Rheumatic Disease/ Valvular Disease- Leah (6) * Flashcards
(44 cards)
Describe the conditions under which rheumatic disease occurs (cause? time of onset?)
How common is it?
How often is it fatal?
-GAS strep pharyngeal infection (NOT other locations only strep throat) -onset: 10 days --> 6 weeks AFTER pharyngitis -occurs in 3% of GAS pharyngitis cases -1 % of cases are fatal
How is rheumatic disease treated?
- PREVENTED by treating pharyngitis with Abx
* Unlike post strep glomerulonephritis *
What are Aschoff bodies?
What three cell types do they contain?
Where are they found?
- Pathonogmonic histo finding for acute rheumatic disease
- T lymphs, Plasma cells, Plump MQs/ Antischow cells
- NOTE: macs/anitschows may fuse to become Giants/aschoffs
- Also note: a bunch of fragmented collagen may also be in these bodies.
- Often located on the MYOCARDIUM of an acutely rheumatic heart (but can be found in all layers)
Describe the anitschow cell (cell type + 2 characteristics):
What can they become?
- Caterpillar like MQ (long and thin)
- Lots of cytoplasm
- wavy slender nucleus (ribbon-like)
- May become giant cell
Describe histologic findings in the 4 layers of the heart during acute rheumatic disease:
- pericardium: fibrin exudate –> friction rub
- myocardium: perivascular Aschoff bodies
- Subendocardium: fibrosis, especially in left atrium
- Endocardium: fibrinoid necrosis + valve vegetations
What is the name for fibrosis of the left atrial Subendocardium in acute rheumatic disease?
MacCallum plaques
Describe the immunopathology of rheumatic disease
CD4+ cells for GAS “M protein” cross react with host tissue
- Makes patient vulnerable to current AND future pharyngitis infections + second acute rheumatic disease
- Effects will be cumulative.
How is rheumatic fever symptomatically diagnosed (major + minor criteria)?
Must have:
- Evidence of preceding GAS pharyngitis
- Two major OR two minor + 1 major criteria.
Major: JONES
- large Joint arthritis (migratory)
- carditis (the “O looks like a heart?) (listen for friction rub)
- Nodules (SubQ)
- Erythema marginatum (trunk, limbs)
- Sydenham’s chorea
Minor:
- fever
- acute phase reactant proteins
- general arthralgias
Labs that may help with the diagnosis of rheumatic fever (2):
- Streptolysin O
- DNAaseB Abs
- verify recent strep infection
- ^^^Acute phase reactants is a minor criteria for diagnosis
Three possible cardiac outcomes of chronic rheumatic disease?
Which is most common?
1 mitral stenosis
Also:
-fibrotic heart disease
-fatal dysfunction
(Disease course is highly variable)
What contributes to mitral stenosis in rheumatic fever? (3)
- leaflet thickening
- commisural fusion
- thickening/fusion of chordae tendinae
What percentage of rheumatic disease cases cause mitral stenosis?
65-70% of cases cause ONLY mitral stenosis
25% cause mitral AND aortic stenosis
Total ~ 95% of cases will involve the mitral valve
Six effects of mitral stenosis (and therefore the sequelae of most rheumatic disease cases) on the heart
- Left atrial dilation (due to backup of blood)
- Mural thrombus in left atrium (due to stasis in atrium)
- Pulm congestion –> Right ventricular hypertrophy (backward effects)
- Arrythmia due to left atrial dilation (can cause AFIB)
- Murmurs
- Hypertrophic heart failure long term
General definition of rheumatic disease:
- IMMUNE mediate disease of multiple systems
- Post group A strep infection
- Can be acute or chronically effecting heart valves
In general, what are the physiologic effects of stenosis (2)?
- pressure overload
- impedes forward flow
In general, what are the physiologic effects of regurgitation (2)?
- volume overload
- allows backward flow
What is “functional” valve insufficiency?
- regurgitation due to malfunction of structures supporting valves
(i. e. dilated chamber or annulus)
What are the most common causes of?
- mitral stenosis-
- mitral regurgitation-
- aortic stenosis-
- aortic regurgitation-
- mitral stenosis- rheumatic disease
- mitral regurgitation- mitral valve prolapse
- aortic stenosis- calcification
- aortic regurgitation- aortic dilation (ascending)
What is the most common valve disease in the world?
In the industrialized world?
worldwide- aortic stenosis
industrialized world- mitral valve prolapse
Causes of aortic stenosis? Which is most common?
1- calcification (presents at 60-80 yoa)
- congenital bicuspid valve (calcifies @ 50-70 yoa)
- rhuematic disease (acquired bicuspid valve possible)
How is a bicuspid aortic valve acquired?
commisural fusion in rheumatic disease (fish mouth)
How to differentiate senile aortic stenosis from rheumatic aortic stenosis? (2)
If rheumatic:
- mitral valve involvement
- commisural fusion
Sequelae of aortic stenosis
- increased pressure –> LVH
- Syncope, Angina, and/ or CHF (Dyspnea)
“Aortic Stenosis makes you “SAD”
Death rates for aortic stenosis
50% within 5 years of angina onset
50% within 2 years of CHF onset
