tender and persist for 4. Su
Er
3. Previous history of RF
ly 4. Laboratory findings: elevated ESR, raised C-reactive protein,
es and leucocytosis
ral
5. ECGfinding of prolonged PR interval.
he
Suppòrtive evidence of greup A streptococcal.infection
in preceding 45 days
NON-RHEUMATIC ENDOCARDITIS
Inflammatory involvemen
NON-RHEUMATIC ENDOCARDITIS
Intlammatory involvement of the endocardial layer of the
heart is called endocarditis. Though in common usage, if
not specified endocarditis would mean inflammation of the
valvular endocardium, several
workers designate endocarditis
on the basis of anatomic area of
the involved endocardium such
as: valvular for
valvular
the lumina of cardiac endocardium, mural for inner lining of
of the chordae
chambers, chordal for the endocardium
of trabeculae
tendineae, trabecular for the endocardium
carneae, and papillary for the
covering the papillary muscles. Endocarditis endocardium
can be
grouped into non-infective and broadly
Most types of infective types (Table 16.6).
endocarditis are characterised
of
'vegetations'or by the presence
'verrucae' which have distinct
features.
ATYPICAL VERRUCOUS (LIBMAN-SACKS)
ENDOCARDITIS
Libman and Sacks, two
American physicians,
endocarditis in 1924 that is characterised described a form of
by sterile endocardial
Table 16.6 Classification of endocarditis.
A NON-INFECTIVE
1. Rheumatic
endocarditis (page 462)
2. Atypical verrucous (Libman-Sacks) endocarditis
3. Non-bacterial thrombotic (cachectic, marantic)
endocarditis
B. INFECTIVE
1. Bacterial endocarditis
2. Other infective types (tuberculous, syphilitic, fungal, viral,
rickettsial)
vegetations which are distinguishable from the vegetations of
eumatic
RHD and bacterial endocarditis.
ETIOPATHOGENESIS Atypical verrucous endocarditis is one of
ococcal, non- the manifestations of 'collagen diseases. Characteristic lesions
yaffecting the of Libman-Sacks endocarditis are seen in 50% cases of acute
subcutaneous systemic lupus erythematosus (SLE); other diseases
associated
with this form of endocarditis are systemic sclerosis, thrombotic
ofthe heart thrombocytopenic purpura (TTP) and other collagen diseases
referred to as
MORPHOLOGIC FEATURES Grossly, characteristic
ween the age the mitral and tricuspid
vegetations occur most frequently on
endocarditis are
valves. The vegetations of atypical verrucous
ipathogenesis and tend to
small (1 to 4 mm in diameter), granular, multiple
sceptibilityand occur on both surfaces of
affected valves, in the valve pockets
ventricular and atrial endocardium.
and on the adjoining
s the presence Ihe vegetations are sterile unless superimposed by bacterial
dies. endocarditis. Unlike vegetations ofRHD, the healed vegetations
y permanent of Libman-Sacks endocarditis do not produce any significant
or serofibrinous
e mitral (alone valvular deformity. Frequently, fibrinous
effusion is associated.
pericarditis with pericardial endocarditis
diac lesions in verrucae of Libman-Sacks
Microscopically, the
material with superimposed
iefly the joints, are composed of fibrinoid
fibrin and platelet thrombi. The endocardium underlying
gs.
eria based on the verrucae shows characteristic histological changes
fibrinoid necrosis, proliferation of capillaries
ajor and some which include
jor criteria are and infiltration by histiocytes, plasma cells, lymphocytes,
bodies
arginatum and neutrophils and the pathognomonic haematoxylin blood.
of LE cells of the
of Gross which are counterparts found in the interstitial S M
occur along
the line of closure of healed
of RHD. Organised and
fungal,viral, friable than the vegetations
vegetations appear as fibrous nodules. Normal age-related
appearance of tag-like appendage at the margin of the valve
cusps known as 'Lambl's excrescences' is an example of such
healed lesions.
Microscopically, the vegetations in NBTE are composed
of fibrin along with entangled RBCs, WBCs and platelets.
Vegetations in NBTE are sterile, bland and do not cause tissue
destruction. The underlying valve shows swollen collagen,
fibrinoid change and capillary proliferation but does not show
any inflanmmatory infiltrate.
INFECTIVE(BACTERIAL) ENDOCARDITIS
DEFINITION Infective or bacterial endocarditis (IE or BE) is
serious infection of the valvular and mural endocardium caused
by different forms of microorganisms and is characterised by
typical infected and friable vegetations..A few specific forms
of IE are named by the microbial etiologic agent causing them
e.g. tubercle bacilli, fungi etc. Depending upon the severity of
infection, BE is subdivided into 2 clinical forms:
1. Acute bacterial endocarditis (ABE) is fulminant and
destructive acute infection of the endocardium by highly virulent
bacteria in a previously normal heart and almost invariably runs
a rapidly fatal course in a period of 2-6 weeks.
SM
2. Location on valve Occur along the line of Occur on both surfaces of Occur along the line of SABE more often on
cusps or leaflets closure, atrial surface of valve leaflets or cusps, in closure diseased valves: ABE on
semilunar valves
3 Gross appearance
Smal, multiple, warty, Medium-sized, multiple, Small but larger than those Often large, grey-tawny to
grey brown, translucent, generally do not produce of rheumatic, single or greenish, iregular, single
firmly attached, generally significant valvular multiple, brownish, firm, or multiple, typically friable
produce permanent deformity but more friable than those
valvular deformity of rheumatic
i) Composed of i) Composed of i) Composed of outer
A. MicroscopPy i) Composed of fibrin with
fibrinoid material with degenerated valvular eosinophilic zone of fibrin
superimposed platelet
thrombi and no bacteria superimposed fibrin and tissue, fibrin platelets and platelets, covering
platelet thrombi and no thrombi and no bacteria. colonies of bacteria and
ii) Adjacent and
bacteria. ii) The underlying deeper zone of non-
underlying endocardium
ii) The underlying valve shows swelling of speciñc acute and chronic
shows oedema,
endocardium shows collagen, fibrinoid change, inflammatory cells.
proliferation of capillaries, proliferation of capillaries
fhbrinoid necrosis, ii) The underlying
mononuclear inflammatory
proliferation of capillaries but no significant endocardium may show
infiltrate and occasional
and acute and chronic inflammatory cell infiltrate. abscesses in ABE and
Aschoff bodies.
inflammatory infiltrate
including the haematoxylin
inflammatory granulation
tissue in the SABE.
bodies of Gross.
endocarditis; RHD, rheumatic heart disease).
subacute bacterial
a c u t e
hacterial endocarditis; SABE,
r