5.heart pathology; valvular heart diseases
TRANSCRIPT
Heart -PathologyHeart -Pathology
Valvular Heart DiseasesTypes
Stenosis= failure to open completely Regurgitation= failure to close completely
Causes congenital or acquiredAcquired = MC ( mostly affect left side)
Clinically abnormalities of flow abnormal heart sounds MurmursMC Valvular problem in world ASMC Valvular heart problem in industrialized world MVPMitral Annular Calcification = Female >60 yr., lead to MS,
MR, Thrombo – Embolism
Valvular Heart DiseasesTypes
Stenosis= failure to open completely Regurgitation= failure to close completely
Causes congenital or acquiredAcquired = MC ( mostly affect left side)
Clinically abnormalities of flow abnormal heart sounds MurmursMC Valvular problem in world ASMC Valvular heart problem in industrialized world MVPMitral Annular Calcification = Female >60 yr., lead to MS,
MR, Thrombo – Embolism
Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Valvular Heart Diseases MVP
Myxomatous degeneration due to Deposition of proteoglycans
Seen in Marfan syndrome Diagnosis
systolic click followed by systolic murmur
Complications ( MR, IE, Stroke) seen in (3%)
Valvular Heart Diseases MVP
Myxomatous degeneration due to Deposition of proteoglycans
Seen in Marfan syndrome Diagnosis
systolic click followed by systolic murmur
Complications ( MR, IE, Stroke) seen in (3%)
Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Valvular Heart Diseases Rheumatic Heart Disease (RHD) Rheumatic Fever (RF)
Acute, immune-mediated multi-system disease occurring a few weeks after an episode of group A streptococcal pharyngitis
MC in children 5-15 yrs old RF RHD (deforming fibrotic valvular disease) After first attack - susceptibility to reactivation of RF
with subsequent pharyngitis
Valvular Heart Diseases Rheumatic Heart Disease (RHD) Rheumatic Fever (RF)
Acute, immune-mediated multi-system disease occurring a few weeks after an episode of group A streptococcal pharyngitis
MC in children 5-15 yrs old RF RHD (deforming fibrotic valvular disease) After first attack - susceptibility to reactivation of RF
with subsequent pharyngitis Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Rheumatic Heart DiseasesTypes
Rheumatic Heart DiseasesTypes
Feature Rheumatic Fever (RF) Rheumatic Heart Disease (RHD
Onset Acute Chronic
Age Children ( 5 – 15 yrs) Adults
Pathology Carditis, arthritis, chorea
Valvular disease ( MS, MR)
Aschoff bodies Pathognomonic Not seen
Diagnosis John’s criteria Not applicable
Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Rheumatic Heart DiseasesRheumatic Heart Diseases
Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Rheumatic Heart Diseases Etiopathogenesis
Hypersensitivity ( immunological) reaction to “M” protein of Group A streptococci
RF develops weeks after Streptococcal pharyngitis Antibodies against “M” protein cross react with
Cardiolipins of Heart Rheumatic diseaseGBM of Kidney Post – streptococcal Glomerulonephritis
(PIGN/PSGN/ Acute nephritic syndrome) Morphology
Acute (RF) Aschoff bodies (Myxoid degerantion with surrounding inflammation), Pancarditis, Anitschkow cells (macrophages with caterpillar like nucleus)
Chronic (RHD) fibrosis of valve cusps, fusion of commisures,
Rheumatic Heart Diseases Etiopathogenesis
Hypersensitivity ( immunological) reaction to “M” protein of Group A streptococci
RF develops weeks after Streptococcal pharyngitis Antibodies against “M” protein cross react with
Cardiolipins of Heart Rheumatic diseaseGBM of Kidney Post – streptococcal Glomerulonephritis
(PIGN/PSGN/ Acute nephritic syndrome) Morphology
Acute (RF) Aschoff bodies (Myxoid degerantion with surrounding inflammation), Pancarditis, Anitschkow cells (macrophages with caterpillar like nucleus)
Chronic (RHD) fibrosis of valve cusps, fusion of commisures,
Dr. Krishna Tadepalli, MD, www.mletips.com
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The Jones Criteria for Rheumatic Fever, Updated 1992
The Jones Criteria for Rheumatic Fever, Updated 1992
Major Criteria Minor Criteria
Carditis Clinical
Migratory polyarthritis Fever
Sydenham's chorea Arthralgia
Subcutaneous nodules Laboratory
Erythema marginatum Elevated acute phase reactants
Prolonged PR interval
plus
Supporting evidence of a recent group A streptococcal infection (e.g., positive throat culture or rapid antigen detection test; and/ or elevated or increasing streptococcal antibody test)
Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Rheumatic Heart DiseasesRheumatic Heart Diseases
pathognomonic
? cells
Dr. Krishna Tadepalli, MD, www.mletips.com
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Heart -PathologyHeart -Pathology
Rheumatic Heart DiseasesRheumatic Heart Diseases
Commissural fusion
Dr. Krishna Tadepalli, MD, www.mletips.com
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