Questions and Answers
What is the only cause of acquired mitral stenosis?
What is the characteristic delay in symptom onset after infection in acute rheumatic fever?
What percentage of infected patients develop rheumatic fever?
What is the pathogenesis of acute rheumatic fever?
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What is the term for the inflammatory disease that occurs following an episode of group A streptococcal pharyngitis?
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What are the manifestations of chronic rheumatic heart disease?
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What is the term for the criteria used to diagnose acute rheumatic fever?
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What is the term for the autoimmune reaction that occurs in acute rheumatic fever?
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What is the percentage of patients who die of acute RF?
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Which of the following is a minor criterion for RF?
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What is the term for the irregular thickenings that can occur in the left atrium due to subendocardial lesions and regurgitant jets?
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What is the term for the focal collections of fibrin-rich exudate that form on the valves in the acute stages of RF?
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What is the term for the histological finding in the myocardium of patients with RF?
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What is the complication that can occur in the pericardial sac in RF?
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What is the term for the inflammation of the pericardial sac in RF?
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What is the age group in which acute RF most commonly occurs?
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What is the typical age range for manifestations of calcific aortic stenosis in anatomically normal valves?
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Which of the following is a common feature of Marfan syndrome?
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What is the percentage of patients who die within 2 to 3 years in severe stenosis leading to CHF?
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What is the approximate ratio of female to male patients affected by primary myxomatous degeneration?
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What is the percentage of cases with concomitant tricuspid valve involvement in primary mitral disease?
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What is a potential complication of myxomatous degeneration?
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What is the typical presentation of asymptomatic patients with aortic stenosis?
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What is the percentage of cases that develop complications such as mitral regurgitation and CHF in myxomatous degeneration?
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What is the characteristic of mitral leaflets in mitral valve prolapse?
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What is the main difference between acute and subacute infective endocarditis?
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What is the most common cause of subacute infective endocarditis?
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What is the characteristic of vegetations in subacute infective endocarditis?
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What is the main complication of acute infective endocarditis?
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What increases the risk for infective endocarditis and adversely affects outcomes?
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What is the fatality rate associated with infections with aerobic gram-negative bacilli or fungi?
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What is the characteristic of the symptoms of subacute infective endocarditis?
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What is the term for the sterile vegetations that can be the source of systemic emboli, producing significant infarcts in the brain or elsewhere?
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What is the underlying condition that can lead to the formation of nonbacterial thrombotic endocarditis?
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What is the characteristic of the vegetations seen in Libman-Sacks endocarditis?
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What is the complication that can occur as a result of embolization of infected endocardial vegetations?
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What is the characteristic of the vegetations seen in acute rheumatic heart disease?
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What is the term for the deposition of immune complexes in glomeruli and small blood vessels?
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What is the characteristic of the vegetations seen in infective endocarditis?
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What is the consequence of fibrosis and calcification of cusps in the healing stages of the disease?
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Study Notes
Endocardial Diseases
- Acute Rheumatic Fever (ARF)
- Immunologically mediated, multisystem inflammatory disease
- Occurs 2-3 weeks after group A streptococcal pharyngitis or skin infection
- Autoimmune reaction: antibodies against streptococcal molecules cross-react with host myocardial antigens and valve components
- Genetic susceptibility: only 3% of infected patients develop rheumatic fever
- Clinical features: diagnosed using Jones criteria, including carditis, arthritis, chorea, dermatologic signs, and laboratory indices
- Valvular Diseases
- Mitral stenosis: most common valvular disease; RHD is the only cause of acquired mitral stenosis
- Calcific Aortic Stenosis
- Morphology: calcific nodules in the annulus
- Clinical features: asymptomatic, but may lead to CHF, arrhythmias, and sudden death
- Complications: mitral regurgitation, infective endocarditis, and stroke
- Infective Endocarditis (IE)
- Acute IE: destructive infections, frequently involving highly virulent organisms, attacking a previously normal valve/heart
- Subacute IE: infections by organisms of low virulence, affecting a previously abnormal valve/heart
- Bacteriology: Acute IE often caused by S. aureus; Subacute IE often caused by Streptococcus viridans
- Pathology: Acute IE characterized by large, friable vegetations; Subacute IE characterized by smaller, less friable vegetations
- Clinical features: Acute IE presents with rapid onset of symptoms, while Subacute IE presents with nonspecific symptoms
- Complications: destruction of valves, dissemination of bacteria, embolization, and immune complexes
Non-Infective Vegetations
- Nonbacterial Thrombotic Endocarditis (NBTE)
- Deposition of small, sterile thrombi on the valve surface
- Histologically, bland thrombi that are loosely attached to the underlying valve
- Can be a source of systemic (sterile) emboli
- Systemic Lupus Erythematosus (SLE)
- Libman-Sacks endocarditis: sterile vegetations on the valve surface, cords, or atrial/ventricular endocardium
- Immune complex deposition leads to inflammation, fibrinoid necrosis, and fibrosis
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Description
This quiz covers the causes, symptoms, and diagnosis of Acute Rheumatic Fever, an immunologically mediated disease that occurs after group A streptococcal infections. Learn about the autoimmune reaction, genetic susceptibility, and clinical features of this condition.
