1. Rheumatic fever
By Dr. Ali Abdel-Wahab

2. Lecture specs At the end of lecture students should be able to
Classify disorders of the heart, especially inflammatory diseases
Define endocarditis and enumerate its causes and pathological subtypes
Define rheumatic fever and enumerate organs affected by this disorder
Describe Aschoff body (rheumatic granuloma)
Enumerate possible complications of rheumatic fever

4. Diseases of heart Heart failure Congenital heart Valve diseases
Hypertensive heart diseases
Ischemic heart disease
Cardiomyopathy
Cardiac transplantation

5. Pericardiac diseases
Myocardiac diseases
Endocardiac diseases
Pancarditis

6. Endocarditis
Usually associated with vegetations (thrombosis on cardiac valve) that may leads to
Emboli
Fibrosis and valve diseases
Non-infective endocarditis
Rheumatic fever(part of pancarditis)
Rheumatoid disease
Infective endocarditis

8. Rheumatic fever It is an non-infective immune disorder
A systemic autoimmune disease affecting mainly the heart, joints, subcutaneous tissue and CNS.

9. Incidence Children between 5-15 years. Developing countries. Familial
Low socioeconomic standards
Poor nutrition
Overcrowding
Poor ventilation
Bad habits

10. Rheumatic fever Pathogenesis
Certain susceptible individuals
An upper respiratory tract infection by Group A β hemolytic streptococci.
After 1-4 weeks start immune reaction
Streptococcal antigen stimulates antibody production
High anti-streptolysin O (ASO) indicate recent streptococcal infection
The antistreptococcal antibody cross-react with host cardiac antigen starting the disease.

12. Manifestations of rheumatic fever
Cardiac; pancarditis
Extra cardiac manifestations
Skin rash
Arthritis
Brain

13. Extra-cardiac manifestations
Fever, malaise and increased ESR.
Joint: arthralgia and migratory polyarthritis that usually heals without residual effect.
Subcutaneous nodules over bony prominences.
Sydenham’s chorea (chorea minor); involuntary semi-purposeful movements associated with emotional liability

14. Rheumatic fever Pancarditis
Inflammation of the 3 heart layers= Pancarditis
Pericarditis
Myocarditis
Endocarditis

15. Rheumatic fever serious lesions
During the acute stage, rheumatic myocarditis is more dangerous
With chronic disease, endocarditis leads to valve lesions

16. Rheumatic pericarditis
It produces serofibrinous pericarditis.
Pericarditis heals by organization (fibrosis)

17. Rheumatic Myocarditis
Aschoff’s nodules (granuloma) developing in the myocardium
Rarely acute left ventricular failure

18. Aschoff’s nodules (granuloma)
Site: myocardium, skin nodules
Paravascuar collections of monocular cells
Caterpillar cells

19. Rheumatic endocarditis
Mural endocardium
Valvular endocarditis
Inflammation of the cardiac cusps commonly affected
The mitral and aortic valves
Mitral ˃mitral with aortic˃ aortic ˃ tricuspid
Edema of the leaflets of the cusps make the endocardium liable to injury during closure of the valve
This leads to small thrombosis on the valve (vegetations)

20. Rheumatic fever Complications
thrombus
Mitral stenosis
Mitral incompetence
Double mitral valve disease
Stenosis

21. Rheumatic fever Complications
Aortic stenosis
Aortic incompetence
Double aortic valve disease

22. Rheumatic fever Complications
Pulmonary and tricuspid valves are rarely affected.

23. Diagnosis of Rheumatic Fever Jones criteria
Major criteria
Carditis
Polyarthritis
Chorea
Skin rash
Skin nodules.
Two major or
Two minors +one major
Minor criteria
Fever
Arthralgia
increased ESR
CRP
Previous rheumatic fever.
ECG changes