rheumatic heart disease
Rheumatic heart disease (not to be confused with rheumatoid heart disease) may refer to either the acute cardiac involvement or chronic cardiac sequelae following rheumatic fever. Carditis is a major Jones criterion of rheumatic fever.
Risk factors include:
- socioeconomic factors eg; overcrowding, poverty, poor access to healthcare
- recurrent group A streptococcus infections
- an increased prevalence in females has been reported
Initial inflammatory events are precipitated by a group A Streptococcus pyogenes infection that causes a type 2 hypersensitivity reaction where antibodies to the bacteria exhibit molecular mimicry to human tissues. The presence of Aschoff cells is a histological diagnostic feature.
Valvular involvement is related to an endocarditis and can result in either stenosis and/or insufficiency, which can manifest either acutely or several years to decades after the initial onset of rheumatic fever. Most commonly the mitral valve is affected, producing a stenosis in later disease . Aortic regurgitation can also occur. Pathologically commissural fusion of valve leaflets is a characteristic feature.
Valvular disease can develop after either a single severe episode of acute rheumatic fever or after multiple episodes .
- pericardial calcification
- pulmonary edema
- pulmonary ossification: due to mitral valve disease
- global cardiomegaly from a dilated cardiomyopathy
- left atrial enlargement (particularly appendage) from mitral valve disease
- valvular calcification
- diffuse alveolar hemorrhage can result from severe mitral stenosis
- valvular or pericardial calcification
- dilated ventricles and atria
- dilated cardiac chambers
- pericardial inflammation
- pericardial effusion
- myocardial inflammation
- diffuse alveolar haemorrhage
- rheumatic fever
- fibrinous pericarditis
- Dilatative Kardiomyopathie