Pathophysiology of Rheumatic Heart Disease

Predisposing Factors: Precipitating Factors:

Etiology
Family history of RHD Environmental factors
Group A Beta-
Age (5-15 years old) Low Socioeconomic Status
Hemolytic
Past history of Rheumatic Geographical Location
Streptococcus
Fever

Bacteria invades the upper

respiratory tract (tonsils and
pharynx)

Inflammation of affected tissues

Macrophages attack bacteria, and then

present its antigen to the immune system

Production of antibodies (IgG & IgM)

Activation of complement system, opsonic

phagocytosis, production of NK cells to
combat pathogens

Immune system cross-reacts and causes

tissue injury to normal body cells due to
Molecular Mimicry

Multi-systemic effects

A
 A

Immune system
cross-reacts with
myocardial tissue

Endocarditis Pericarditis Myocarditis

Mechanical injury Increased Myocardium loses

caused by permeability of its contractility
inflammation and capillaries
tachycardia
Decreased Cardiac
Shifting of plasma
Output
Erosion of mitral and fibrinogen to
valve leaflets pericardial sac
Decreased Perfusion

Aggregation of Swelling of
platelets and fibrin pericardium
Sympathetic
along the valve Response: Increased
Heart Rate, Increased
C Contractility,
Fomation of vegetations along Vasoconstriction
the edges of the leaflets

D
B
 B C D

Vegetations heal Increased Residual Volume of LV

with fibrosis and Pericardial Increased
calcifications layers rub pressure on
Increased Pressure in LV
each other parietal
Permanent pericardium
Dilatation/Hypertrophy of LV
distortions of the
Pericardial
leaflets of the valve
friction rub on Compression
auscultation Increased Volume in LA
of nerves

Mitral Stenosis Mitral Regurgitation

Increased Volume in Vein
Sharp, stabbing
localized pain
Increased Pressure in
capillary bed edema, dyspnea

Pulmonary
Hypertension

Increased Pressures in the RV and RA

Dilatation/Hypertrophy of RV

Cor Pulmonale/Congestive heart

Failure