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Rheumatic Heart Disease
Transcript of Rheumatic Heart Disease
Lancefield Group A Bacterial Infection Multi Systemic Immune Mediated Non-Suppurative Inflammation CNS
HEART Motor Distirbances
SYDENHAN'S CHOREA (<5-30%)
"St. Vitus Dance"
a neurologic disorder with involuntary purposeless rapid, jerky movements of the face and arms. Inflammation of Synovial Joints
A temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
ARTHRALGIA Skin Lesions
ERYTHEMA MARGINATUM (<5%)
A type of skin rash which begins as pink macules that clear centrally, leaving a serpiginous, spreading edge. SUBCUTANEOUS NODULES (<5-10%)
Painless, small (0.5-2cm), mobile lumps beneath the skin overlying bony prominences which last for just a few days up to 3 weeks. 97% 3% Diagnosis:
No definitive test
Combination of TWO MAJOR manifestations or
ONE MAJOR & TWO MINOR manifestations: MINOR MANIFESTATION
1. Fever of 38.2–38.9 °C (101–102 °F)
2. Arthralgia: Joint pain without swelling
3. Raised ESR or CRP
5. ECG changes as a prolonged PR interval (Cannot be included if carditis is present as a major symptom)
6. Previous episode of rheumatic fever or inactive
heart disease MAJOR MANIFESTATION:
3. Erythema Marginatum
4. Subcutaneous Nodules
RHEUMATIC CARDITIS (50-60%)
Inflammation of the heart muscle (myocarditis) which can manifest as CHF with shortness of breath, pericarditis with a rub, or a new heart murmur. Cross-reactivity
due to Antigen Mimicry RHEUMATIC PERICARDITIS 1. RHEUMATIC PERICARDITIS
2. RHEUMATIC MYOCARDITIS
3. RHEUMATIC ENDOCARDITIS PANCARDITIS Inflammation of the entire heart. Acute Pericarditis/ Fibrinous Pericarditis/ Bread & Butter Pericarditis GABHS triggers Autoimmune response
Release of Inflammation Mediators in to surrounding tissue
INFLAMMATION caused by friction against Pericardial Layers
Vessel wall will LEAK fluids and proteins (FIBRINOGEN) from capillaries and DEPOSIT them to the pericardial sac.
Accumulation of fibrous exudates in the pericardial space
"Bread and Butter Appearance"
Contents of cavity autolyze and Progress to deposition of scar tissue &
gradually be absorbed into form adhesion bet. the layers of the
healthy tissues. serous pericardium.
"Chronic Adhesive Pericarditis"
** Generally, no long term sequelae . CARDINAL MANIFESTATIONS:
1. PERICARDIAL PAIN
2. PERICARDIAL RUB
3. ECG Changes - Elevated ST segment with NO significant changes in QRS complexes.
4. PULSUS PARADOXUS - Significant decrease in Systolic BP(10mm/Hg) & PR during inspiration. RECOMMENDED TESTS IN CASE OF POSSIBLE ACUTE RF WBC Count
Erythrocyte Sedimentaton Rate - Increased ESR indicates inflammation
C-Reactive Protein - Increased levels indicate inflamm. & Bact'l infection
Blood Cultures - if febrile.
Rep. BC if possible endocarditis.
ECG - Rep. in 2 wks and 2 mos if prolong PR interval or other rhythm abnormality.
Echocardiogram - Consider repeating after 1 month if negative.
CXR - If clinical or echocardiographic evidence of carditis.
Throat swab RHEUMATIC MYOCARDITIS GABHS triggers autoimmune reaction
Left ventricular myocardial hypertrophy;
(Hypokinetic & poorly contractile)
becomes loose & flabby
Formation of Immune mediate lesion
"Aschoff Bodies" in the myocardium - small pinhead immune mediated granuloma in connective tissues
. ***Acute stage: can lead to heart failure
. features and sudden death
If none, no long term (Chronic) sequelae Constitutes a foci of fibrinoid necrosis surrounded at first by lymphocytes and macrophages with an occasional plasma cell
Aschoff boddies are nodules formed by a reaction to inflammation with accompanying swelling and fragmentation of collagen fibers.
As they reach full maturity, plump modified histiocytes appear in the inflammatory infiltrate called ANITSCHKOW CELLS or ASCHOFF CELLS, they become more fibrous, and scar tissue is formed in the myocardium ASCHOFF BODY RHEUMATIC ENDOCARDITIS GABHS triggers Autoimmune reaction
Endocardium: valvular endocardium affected
Rheumatic valvulitis- inflammation of valves
Erosions on endothelial lining leaflets/ line of closures of the valve
Platelet formation & fibrin aggregation on the erosion
Platelets release Platelet Derived Growth Factor
Formation of Rheumatic Vegetations on the valve due to immume mediated injury
Edges of the valve/leaflets will fuse/ adhere
Valves become fibrotic and disorted IV. Infectious Disease of the Heart Group A Beta-Hemolytic
Streptococcus THANK YOU for listening! SEE YOU LATER! ;) RHEUMATIC HEART DISEASE