Rheumatic Fever Overview
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Questions and Answers

What is the key pathology associated with rheumatic fever?

  • Myocardial hypertrophy
  • Aschoff bodies and Anitschkow cells (correct)
  • Atherosclerotic plaques
  • Calcific degeneration of valves

Which of the following is NOT a major criterion in the Jones criteria for rheumatic fever?

  • Migratory polyarthritis
  • Erythema marginatum
  • Subcutaneous nodules
  • Fever (correct)

What is the most common consequence of chronic rheumatic heart disease?

  • Aortic regurgitation
  • Mitral valve stenosis (correct)
  • Pulmonary valve stenosis
  • Right-sided heart failure

Which type of endocarditis is characterized by rapid progression and virulent bacteria?

<p>Acute bacterial endocarditis (B)</p> Signup and view all the answers

Which of the following valves is least likely to be involved in rheumatic heart disease?

<p>Pulmonary valve (C)</p> Signup and view all the answers

What type of fever is associated with rheumatic fever?

<p>Intermittent fever (C)</p> Signup and view all the answers

What characteristic finding is indicative of infective endocarditis?

<p>Bulky friable vegetations (C)</p> Signup and view all the answers

Which of the following conditions is associated with valvular insufficiency as a complication of rheumatic heart disease?

<p>Chronic aortic regurgitation (B)</p> Signup and view all the answers

What is a characteristic clinical feature of Sydenham chorea?

<p>Involuntary movements (A)</p> Signup and view all the answers

Which acute condition is a potential complication of infective endocarditis?

<p>Acute renal failure (C)</p> Signup and view all the answers

Which condition is characterized by small masses of fibrin and platelets on heart valves?

<p>Non-bacterial thrombotic endocarditis (D)</p> Signup and view all the answers

What type of cardiomyopathy is associated with progressive cardiac dilation and systolic dysfunction?

<p>Dilated cardiomyopathy (C)</p> Signup and view all the answers

Which of the following is a common cause of myocarditis?

<p>Viral infections (D)</p> Signup and view all the answers

Which condition features subendocardial scars due to ischemic necrosis?

<p>Dilated cardiomyopathy (D)</p> Signup and view all the answers

What is the primary mechanism leading to ischemic heart disease?

<p>Imbalance between oxygen demand and supply (A)</p> Signup and view all the answers

Which type of myocarditis is most commonly associated with viral infections?

<p>Idiopathic giant cell myocarditis (D)</p> Signup and view all the answers

What abnormality is commonly observed in restrictive cardiomyopathy?

<p>Decreased ventricular compliance (B)</p> Signup and view all the answers

What are Osler nodes indicative of?

<p>Bacterial endocarditis (A)</p> Signup and view all the answers

Which type of cardiomyopathy is characterized by thickened walls without chamber enlargement?

<p>Hypertrophic cardiomyopathy (D)</p> Signup and view all the answers

Which condition can cause Libman-Sacks endocarditis?

<p>Systemic lupus erythematosus (SLE) (C)</p> Signup and view all the answers

Which congenital heart defect is characterized by a left to right shunt at the atrial level and results in increased pulmonary blood flow?

<p>Patent ductus arteriosus (D)</p> Signup and view all the answers

In which type of congenital heart disease does the aorta narrow, commonly seen in males with Turner syndrome?

<p>Aortic coarctation (D)</p> Signup and view all the answers

What factor can delay the closure of a patent ductus arteriosus?

<p>Hypoxia (B)</p> Signup and view all the answers

Which condition is identified as the most common cyanotic congenital heart disease in children?

<p>Tetralogy of Fallot (A)</p> Signup and view all the answers

What describes constrictive pericarditis?

<p>Heart surrounded by fibrous scar tissue (C)</p> Signup and view all the answers

What is a common symptom seen in infants with preductal aortic coarctation?

<p>Cyanosis of the lower body (C)</p> Signup and view all the answers

Which condition involves the heart being unable to pump blood at a sufficient rate to meet the body's demands?

<p>Congestive heart failure (C)</p> Signup and view all the answers

What is the primary pathological feature of gaseous pericarditis?

<p>Tuberculous infection in the pericardial sac (C)</p> Signup and view all the answers

What complication often accompanies aortic coarctation in over half of affected individuals?

<p>Bicuspid aortic valve (B)</p> Signup and view all the answers

What characterizes the ventricular septal defect (VSD) seen in Tetralogy of Fallot?

<p>VSD with aortic override (B)</p> Signup and view all the answers

What is the most common congenital heart disease in children?

<p>Ventricular Septal Defect (D)</p> Signup and view all the answers

Which complication is NOT associated with myocardial infarction?

<p>Constipation (B)</p> Signup and view all the answers

What characterizes a left to right shunt in congenital heart disease?

<p>Volume overload in the right heart (A)</p> Signup and view all the answers

What is the relationship between aortic valve stenosis and sudden cardiac death?

<p>Contributes to arrhythmias and heart failure (C)</p> Signup and view all the answers

What is a common feature of subendocardial infarction?

<p>Least well pursued area (D)</p> Signup and view all the answers

Which of the following is NOT considered a risk factor for coronary artery disease?

<p>Regular exercise (B)</p> Signup and view all the answers

What defines a transmural infarction?

<p>Results in full-thickness damage to the myocardial wall (B)</p> Signup and view all the answers

What is a significant characteristic of cyanotic congenital heart disease?

<p>Causes secondary polycythemia (D)</p> Signup and view all the answers

Which of the following is a symptom of myocardial infarction?

<p>Nausea and vomiting (A)</p> Signup and view all the answers

What is one result of significant left ventricular hypertrophy?

<p>Increased risk of sudden cardiac death (C)</p> Signup and view all the answers

Flashcards

Thrombus

A blood clot that forms inside a blood vessel, obstructing the flow of blood.

Thromboembolism

A piece of a thrombus that breaks off and travels through the bloodstream, potentially blocking a smaller blood vessel.

Myocardial Infarction (MI)

A condition characterized by the death of heart muscle tissue due to a lack of oxygen.

Transmural Infarction

A type of myocardial infarction where the damage extends through the entire thickness of the heart wall.

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Subendocardial Infarction

A type of myocardial infarction limited to the inner layer of the heart wall.

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Stenosis

A narrowing or constriction of a blood vessel, often due to plaque buildup.

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Sudden Cardiac Death

A condition characterized by a sudden and unexpected death caused by a cardiac event.

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Dextrocardia

A congenital heart defect where the heart is located on the right side of the chest.

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Left-to-Right Shunts

A type of congenital heart defect where blood flows abnormally from the left side of the heart to the right.

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Ventricular Septal Defect (VSD)

A congenital heart defect characterized by a hole in the wall separating the two ventricles of the heart.

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Chronic Rheumatic Heart Disease

A common heart condition that develops after untreated or poorly treated acute rheumatic fever. It leads to permanent damage to the heart valves, primarily affecting the mitral valve. This damage can cause stenosis (narrowing) or insufficiency (leakage), leading to heart failure.

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Acute Rheumatic Fever

A condition triggered by an infection with Group A beta-hemolytic streptococcus (Strep throat). It leads to inflammation in various tissues, including heart, joints, and skin. This inflammation can cause long-term damage to the heart valves, leading to Chronic Rheumatic Heart Disease.

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Mitral Stenosis

A common consequence of Chronic Rheumatic Heart Disease. It occurs when the mitral valve narrows, restricting blood flow from the left atrium to the left ventricle. This can lead to increased pressure in the left atrium, leading to atrial fibrillation, heart failure, and other complications.

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Valvular Vegetations

Abnormal growths that form on the heart valves, usually in the context of bacterial endocarditis. They are made up of bacteria, blood clots, and inflammatory cells. These growths can damage the valves, causing leakage or narrowing.

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Infective Endocarditis

An infection that occurs when bacteria enter the bloodstream and colonize the heart valves or the inner lining of the heart. This is a serious condition that can cause permanent damage to the heart valves and can lead to heart failure.

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Subacute Bacterial Endocarditis

A type of endocarditis that usually affects previously damaged heart valves. It develops slowly and is caused by less aggressive bacteria. This type of endocarditis can lead to heart failure.

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Acute Bacterial Endocarditis

A type of endocarditis that affects healthy heart valves. It is caused by highly aggressive bacteria and develops rapidly. If untreated, it can lead to severe heart failure and even death.

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Jones Criteria

A complex of criteria used to diagnose Rheumatic Fever. These criteria include major manifestations like arthritis, carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea, and minor manifestations like fever, joint pain, elevated ESR, and presence of Strep infection.

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Aschoff Bodies

Small, microscopic nodules found in the myocardium (heart muscle) of patients with Rheumatic Fever. These nodules are characteristic of Rheumatic Fever and represent an inflammatory response to the Streptococcus infection.

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MacCallum Plaques

Large, irregular growths on the surface of the heart valves, specifically seen in patients with Rheumatic Fever. These growths are associated with valvular inflammation and damage.

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Non-bacterial thrombotic endocarditis

A type of endocarditis characterized by small, loose vegetations on heart valves, caused by fibrin, platelets, and bacteria. These vegetations are relatively smaller than those seen in bacterial endocarditis.

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Libman-Sacks Endocarditis

A type of endocarditis associated with systemic lupus erythematosus (SLE), characterized by small vegetations on both sides of heart valves, caused by circulating antiphospholipid antibodies. Microscopically, vasculitis is present, leading to valve deformation due to fibrosis.

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Carcinoid Heart Disease

A condition affecting the endocardium and heart valves, often on the right side of the heart, characterized by activation of serotonin and bradykinin in the lungs via monoamine oxidase (MAO). It presents with a constellation of symptoms including episodic flushing, cramps, nausea, vomiting, diarrhea, and a fibrous, abnormal thickening of the endocardium.

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Myocarditis

Inflammation of the myocardium, the muscular layer of the heart, can be a component of systemic diseases or an isolated disorder. Causes include infection, immune reactions, unknown factors, sarcoidosis, and anti-cell myocardial antibodies.

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Fiedler's myocarditis

A benign, self-limited form of myocarditis, typically viral, that features pale or yellowish spots on the myocardium. Importantly, healing occurs without scar formation, which can lead to dilated cardiomyopathy.

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Idiopathic Giant Cell myocarditis

A rare type of myocarditis characterized by a broad spectrum of clinical presentations, ranging from asymptomatic recovery without sequelae to heart failure or sudden cardiac death. It can mimic myocardial infarction (MI), potentially progressing to dilated cardiomyopathy.

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Cardiomyopathy

A condition resulting from primary abnormalities within the myocardium, often of idiopathic origin. Classified into three main types: dilated (90%), hypertrophic, and restrictive.

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Dilated Cardiomyopathy

The most common type of cardiomyopathy, characterized by progressive cardiac hypertrophy and dilation, leading to contractile dysfunction. Causes include myocarditis, viral infections, toxic effects of alcohol, idiopathic factors, pregnancy-associated conditions, and genetic or familial predisposition.

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Restrictive Cardiomyopathy

A type of cardiomyopathy characterized by impaired ventricular compliance, leading to reduced ventricular filling during diastole. This results in normal-sized ventricles with non-dilated cavities. Causes include idiopathic factors, radiation fibrosis, amyloidosis, sarcoidosis, and metastatic tumors.

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Ischemic Heart Disease

An imbalance between the demand for and supply of oxygen to the heart muscle, often related to acute changes in atheroma. It rarely results from vascular spasm. Clinically, it manifests as myocardial infarction, angina pectoris, IHD, and sudden cardiac death.

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Patent Foramen Ovale (PFO)

A congenital heart defect where blood flows from the left atrium to the right atrium, bypassing the lungs. This leads to increased blood flow to the lungs.

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Patent Ductus Arteriosus (PDA)

A congenital heart defect where a duct between the aorta and pulmonary artery remains open after birth, allowing blood to flow from the aorta to the pulmonary artery. This can cause increased blood flow to the lungs.

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Aortic Coarctation

A rare type of congenital heart disease where the aorta is narrowed, causing restricted blood flow to the body.

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Tetralogy of Fallot

The most common cyanotic congenital heart disease, characterized by a combination of four defects: ventricular septal defect (VSD), pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta.

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Constrictive Pericarditis

A thickened and scarred pericardium, restricting the heart's ability to expand and pump efficiently.

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Caseous Pericarditis

A type of pericarditis where the pericardium becomes thick and inflamed, often due to tuberculosis infection.

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Adhesive Mediastinitis

An inflammation of the pericardium that can occur after surgery or radiation therapy.

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Congestive Heart Failure

A condition where the heart is unable to pump blood effectively to meet the body's needs.

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Right-to-Left Shunt

A right-to-left shunt in the heart where oxygen-poor blood from the right side of the heart enters the systemic circulation, causing early cyanosis.

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Study Notes

Rheumatic Fever

  • Systemic, acute, often recurrent
  • Any age, first attack 5-15 years
  • Non-suppurative
  • Related to prior group A β-hemolytic streptococci
  • Streptococcal antigens cross-react with human antigens
  • Heart valve glycoproteins, myocardial smooth muscle, sarcolemma, tissue glycoproteins in joints
  • Jones criteria: 2 major or 1 major, 2 minor needed
  • Major Criteria*:
  • Migratory polyarthritis in large joints
  • Carditis
  • Subcutaneous nodules
  • Sydenham chorea
  • Erythema marginatum
  • Minor Criteria*:
  • Prior strep infection
  • Fever
  • Elevated strep antigens
  • Arthralgia
  • Elevated acute phase reactants

Key Pathology

  • Aschoff bodies, Anitschkow cells

Macroscopic Findings

  • Diffuse inflammation, pancarditis
  • Fibrinous/serofibrinous pericarditis

Chronic Rheumatic Heart Disease

  • Deforming fibrotic valvular disease
  • Mitral valve stenosis
  • Permanent dysfunction
  • Leaflet thickening
  • Commissural fusion
  • Shortening, thickening, and fusion of chordae tendineae
  • Fish mouth/buttonhole stenosis
  • MacCallum plaques
  • Verrucae

Chronic Rheumatic Heart Disease

  • Deforming fibrotic valvular disease
  • Mitral valve stenosis
  • Permanent dysfunction
  • Leaflet thickening
  • Commissural fusion
  • Shortening, thickening, and fusion of chordae tendineae
  • Fish mouth/buttonhole stenosis
  • MacCallum plaques
  • Verrucae

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Description

This quiz explores the key concepts of Rheumatic Fever, including its clinical criteria, pathology, and chronic effects on the heart. Learn about the major and minor criteria established by the Jones criteria and the macroscopic findings associated with the disease. Ideal for medical students and professionals looking to test their knowledge on this condition.

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