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5.heart pathology; valvular heart diseases
1. 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
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Dr. Krishna Tadepalli, MD, www.mletips.com
2. 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%)
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Dr. Krishna Tadepalli, MD, www.mletips.com
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
3
Dr. Krishna Tadepalli, MD, www.mletips.com
4. 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,
chorea
Valvular disease ( MS, MR)
Aschoff bodies
Pathognomonic
Not seen
Diagnosis
John’s criteria
Not applicable
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Dr. Krishna Tadepalli, MD, www.mletips.com
6. 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,
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Dr. Krishna Tadepalli, MD, www.mletips.com
7. The Jones Criteria for Rheumatic
Fever, Updated 1992
Major Criteria
Minor Criteria
Carditis
Clinical
Migratory polyarthritis
Fever
Sydenham's chorea
Arthralgia
Subcutaneous nodules
Erythema marginatum
Laboratory
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
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streptococcal antibody test)
Dr. Krishna Tadepalli, MD, www.mletips.com