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Questions and Answers
What is the most important functional consequence of rheumatic heart disease?
What is the typical cause of acute rheumatic fever in children?
Which type of cells are primarily found in Aschoff bodies in acute rheumatic fever?
Which valve is predominantly involved in cases of rheumatic heart disease?
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What condition leads to right ventricular hypertrophy and failure in chronic rheumatic heart disease?
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What is the most common cardiac manifestation of rheumatic fever?
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Which clinical manifestation is typically seen in all age groups with acute rheumatic fever?
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Which of the following describes the lesions commonly found in chronic rheumatic heart disease?
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What is the main consequence of tight mitral stenosis in chronic rheumatic heart disease?
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What causes the formation of verrucae in rheumatic heart disease?
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Which term is used to describe the permanent thickening and retraction of valve cusps and leaflets in chronic rheumatic heart disease?
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What characterizes the organization of acute inflammation and subsequent scarring in chronic rheumatic heart disease?
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Which serological evidence is used to diagnose acute rheumatic fever?
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Which of the following is NOT one of the major Jones criteria for diagnosing acute rheumatic fever?
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Which organism is commonly associated with infective endocarditis in intravenous drug abusers?
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What is a consequence of embolus formation in infective endocarditis?
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What distinguishes subacute infective endocarditis from acute infective endocarditis?
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Which condition is characterized by involuntary, purposeless, rapid movements and may be seen in acute rheumatic fever?
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Study Notes
Acute Rheumatic Fever
- Diagnosis is based on serologic evidence of previous streptococcal infection and two or more of the Jones criteria:
- Carditis
- Migratory polyarthritis of large joints
- Subcutaneous nodules
- Erythematous annular rash (erythema marginatum) in the skin
- Sydenham chorea, a neurologic disorder
Infective Endocarditis
- An inflammatory condition affecting the endocardium, particularly on the heart valves
- Characterized by the development of large, friable, vegetations on the heart valves
- Vegetations can embolize and impact in distant vessels, causing infarction and spread of infection
- Two forms: acute and subacute
- Acute IE:
- Occurs on previous normal valves
- Destructive with fatal results
- Caused by Staphylococcus aureus, often in intravenous drug abusers
- Affects right-sided valves
- Subacute IE:
- Occurs on top of diseased valves (e.g. rheumatic heart disease or prosthetic)
- Caused by less virulent Streptococcus viridans
- Vegetations are smaller and firmer, with less common embolization
Morphology of Vegetations
- Acute IE: 1-2 cm in size
- Subacute IE: 0.5-1 cm in size
- Vegetations can be single or form a confluent valve-destroying mass
- Located on the upper aspect of tricuspid and mitral valves, and on the ventricular surface of pulmonary and aortic valves
Consequences of Infective Endocarditis
- Embolus formation: may travel along coronary artery or systemic circulation, leading to mycotic aneurysm
- Valve perforation and destruction, leading to heart failure
- Immune complex tissue injury, causing glomerulonephritis, vasculitis, or arthralgia
Pathology of Rheumatic Fever and Rheumatic Heart Disease
- Acute rheumatic fever: characterized by discrete inflammatory foci called Aschoff bodies
- Aschoff bodies: collections of lymphocytes, plasma cells, and Anitschkow cells with zones of fibrinoid necrosis
- Pancarditis: involvement of the pericardium, myocardium, and valves
- Chronic rheumatic heart disease: characterized by organization of acute inflammation and subsequent scarring
- Valve cusps and leaflets become permanently thickened and retracted
- Mitral valves exhibit leaflet thickening, commissural fusion, and shortening, and thickening and fusion of the chordae tendineae
Clinical Features of Rheumatic Fever and Rheumatic Heart Disease
- Acute rheumatic fever: occurs most often in children, with principal clinical manifestation of carditis
- Symptoms: fever, migratory polyarthritis, and carditis
- Symptoms begin 2-3 weeks after streptococcal infection
- Mitral stenosis: the most important functional consequence of rheumatic heart disease
- Long-standing passive venous congestion: leads to pulmonary vascular and parenchymal changes, and right ventricular hypertrophy and failure
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Description
Learn about the diagnosis of acute rheumatic fever based on serologic evidence of previous streptococcal infection and the Jones criteria. Understand the manifestations required for diagnosis: carditis, migratory polyarthritis, subcutaneous nodules, and erythematous annular rash.
