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Lecturer
Rheumatic Heart Disease Department of pathology
+919738286092
Pathogenesis:-
Autoimmune mechanism has been proposed
1(a).Rheumatic Valvulitis
Grossly Microscopically
Acute Acute
1.Thickening and loss of translucency 1.Edema
of the valve leaflets 2.Cellular infiltration
2.Gray brown, watery vegetations 3.Vegetations of fibrin
Chronic
1.Permanent deformity of on one or Chronic
more valves (mitral or aortic) 1.Thicken by fibrous tissue with
2.”Fish mouth” or “button hole” hyalinization (Calcification rarely)
3.Thickening, shortening and fusion of 2.Thickened blood vessels with
chordae tendinae narrowed lumina
2. Rheumatic Myocarditis
Grossly Microscopically
Acute Acute
Left ventricular myocardium soft and Aschoff nodules are scattered (inter
flabby venticular septum, left ventricle and left
atrium)
Intermediate stage Intermediate stage
Interstitial tissue of the myocardium shows In Aschoff:- Granuloma with central
small foci of necrosis fibrinoid necrosis and surrounded by
palisade of anitschkow cells
Late stage Late stage
Foci of aschoff bodies are visible Aschoffs bodies are replaced by small
fibrous scars
3. Rheumatic Pericarditis
Grossly Microscopically
chronic chronic
a). Deposition of fibrous exudates (Loss of a). Fibrosis aschoff bodies on the surfaces
normal shiny pericardial surface)
b). Accumulation of fibrous exudates in the
pericardial sac b). Infiltrated sub serosal connective tissue
(“Bread and butter” appearance)
c). Chronic adhesive pericarditis
Extracardiac Lesions
Polyarthritis
Subcutaneous nodules
Erythema marginatum
Rheumatic arteritis
Chorea minor
Rheumatic pneumonitis pleuritis
ANTOBODIES AGAINST
Diagnosing criteria
Diagnosed by Jones Criteria:
Either two of the major manifestations or one major and two minor manifestations.
JONES CRITERIA
1.Carditis 1.Fever
2.Poly arthritis 2.Arthralgia
3.Chorea:- a neurologic disorder with 3.Previous History of RF
involuntary purposeless rapid movements. 4.Increased
4.Erythema Marginatum a. E.S.R
5.Subcutaneous Nodules b. C-Reactive Protein
c. Leucocytosis
5.Prolonged PR interval
Complications
*anitschkow cell: are the cardiac histocytes present in small numbers in the normal heart.
The nuclei are vesicular and contain prominent central chromatin mass which in
longitudinal section appears “serrated” or “caterpillar” like and in cross section it look
like an “owl’s eye”
**Aschoff bodies: are spheroidal or fusiform distinct microscopic structures occurring in
the intestitium of the heart in RHD.(it contains almost four anitschkow cells )