Rheumatic Fever

Normal Heart Anatomy

 Rheumatic Fever (RF)
Definition:
Rheumatic fever (RF) is an autoimmune
disease affecting the heart and extra-
cardiac sites (joints, brain, skin and
others)
 The incidence of RF has been lowered in
the developed countries but is still high in
poor communities
The disease affects children and young
adults (5-15years)
The disease follows upper respiratory
infection (tonsillitis) with Group A Beta
hemolytic streptococci
Theories of Pathogenesis:

Toxic products of streptococci

Immunologic cross-reactivity between
Streptococcal substances and heart muscle
(heart reactive antibodies)
Sensitized T-lymphocytes may lead to cardiac
injury
 JONES' CRITERIA FOR
DIAGNOSIS OF RF:
Major Manifestations Minor Manifestations
Carditis (friction rub, Clinical
murmur, cardiomegaly, Fever
CHF) Arthralgia
Arthritis (migratory History of rheumatic fever
polyarthritis, swollen, red, or rheumatic heart disease
tender) Laboratory
Chorea Acute phase reactants
Subcutaneous nodules (ESR, C-reactive protein,
leukocytosis)
Erythema marginatum
Prolonged P-R interval on
ECG
PATHOLOGY OF RHEUMATIC FEVER
Cardiac Disease (Rheumatic heart
disease)
Extra-Cardiac Disease
RHEUMATIC HEART DISEASE
Rheumatic heart disease: all the heart
layers are affected (pancarditis)
1. Rheumatic myocarditis
2. Rheumatic pericarditis
3. Rheumatic endocarditis
 1- Rheumatic myocarditis:
Acute phase: it is characterized by the development of
pathognomonic lesions called Aschoffs Bodies
within the myocardium.

Gross features:
Aschoff bodies are multiple tiny nodules (1-2 mm in
diameter)

Microscopic features:
Aschoff body is a lesion composed of:
Fibrinoid necrosis ( destroyed fragmented collagen)
Surrounded by lymphocytes and histiocytes &
Aschoff cells (large mononuclear or multinuclear
macrophages)
Aschoffs body

Blood vessel
fibrinoid degeneration

Aschoff cells
Chronic phase:
Over years or decades the Aschoff
bodies undergo fibrous scarring
 2- Rheumatic Pericarditis:
Acute phase: Aschoff bodies are formed
accompanied by serofibrinous inflammation.

Chronic phase: Fibrosis and adhesions may

occur between the visceral and the parietal
layers of the pericardium
 3- Rheumatic Endocarditis:
It affects both mural and valvular endocardium
1. Mural Endocardium:

i- Acute phase: Aschoff bodies develop in the

endocardium
ii- Chronic phase: healing results in a white
patch
 Valvular Endocardium

Vegetations (thrombi) develop at the lines

of contact of the cusps causing friction of
the swollen cusps.
Rheumatic Mitral Valve

Small vegetations are

formed at injured parts
 CHRONIC RHEUMATIC
VALVULAR DISEASE
Mitral & Aortic Valves Pathology:
Thickening of valve leaflet, especially along the
lines of closure
Fusion of commissures
Result is mitral or aortic stenosis, insufficiency,
or both
Rheumatic Mitral Stenosis

Fusion of commisures

Thick valve leaflet

 EXTRACARDIAC LESIONS OF RHEUMATIC FEVER

Joints: Rheumatic arthritis affect the large joints in a fleeting

way i.e joint inflammation is followed by joint resolution, then
another joint become inflamed followed by resolution and so on.
The affected joint is painful, tender, hot & swollen.

Brain: Rheumatic chorea (rapid involuntary purposeless

movements); it is due to inflammation of the basal ganglia. The
condition is reversible

Skin: Rheumatic subcutaneous nodules occur over bony

prominences and their structure is similar to the Aschoff bodies.

Rheumatic arteritis: affecting the coronaries, renal, mesenteric

and cerebral arteries

Pleurisy and peritonitis: serofibrinous type

 PERICARDIAL DISEASES

I. PERICARDITIS

Inflammation of the pericardium

Causes
MI, Staphylococcus, tumor, TB, uremia
II. PERICARDIAL EFFUSION
Serous fluid in pericardial sac

Usual cause: Chronic Heart Failure

III. HEMOPERICARDIUM
Myocardial rupture from MI

Trauma

Bleeding from infection, tumor, etc.

Haemorrhage from aorta

Hemopericardium