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What is the definition of Rheumatic Fever?
What is the definition of Rheumatic Fever?
An immune mediated multisystem disease affecting all layers of the heart and extra-cardiac sites.
What is the pathogenesis of Rheumatic Fever?
What is the pathogenesis of Rheumatic Fever?
During the chronic phase of Rheumatic Fever, which part of the heart is primarily affected? Valvular: Permanent valve deformity (stenosis, incompetence or both) Mural: ______________.
During the chronic phase of Rheumatic Fever, which part of the heart is primarily affected? Valvular: Permanent valve deformity (stenosis, incompetence or both) Mural: ______________.
McCallum patch (left atrium)
Rheumatic Chorea is a symptom of Rheumatic Fever that involves involuntary purposeless rapid movement.
Rheumatic Chorea is a symptom of Rheumatic Fever that involves involuntary purposeless rapid movement.
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What is the main cause of acute infective endocarditis?
What is the main cause of acute infective endocarditis?
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What are the causes of Hyperlipidemia?
What are the causes of Hyperlipidemia?
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What is the main factor contributing to the development of Atheromatous plaques?
What is the main factor contributing to the development of Atheromatous plaques?
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True aneurysms involve localized dilatation of the arterial wall, while false aneurysms are not part of the arterial wall but consist of fibrous tissue. One common cause of true aneurysms is __________.
True aneurysms involve localized dilatation of the arterial wall, while false aneurysms are not part of the arterial wall but consist of fibrous tissue. One common cause of true aneurysms is __________.
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Match the following types of pericarditis with their descriptions:
Match the following types of pericarditis with their descriptions:
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Atherosclerosis is common in essential hypertension.
Atherosclerosis is common in essential hypertension.
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Study Notes
Rheumatic Fever
- Definition: An immune-mediated multisystem disease affecting all layers of the heart and extra-cardiac sites.
- Occurs after group A beta-hemolytic streptococcal pharyngitis or tonsillitis, typically affecting children and young adults (5-15 years).
- Pathogenesis:
- Altered antigenicity: Streptococcal antigen binds to tissues, rendering them antigenic.
- Antigenic similarity (cross-reactivity): Antibodies against streptococcal antigens (M protein) cross-react with human tissue protein (antigens).
Phases of Rheumatic Fever
- Acute Phase:
- Heart: Resolves completely.
- Extra-cardiac tissues: Joint, skin, brain, etc.
- Chronic Phase:
- Heart only: Valve fibrosis.
Pathology of Rheumatic Fever
- All layers of the heart are affected (Pancarditis).
- Pericardium:
- Acute Phase: Fibrinous Pericarditis (Bread & Butter).
- Chronic Phase: Milk spots, Fibrous adhesions.
- Myocardium:
- Acute Phase: Aschoff bodies (pathognomonic of Rheumatic Fever).
- Chronic Phase: Fibrosis.
- Endocardium:
- Acute Phase: Vegetations (small thrombi on valves).
- Chronic Phase: Valvular deformity (stenosis, incompetence, or both).
Complications of Rheumatic Fever
- Predisposes to subacute infective endocarditis.
- Heart failure (valve lesions): Stenosis or incompetence or both.
- Severe rheumatic myocarditis.
- Pericardial fibrosis and adhesions.
- Extra-cardiac: Pathological changes in joints, brain, skin, and serofibrinous inflammation of pleura and peritoneum.
Endocarditis
- Definition: Inflammation of the valvular endocardium, with or without inflammation of the mural endocardium.
- Types:
- Non-infective Endocarditis (e.g., Rheumatic endocarditis).
- Infective Endocarditis:
- Acute Infective Endocarditis.
- Subacute Infective Endocarditis.
Acute Infective Endocarditis
- Aetiology and Pathogenesis:
- Highly virulent organisms (e.g., Staph. aureus, Strept. hemolyticus).
- Suppurative inflammation (pus) in the valve tissue.
- Pathologic Manifestations:
- Suppurative inflammation of the valve tissue.
- Vegetations (detachable, friable, and yellowish).
Subacute Infective Endocarditis
- Aetiology and Pathogenesis:
- Low virulent organisms (e.g., Strept. viridans).
- Inflammation of the valve tissue without pus.
- Pathologic Manifestations:
- Inflammation of the valve tissue.
- Vegetations (friable, grayish, and detachable).
Clinical Picture
- Acute Infective Endocarditis:
- Septicemia (fever, chills, and weakness).
- Embolic lesions (e.g., septic infarctions, pyemia, and pyemic abscesses).
- Subacute Infective Endocarditis:
- Moderate toxemia (fever, clubbing of fingers).
- Embolic lesions (e.g., infarction of kidney, brain, and spleen).
Ischaemic (Coronary) Heart Disease (IHD)
- Definition: Cardiac ischaemia results from an imbalance between myocardial oxygen supply and demand.
- Coronary Artery Disease Manifestations:
- Asymptomatic cases.
- Angina Pectoris.
- Myocardial Infarction.
- Classification of IHD:
- Chronic Ischaemia:
- Incomplete Coronary Insufficiency (Arteriosclerotic Heart Disease).
- Acute Ischaemia:
- Complete Coronary Occlusion.
- Chronic Ischaemia:
Myocardial Infarction
- Definition: Complete occlusion of a coronary artery.
- Causes: Complete Sudden Coronary Occlusion.
- Sites of Infarction:
- Left Ventricle (LV): Anterior, lateral, and posterior infarcts.
- Right Ventricle (RV): Rare, due to right coronary occlusion.
- Gross and Microscopic Picture:
- Recent Infarction: Swollen, pale, friable, and hyperemic margins.
- Healed Infarction: Thin, gray, fibrotic, and may dilate.
Atherosclerosis
- Definition: Patchy thickening of the intima as a result of lipid deposition, covered by a fibrous cap.
- Predisposing Risk Factors:
- Major Risk Factors:
- Hyperlipidemia (high level of plasma lipids).
- Hypertension.
- Diabetes Mellitus.
- Smoking.
- Constitutional Risk Factors:
- Age.
- Sex.
- Hereditary predisposition.
- Lack of exercise and stressful life.
- Diet (hyperlipaemia).
- Major Risk Factors:
Pathogenesis
- Chronic endothelial injury.
- Oxidation of soluble LDL.
- Migration and proliferation of smooth muscle cells.
- Proliferation of fibroblasts and deposition of collagen.
Pathological Features
- Distribution: Large arteries, small arteries, and medium-sized arteries.
- Gross and Microscopic Features:
- Fatty Streaks.
- Atheromatous Plaque (Atheroma).
- Atheromatous Ulcer.
Effects and Complications
- Ischaemia.
- Aneurysms.
- Thrombosis.
Hypertension
- Definition: Persistent elevation of resting blood pressure above 140/90.
- Etiologic Types:
- Primary (Essential) Hypertension.
- Secondary Hypertension.
Clinicopathologic Classification
- Primary Essential Hypertension:
- Benign Essential Hypertension.
- Malignant Essential Hypertension.
Pathology
- Blood Vessels: Arteriolosclerosis.
- Kidney: Benign Nephrosclerosis, Malignant Nephrosclerosis.
- Heart: Marked Concentric Hypertrophy of Left Ventricle.
- Retina: Thickening of Retinal Arterioles, Papilledema, Retinal Hemorrhage, and Exudate.
- Brain: Microaneurysms of Cerebral Arteries, Thrombosis, and Hemorrhage.
Congenital Heart Diseases
- Complications of Large ASD, VSD, and PDA:
- Left to Right Shunt.
- Right-Sided Hypertrophy and Dilatation.
- Reversal of Shunt (Eisenmenger's Syndrome).
True Aneurysms
- Definition: Localized dilatation of the arterial wall.
- Etiology:
- Hypertension.
- Weakening of the Media.
- Congenital.
- Atherosclerosis.
- Medionecrosis.
- Inflammatory.
Complications of True Aneurysm
- Pressure on the Surroundings.
- Thrombosis and Embolism.
- Rupture and Hemorrhage.
Types of True Aneurysm
- According to Shape:
- Saccular Aneurysm.
- Fusiform Aneurysm.
- According to Etiology:
- Congenital (Berry) Aneurysm.
- Atherosclerotic Aneurysm.
- Syphilitic Aneurysm.
- Mycotic Aneurysm.
- Dissecting Aneurysm.
Pericarditis
-
Definition: An inflammatory reaction involving the visceral and or the parietal layers.
-
Types:
- True Aneurysms.
- False Aneurysms.
- Infective Pericarditis.
- Non-Infective Pericarditis.### Pericarditis
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Serofibrinous pericarditis is a type of pericarditis that occurs in Rheumatic fever, also known as "Bread & Butter pericarditis"
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Fibrinous pericarditis is another type that occurs in Rheumatic fever, also known as "Bread & Butter pericarditis"
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Hemorrhagic pericarditis occurs in Trauma and Tumor
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Suppurative pericarditis occurs in Septicemia
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Tuberculous pericarditis is characterized by Granulomas with caseous necrosis
-
Constrictive pericarditis is characterized by Pericardial fibrosis and adhesions
Aortic Stenosis
Aetiology
- Chronic rheumatic valvulitis
- Healed subacute infective endocarditis
- Calcific aortic stenosis in atherosclerosis
Effects and Complications
- Left ventricle hypertrophy
- Hypertrophied myocardium tends to be ischemic due to diminished coronary flow, leading to angina pectoris
- Cardiac decompensation and congestive heart failure
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Description
Assess your knowledge of Rheumatic Fever, its pathogenesis, and its effects on the heart. This quiz covers the chronic phase of the disease, valvular and mural involvement, and related symptoms like Rheumatic Chorea.