Rheumatic Heart Disease Overview
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Questions and Answers

What is the most common symptom of rheumatic fever?

  • Oedema
  • Chest discomfort
  • Dyspnea
  • Migratory polyarthritis (correct)

    • Which of the following is NOT a major criterion for diagnosing rheumatic fever?

  • Erythema marginatum skin rashes
  • Carditis
  • Joint swelling (correct)
  • Migratory polyarthritis of large joints

    • What cardiovascular complication may arise from myocarditis in rheumatic fever?

  • Coronary artery disease
  • Pericardial effusion
  • Functional mitral valve insufficiency (correct)
  • Aortic regurgitation

    • Which of the following is associated with the highest risk of complications in rheumatic fever?

    <p>Acute carditis</p> Signup and view all the answers

    What are the antibodies typically elevated in rheumatic fever?

    <p>Anti-streptolysin O and Anti-DNAse B</p> Signup and view all the answers

    Which symptom is categorized under minor criteria for rheumatic fever diagnosis?

    <p>Fever</p> Signup and view all the answers

    What is the long-term prognosis of rheumatic fever dependent on?

    <p>Number of valves involved</p> Signup and view all the answers

    What is pericardial friction rub a sign of in rheumatic fever?

    <p>Acute carditis</p> Signup and view all the answers

    What is a common clinical presentation associated with cardiac valvular vegetation?

    <p>Concentric left ventricular hypertrophy</p> Signup and view all the answers

    Which of the following risk factors is NOT associated with calcific aortic stenosis?

    <p>Low serum LDL</p> Signup and view all the answers

    What complication can result from embolic phenomena associated with infective endocarditis?

    <p>Cerebral infarction</p> Signup and view all the answers

    Which symptom is least likely to present in patients with infective endocarditis?

    <p>Peripheral edema</p> Signup and view all the answers

    What is a key feature of valvitis characterized by fibrinoid necrosis?

    <p>Regurgitation and stenosis</p> Signup and view all the answers

    What is a common initiating factor of calcific aortic stenosis?

    <p>Rheumatic heart disease</p> Signup and view all the answers

    Which of the following is NOT a common symptom of congestive heart failure due to valve problems?

    <p>Persistent cough</p> Signup and view all the answers

    What adverse effect can arise from stenosis of the aortic valve?

    <p>Increased left ventricular outflow pressure</p> Signup and view all the answers

    What causes the irregular thickening called Mac Callum plaque in the left atrium?

    <p>Regurgitant jets resulting from inflammation</p> Signup and view all the answers

    Which of the following is a common feature of chronic rheumatic heart disease affecting the mitral valve?

    <p>Thickening and fusion of the chordae tendineae</p> Signup and view all the answers

    What is the predominant functional consequence of rheumatic heart disease?

    <p>Valvular regurgitation and stenosis</p> Signup and view all the answers

    What is a potential consequence of left atrial dilation due to mitral stenosis?

    <p>Atrial fibrillation</p> Signup and view all the answers

    Which factor primarily contributes to pulmonary hypertension in patients with prolonged mitral stenosis?

    <p>Passive venous congestion</p> Signup and view all the answers

    What percentage of rheumatic heart disease cases involve the mitral valve?

    <p>70%</p> Signup and view all the answers

    What is the characteristic appearance of severe stenosis of the mitral valve described in the context?

    <p>Buttonhole or fish mouth stenosis</p> Signup and view all the answers

    Which clinical feature is NOT commonly associated with acute rheumatic fever?

    <p>Right ventricular failure</p> Signup and view all the answers

    What is a characteristic of nonbacterial thrombotic endocarditis (NBTE)?

    <p>Sterile vegetations loosely attached to valve leaflets</p> Signup and view all the answers

    Which of the following criteria is considered a major clinical criterion for diagnosing infectious endocarditis?

    <p>Positive blood culture</p> Signup and view all the answers

    What type of cancer is commonly associated with the development of nonbacterial thrombotic endocarditis?

    <p>Mucus secreting adenocarcinoma of the pancreas</p> Signup and view all the answers

    In the context of endocarditis, what do vegetations typically consist of in nonbacterial thrombotic endocarditis?

    <p>Sterile fibrin and platelets</p> Signup and view all the answers

    What is a significant morphologic feature of vegetations in endocarditis of systemic lupus erythematosus (SLE)?

    <p>Smooth or verrucous single vegetations</p> Signup and view all the answers

    What could cause emboli in nonbacterial thrombotic endocarditis?

    <p>Deposition of sterile vegetations</p> Signup and view all the answers

    In the context of infectious endocarditis, which of the following is a minor clinical criterion?

    <p>Presence of immunologic phenomena</p> Signup and view all the answers

    What happens to the vegetations in nonbacterial thrombotic endocarditis over time if the patient survives?

    <p>They undergo organization without causing damage</p> Signup and view all the answers

    What characteristic is typical of nodules associated with erythema marginatum?

    <p>They appear over the extensor surfaces of joints.</p> Signup and view all the answers

    How long does arthritis typically persist after the onset of symptoms?

    <p>2 – 6 days</p> Signup and view all the answers

    Which of the following best describes the lesions associated with arthritis?

    <p>They are migratory but not additive.</p> Signup and view all the answers

    In which age group is arthritis reported to be more severe and common?

    <p>Teenagers</p> Signup and view all the answers

    What is a potential consequence of chronic rheumatic heart disease?

    <p>Thromboembolism leading to stroke.</p> Signup and view all the answers

    What describes the infection classified as acute infective endocarditis?

    <p>Involves highly virulent organisms attacking a normal valve.</p> Signup and view all the answers

    What type of characteristics do the vegetations in infective endocarditis typically possess?

    <p>Bulky and friable.</p> Signup and view all the answers

    What is the anticipated clinical feature of chronic rheumatic heart disease?

    <p>Cardiac murmurs resulting from valvular damage.</p> Signup and view all the answers

    Study Notes

    Mitral Valve and Acute Rheumatic Fever

    • Vegetations form due to fibrin precipitation at eroded inflamed tissues, leading to minor disturbances in cardiac function.
    • Mac Callum plaque is characterized by irregular thickening of the left atrial endocardium due to regurgitant jets.
    • Chronic rheumatic heart disease involves fibrosis, scarring, thickened valve cusps, and retraction of leaflets.
    • Features of mitral valve changes include leaflet thickening, commissural fusion, and alterations in the chordae tendineae, resulting in "fish mouth" or "buttonhole" stenosis.
    • Valvular stenosis and regurgitation are the most significant outcomes, with mitral valve involvement in 70% of cases and combined mitral and aortic disease in 25%.
    • Left atrial dilation may lead to thrombus formation, while chronic lung congestion can cause pulmonary changes and right ventricular hypertrophy.

    Clinical Features of Acute Rheumatic Fever

    • Symptoms appear 2-3 weeks after streptococcal infection; common symptoms include fever, migratory polyarthritis, and carditis.
    • The disease predominantly affects children aged 5-15, with 20% of cases in adults.
    • Clinical manifestations include carditis with pericardial friction rubs, CHF, arrhythmias, chorea, subcutaneous nodules, and erythema marginatum.
    • Serologic tests (ASO, DNAse B) are positive, confirming recent streptococcal infection.

    Major Manifestations

    • Carditis: Pancarditis is the most serious complication, causing dyspnea, chest discomfort, and potential CHF from severe valve insufficiency.
    • Arthritis: Most common symptom, starting in lower limb large joints, progressing migratorily. Severity peaks in 12-24 hours, lasting 2-6 days, responsive to aspirin.
    • Erythema Marginatum and Subcutaneous Nodules: Lesions appear as raised, non-pruritic macules or papules; subcutaneous nodules are non-tender, usually found over extensor surfaces.

    Chronic Rheumatic Heart Disease

    • Develops years after acute rheumatic fever, resulting in valvular damage, murmurs, hypertrophy, dilation, and CHF.
    • Increased risk of infective endocarditis.

    Infective Endocarditis

    • A serious infection of heart valves characterized by friable vegetations formed by necrotic debris and organisms.
    • Classification:
      • Acute: High virulence organisms affecting normal valves, leading to rapid morbidity.
      • Subacute: Low virulence organisms targeting scarred valves.

    Diagnostic Criteria

    • Pathologic criteria involve demonstrating microorganisms via culture or histology of vegetations or emboli.
    • Major clinical criteria include positive blood cultures and echocardiographic findings; minor criteria involve predisposing factors and non-diagnostic echocardiographic findings.

    Nonbacterial Thrombotic Endocarditis (NBTE)

    • Characterized by sterile vegetations on valve leaflets, associated with hypercoagulable states, especially in cancer patients.
    • Vegetations are small, non-destructive, and adhere loosely; local effects are minor, but they can cause embolic events.

    Libman-Sacks Endocarditis

    • Associated with SLE, featuring mitral and aortic valve inflammation with sterile vegetations resulting from immune complexes.
    • Symptoms may include cardiac failure, embolic events, and manifesting SLE symptoms.

    Calcific Aortic Stenosis

    • A condition leading to stiff valve leaflets and obstructed left ventricular outflow, often secondary to rheumatic heart disease or congenital defects.
    • Risk factors include age, male gender, high LDL, smoking, hypertension, and diabetes.
    • Obstruction causes left ventricular hypertrophy, angina, palpitations, dyspnea, and potential heart failure if untreated.

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    Description

    This quiz delves into the implications of acute rheumatic fever on mitral valve function and the development of chronic rheumatic heart disease. It covers the pathological changes such as Mac Callum plaque and valve thickening, and their effects on cardiac performance. Test your understanding of these critical concepts in cardiac pathology.

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