1. Faculty of allied medical sciences
Histopathology and cytology
(MLHC-201)

2. PATHOLOGY OF THE CARDIOVASCULAR SYSTEM
DISEASES OF THE
HEART
Supervision:
Prof.Dr. Noha Ragab

3. Outcomes:
By the end of this lecture, the student will be able to know:
1-Definition, types and diagnosis of rheumatic fever.
2-Type and causes of heart failure.

4. Normal Heart Anatomy

5. Rheumatic Fever (RF) Definition:
Rheumatic fever (RF) is an autoimmune disease affecting the heart and extra- cardiac sites (joints, brain, skin and others)

6. 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

7. Theories of Pathogenesis:
Toxic products of streptococci
Sensitized T-lymphocytes may lead to cardiac injury

8. JONES' CRITERIA FOR DIAGNOSIS OF RF:
Major Manifestations
Carditis (friction rub, murmur, cardiomegaly, Chronic Heart Failure (CHF)
Arthritis (migratory polyarthritis, swollen, red, tender)
Chorea
Subcutaneous nodules
Erythema marginatum
Minor Manifestations
Clinical
Fever
Arthralgia
History of rheumatic fever or rheumatic heart disease
Laboratory
Acute phase reactants (ESR, C-reactive protein, leukocytosis)
Prolonged P-R interval on ECG

9. PATHOLOGY OF RHEUMATIC FEVER
Cardiac Disease (Rheumatic heart disease)
Extra-Cardiac Disease

10. RHEUMATIC HEART DISEASE
Rheumatic heart disease: all the heart layers are affected (pancarditis)
Rheumatic myocarditis
Rheumatic pericarditis
Rheumatic endocarditis

11. 1- Rheumatic myocarditis:
Acute phase: it is characterized by the development of pathognomonic lesions called Aschoff’s 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)

12. Aschoff’s body
Blood vessel
fibrinoid degeneration
Aschoff cells

13. Chronic phase:
Over years or decades the Aschoff bodies undergo fibrous scarring

14. 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

15. 3- Rheumatic Endocarditis:
It affects both mural and valvular endocardium
Mural Endocardium:
i- Acute phase: Aschoff bodies develop in the endocardium
ii- Chronic phase: healing results in a white patch

16. Valvular Endocardium
Vegetations (thrombi) develop at the lines of contact of the cusps causing friction of the swollen cusps.

17. Rheumatic Mitral Valve
Small vegetations are
formed at injured parts

18. 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

19. Rheumatic Mitral Stenosis
Fusion of commisures
Thick valve leaflet

20. 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. Microscopically: it shows congestion, oedema, lymphocytes, plasma cells and macrophages.
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

21. PERICARDIAL DISEASES I. PERICARDITIS Inflammation of the pericardium
Causes
Myocardial Infarction (MI), Staphylococcus, tumor, TB, uremia

22. II. PERICARDIAL EFFUSION
Serous fluid in pericardial sac
Usual cause: Chronic Heart Failure

23. III. HEMOPERICARDIUM
Myocardial rupture from MI
Trauma
Bleeding from infection, tumor, etc.
Haemorrhage from aorta

24. Hemopericardium

25. IHD-Ischaemic Heart Disease:

26. Coronary Arteries Left Coronary A. L.A.Descending Left Circumflex
LCx
LAD
Left Coronary A.
L.A.Descending
Left Circumflex
Right Coronary A.

27. Ischaemic Heart Disease
Common Health problem.
High Mortality & Morbidity.
Etiology – common Atherosclerosis
Two major types Angina & MI.
Risk factors –
Hypertension
Hypercholesterolemia
Diabetes
Smoking, Life style, Diet, Genetic.

28. Patterns of Coronary Heart Disease:
Angina Pectoris
Acute Myocardial Infarction
Sudden cardiac death

29. Pathogenesis: Obstruction to blood flow.
Atheroma, Thrombosis, Embolism
Diminished coronary blood flow.
Ischemia leads to Angina Pectoris
Infarction leads to Coagulative Necrosis
Inflammation
Granulation tissue
Fibrous scarring.

30. Myocardial Infarction-MI
“Death of heart tissue due to lack of blood supply”
Atherosclerosis is the common cause.
Coagulative necrosis – intact tissue shape.
Characterized by Severe chest pain, breathlessness & sweating
Complications: Shock, Death or Cardiac failure.

31. Normal Myocardium:

32. MI 18-24 hr loss of nucleus, coagulative necrosis.

33. Laboratory Diagnosis
LDH
Creatinine Kinase- Isoenzymes
Troponins

34. Management: Aims at preventing complications. Rest & sedation
Supportive measures
Thrombolytic agents - Streptokinase

35. HEART FAILURE

36. Definition:
Failure of the ventricles to pump enough blood to meet the body needs
Types of heart failure:
Acute heart failure
Chronic heart failure

37. ACUTE HEART FAILURE Eitiology:
Acute myocardial infarction or myocarditis
Massive pulmonary embolism
hemopericardium  heart compression
Complications:
Acute congestion and edema

38. CHRONIC HEART FAILURE Pathogenesis: I-Stage of compensation:
The heart maintains adequate cardiac output by:
1-slight dilatation  stretch of myocardial fibers  stronger contraction
2-compensatory hypertrophy  stronger contraction
3-increased heart rate

39. II- Stage of decompensation:
Marked dilatation of the affected chamber & cardiac fatigue
dilatation  overstretching of muscle fibers  weak contraction of heart

40. CAUSES OF CHRONIC HEART FAILURE:
hypertension
coronary disease
valve diseases as aortic stenosis, aortic incompetence or mitral incompetence
congenital heart diseases as ASD &VSD

41. Questions Complete: 1-Rheumatic fever (RF) is ………………………..
2-Complications of myocardial infarction are……………
3-Rheumatic arteritis affecting ………………
4-Risk factors for Ischaemic Heart Disease are……….
5- Stages of compensation in CHRONIC HEART FAILURE are……………….

42. Assignments Myocardial infarction احمد محمد احمد اسراء محمد عبد الوكيل
اسماء حسن احمد
Heart failure
اسماء محمد عبد الوهاب
الزهيري عاطف
امال عرابي الكردي