RHEUMATIC

HEART DISEASE
RHEUMATIC
FEVER
Acute immunologically
mediated multisystem
inflammatory disease

That occurs few weeks

after an episode of group A
streptococcal pharyngitis
PATHOGENESIS
Hypersensitivity reaction

Cross reaction of antibodies against

streptococcal M protein with glycoprotein
antigens in heart, joints and other tissues

The M proteins molecules has a particular

surface exposed antigenic domain against
which Rheumatic fever patients mount a
strong antibody response
JONES CRITERIA FOR
RHEUMATIC FEVER
MAJOR Carditis
CRITERIA
Migratory polyarthritis

Syndenham‘s chorea

Subcutaneous nodules

Erythema marginatum
 Fever Arthralgia

Elevated
Prolonged
acute
PR
phase
interval
MINOR reactants
CRITERIA
PLUS Supporting evidence of a
recent group A Streptococcal
infection
Requirements to
fulfill Jones
two major ctiteria
criteria

Or one major and two minor

criteria

plus evidence of antecedent

streptoccal infection
TYPES OF
RHEUMATIC
CARDITIS
Acute

Chronic
PATHOLOGY
Acute Rheumatic Carditis

“Bread and
butter”
pericarditis

s
ct ion Dif
je the fu
y pro ong he my se n
o
art e al on t As ocard n-sp
a ll w ruca sure ets. cho iti eci
Sm e., ve f clo leafl ff b s wi fic
i. e o lar odi th
es
lin alvu
v
Chronic Valve leaflets are involved and characterized by-

Rheumatic • Leaflet thickening

• Commisural fusion

carditis • Bridging across valvular commissures create “fish

mouth” or “Buttonhole” stenosis
• Shortening, thickening and fusion of chordae tendinae

Most commonly involved valve- Mitral valve

Irregular thickening of the posterior wall of left

atrium

MacCallum patch
WHAT ARE
ASCHOFF
BODIES?
Focal inflammatory lesions seen
during acute rheumatic fever

Lymphocytes
Aschoff giant
cells
Consist of foci of (macrophages of
rheumatic fever)
swollen eosinophilic Anitschkow
collagen surrounded cells
Histiocytes
by Fibroblasts
Occasional
plasma cells
WHAT ARE
These are modified macrophages
ANITSCHKOW
CELLS?

Have abundant cytoplasm

Nuclei is central round to ovoid in

shape

Chromatin is disposed in wavy

ribbon like pattern- Caterpillar cells