Rheumatic heart disease

Define rheumatic heart disease

Cardiac manifestation of Acute , immune mediated , inflammatory disease caused due to A beta
hemolytic streptococcal infection.

List the diagnostic JOHNS criteria for acute rheumatic fever.

joint pain (arthritis), Obvious (heart disease), Nodules, Erythema marginatum, and Sydenham
chorea

Describe the progression of rheumatic heart disease cardiac symptoms throughout the
disease’s natural history.

Patients first presents with acute rheumatic fever which causes inflammation across the heart,
including the pericardium and all layers of the muscle wall (epicardium, myocardium, and most
significantly endocardium).Endocardial inflammation manifests as valvular heart disease,
particularly causing mitral valve regurgitation. If not treated with antibiotics the heart dieases
takes chronic form .

With chronic inflammation, the mitral valve thickens and the chordae tendineae lengthen and
fuse. In addition to the mitral valve, the aortic valve is also frequently affected and in rare cases
the tricuspid as well. Left ventricular hypertrophy.The result of a thickened mitral valve is mitral
stenosis, or narrowing of the mitral valve, with the deformed valve leaflets forming a
characteristic “fish-mouth” appearance.Progression of mitral stenosis results in reduced cardiac
output and increased pulmonary congestion, manifesting as dyspnea and decreased exercise
tolerance. younger patients (<30 years) tend to have chronic mitral regurgitation, whereas older
patients progress to mitral stenosis or mixed mitral stenosis with regurgitation.

Describe the histopathologic features of acute rheumatic heart disease

Autoreactive CD4+ T cells arrive at the site, secreting inflammatory cytokines such as interferon
γ as they infiltrate into the endocardium. Over time, the T cells organize into tight structures
called Aschoff bodies, which are granulomatous structures that also contain macrophages and
plasma cells visible under hematoxylin and eosin stain.The macrophages found in Aschoff
bodies are unique and have the name Anitschkow cells.the macrophages fuse together to form
multinucleated giant cells, which in rheumatic heart disease are conveniently called Aschoff
cells