RHEUMATISM.

ENDOCARDITIS
VALVE DISEASES
AND
MALFORMATIONS

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RHEUMATIC DISEASES

RHEUMATIC DISEASES ARE

IMMUNE DISEASES
WITH SYSTEMIC
DISORGANIZATION OF
THE CONNECTIVE TISSUE

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 CLASSIFICATION

1 Rheumatism
2 Systemic lupus erythematosus
3 Periarteritis nodosa
4 Rheumatoid arthritis
5 Systemic scleroderma
6 Dermatomyositis

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 RHEUMATISM

Rheumatism is autoimmune
disease with systemic
disorganization of the connective
tissue with predominance
destruction of the cardiovascular
system.

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 RHEUMATISM

Clinical morphologic forms are as

follow:
1Cardiovascular
2 Arthritic
3 Cerebral
4 Nodosal

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 RHEUMATISM
Etiology
Rheumatic fever develops in about
3% of patients with β-hemolytic
group A streptococcal pharyngitis.

Rheumatic fever is a
hypersensitivity reaction induced
by group A streptococci

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 RHEUMATISM

Pathogenesis

Antibodies directed against the M

proteins of certain strains of
streptococci cross-react with
tissue contained glycoproteins in
the heart, the joints, and other
organs.
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 RHEUMATISM

Rheumatic fever results from an

immune response against the
offending bacteria.

The streptococcal infection evokes an

autoimmune response against self-
antigens.

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 RHEUMATISM

Stages of connective tissue

disorganization are as follow:

1 mucoid swelling
2 fibrinoid swelling
3 fibrinoid necrosis
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 RHEUMATISM

Rheumatism includes pathological

processes :
1inflammation
2 dystrophy
3 necrosis
4 sclerosis
5 thrombosis

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 RHEUMATISM

2 STROMAL
VASCULAR
dystrophy

MUCOID SWELLING
Crimson color
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 RHEUMATISM
Electronic microscopic picture

1 fibrinoid necrosis of
Connective tissue
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 RHEUMATISM

The course of Rheumatism

may be

Acute
Subacute
Lingering
Latent
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 RHEUMATISM
Active phase of Rheumatism is
termed Rheumatic fever
Rheumatic fever is an acute immune
mediated multisystem inflammatory
disease,
Predominantly affecting
cardiovascular system, characterized
by recurrent episodes of acute phase
alternating with remission
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 RHEUMATISM
There are rheumatic
Pericarditis,
Myocarditis,
Endocarditis,
Carditis (Endocarditis, Myocarditis
together),
Pancarditis (Endocarditis,
Myocarditis, and Pericarditis
together), 15
 RHEUMATISM

Rheumatic pericarditis may be

Serous

Fibrinous ( “Hair heart”)

Serous-fibrinous

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RHEUMATIC PERICARDITIS
SCHEME

NORMAL FIBRINOUS
PERICARDIAL PERICARDITIS
CAVITY
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RHEUMATIC PERICARDITIS
NORMAL SYNECHII HAIR HEART

semi-transparent
smooth

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Results of fibrinous pericarditis
Development of connective
tissue

1 synechii

2 obliteration of the pericardial

cavity by connective tissue and

3 Its calcification (“Shell heart”)

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RHEUMATIC MYOCARDITIS

1 PRODUCTIVE
GRANULOMATOUS

2 EXUDATIVE DIFFUSE STROMAL

3 EXUDATIVE LOCAL STROMAL

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 RHEUMATIC MYOCARDITIS
PRODUCTIVE GRANULOMATOUS
INFLAMMATION

ASCHOFF-TALALAEV’S
BODY

THERE ARE A LOT OF

BODIES AS
RHEUMATIC
1 GRANULOMA
GRANULOMAS 2 MYOCARDIUM

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 LOCATION OF RHEUMATIC
GRANULOMAS
FIRST OF ALL THEIR LOCATION
IS NEAR VESSELS IN THE
MYOCARDIAL STROMA

IN THE LEFT AURICULAR REGION

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RHEUMATIC MYOCARDITIS

Result of rheumatic myocarditis is in

cardiosclerosis

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RHEUMATIC ENDOCARDITIS

CLASSIFICATION ACCORDING TO
LOCATION ARE AS FOLLOW:

1CHORDAL
2 MURAL
3 VALVULAR

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RHEUMATIC ENDOCARDITIS

CLASSIFICATION ACCORDING TO
MORPHOLOGIC TYPES ARE
AS FOLLOW:
1 VALVULITIS
2 VERRUCOUS ENDOCARDITIS
3 RECCURENT VERRUCOUS
4 FIBROPLASTIC

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VERRUCOUS ENDOCARDITIS
MITRAL VALVE

CHORDAES
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 RECCURENT VERRUCOUS
ENDOCARDITIS

MITRAL VALVE

VERRICES

LEFT VENTRICLE

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 RECCURENT VERRUCOUS
ENDOCARDITIS
MICROSCOPIC
PICTURE:
1 FIBRINOID
NECROSIS
2 THROMBUS
3 INFLAMMATION

RESULT IS IN SCLEROSIS AND HYALINOSIS

WITH DEFORMATION OF THE VALVE AND
FORMATION OF VALVE DISEASE
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 ENDOCARDITIS

Endocarditis is inflammation
of endocardium as inner coat
of the heart with various types
of etiology

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 ENDOCARDITIS

There are Endocarditis as follow:

1 Rheumatic endocarditis
2 Bacterial or septic endocarditis
3 Libman-Sacks endocarditis
4 Non infective endocarditis
5 Lefler’s endocarditis

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 Bacterial or septic
ENDOCARDITIS
Diseases are sepsis, scarlet fever,
diphtheria, pneumonia, typhoid fever

Locations are valvular and rarely

parietal endocardium.

It may be acute, subacute, lingering

bacterial or septic endocarditis
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 Bacterial or septic
ENDOCARDITIS
1 Acute bacterial endocarditis
occurs on intact (unaltered) valve

2 polypous-ulcerous endocarditis

3 the most common disease is

termed septicopyemia

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 Acute bacterial endocarditis
There are massive
thrombotic imposition
like polyps.
Under them we can see
Ulceration of the leaflet.
Tchernogubov’s Disease is
named polypous-
ulcerous endocarditis of
Aortic valve disease
intact valve as primary
endocarditis.
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Acute bacterial endocarditis

thrombus

Colonies of
microorganisms

ulcerous

Result is in valve disease with thrombus

organization, contracted leaflets and
valve deformation
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 Libman-Sacks endocarditis
Lupus erythematosus
Mitral valve
The small vegetation
attached to the margin
of the valve leaflet
can be seen.

Result is in valve disease with sclerosis

of vegetation and valve deformation

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 Non infective endocarditis
Non bacterial
thrombotic
endocarditis may
occur in older
patients with
terminal cancers or
chronic diseases
(ailments) or in
young patients with
Nonfatal disorders.
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 ENDOCARDITIS

The most common complication is

thromboembolism

Aorta

Embolus

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VALVULAR HEART DISEASES

There are two principle types of

valvular diseases:

Stenosis and

Insufficiency

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VALVULAR HEART DISEASES

Causes are as follow:

1 Endocarditis

2 Calcification of the valve

3 Mitral valve prolapse

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 Stenosis
Stenosis is the failure of valve
to open completely with constriction
of orifice.
This type of stenosis is termed “funnel”

Mitral valve

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 Stenosis
This type of stenosis is termed
“ fish mouth”

Mitral valve

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 Stenosis
This type of stenosis is termed
“diaphragm”

Mitral valve

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 Stenosis
Aortal valvular disease

Valvular
orifice

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 Insufficiency
Insufficiency or regurgitation results
from failure of a valve to close
completely, leaflets do not close
completely.

Aortic valve disease

with leaflet scaring
and retraction
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VALVULAR HEART DISEASES

Stenosis and insufficiency may be

pure as only stenosis or only
insufficiency.
They may be present mixed in a
single valve as mixed valve disease.
More then one valve may be
dysfunctional as combined valve
disease.
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VALVULAR HEART DISEASES

They may be original and functional

Original is real organic valvular
diseases, we can see earlier.
Functional valve disorders may be
connected with chamber delation or
calcification of cardiac annulus.

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 VALVULAR HEART DISEASES
Mitral stenosis or insufficiency leads
to
left atrial chamber delation and

leads to brown induration of the

lungs
(chronic venous congestion in the
lungs).
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VALVULAR HEART DISEASES

Aortal stenosis or insufficiency leads to

Myocardial hypertrophy of the left

ventricle and its chamber delation.

After this situation brown induration of

the lungs appears.

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 Surgical operations

Replacement of damaged cardiac

valves with prostheses has become a
common lifesaving mode of therapy.
There are two types of artificial valve
First is natural material prostheses
Second is mechanical prostheses

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Natural material prostheses

This is an excised porcine

bioprosthesis. Note there are three
cusps seen into a synthetic ring.

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 Mechanical prostheses

This is a mechanical valve prosthesis

of the more modern tilting disk variety.

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 Mechanical prostheses

This is a mechanical valve prosthesis

of the older ball and cage variety.

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Congenital heart diseases

Ventricular septal defect

Atrial septal defect
Patent ductus arteriosus
Coarctation of the aorta
Tetralogy of Fallot

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 Ventricular septal defect

This is “blue” type

of malformation
Because infant
skin is cyanotic

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 Atrial septal defect
Atrial septal defect

Atrial septal defect

Thrombus is in
Atrial septal
defect

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 Patent ductus arteriosus

Patent ductus arteriosus is an arterial

channel between the pulmonary
artery and aorta. During intrauterine
life blood flows freely from the
pulmonary artery to the aorta.
After birth with irreversible closure the
ductus turns into ligamentum
arteriosum.

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 Coarctation of the aorta

Coarctation of the aorta is a

segmental narrowing of the aorta

This is “ white type of malformation

The infant skin is pale white colored
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 Tetralogy of Fallot
1Hypertrophy of the
right ventricle
2 Dextral position of
the aorta
3 Ventricle septal
defect
4 Narrowing of the
pulmonary artery

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THE END

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