Heart -Pathology
Valvular Heart Diseases
Types
Stenosis= failure to open completely
Regurgitation= failure to close completely
Causes
congenital or acquired
Acquired = MC ( mostly affect left side)
Clinically
abnormalities of flow abnormal heart sounds Murmurs
MC Valvular problem in world AS
MC Valvular heart problem in industrialized world
MVP
Mitral Annular Calcification = Female >60 yr., lead to MS,
MR, Thrombo – Embolism
Heart -Pathology
Valvular Heart Diseases
MVP
Myxomatous degeneration due
to Deposition of proteoglycans
Seen in Marfan syndrome
Diagnosis
systolic click followed by
systolic murmur
Complications ( MR, IE,
Stroke) seen in (3%)
Heart -Pathology
Valvular Heart Diseases
Rheumatic Heart Disease (RHD)
Rheumatic Fever (RF)
Acute, immune-mediated multi-system disease
occurring a few weeks after an episode of
group A streptococcal pharyngitis
MC in children 5-15 yrs old
RF RHD (deforming fibrotic valvular disease)
After first attack - susceptibility to reactivation of RF
with subsequent pharyngitis
Heart -Pathology
Rheumatic Heart Diseases
Types
Feature Rheumatic Fever (RF) Rheumatic Heart Disease
(RHD
Onset Acute Chronic
Age Children ( 5 – 15 yrs) Adults
Pathology Carditis, arthritis, Valvular disease ( MS, MR)
chorea
Aschoff bodies Pathognomonic Not seen
Diagnosis John’s criteria Not applicable
Heart -Pathology
Rheumatic Heart Diseases
Heart -Pathology
Rheumatic Heart Diseases
Etiopathogenesis
Hypersensitivity ( immunological) reaction to “M” protein of
Group A streptococci
RF develops weeks after Streptococcal pharyngitis
Antibodies against “M” protein cross react with
Cardiolipins of Heart Rheumatic disease
GBM of Kidney Post – streptococcal Glomerulonephritis
(PIGN/PSGN/ Acute nephritic syndrome)
Morphology
Acute (RF) Aschoff bodies (Myxoid degerantion with
surrounding inflammation), Pancarditis, Anitschkow cells
(macrophages with caterpillar like nucleus)
Chronic (RHD) fibrosis of valve cusps, fusion of commisures,
The Jones Criteria for Rheumatic
Fever, Updated 1992
Major Criteria Minor Criteria
Carditis Clinical
Migratory polyarthritis Fever
Sydenham's chorea Arthralgia
Subcutaneous nodules Laboratory
Erythema marginatum Elevated acute phase reactants
Prolonged PR interval
plus
Supporting evidence of a recent group A streptococcal infection (e.g., positive
throat culture or rapid antigen detection test; and/ or elevated or increasing
streptococcal antibody test)
Heart -Pathology
Rheumatic Heart Diseases
? cells
pathognomonic
Heart -Pathology
Rheumatic Heart Diseases
Commissural fusion