Lecture objectives
- Overview of the different pathological forms of valvular heart disease
- Describe the clinical and pathogenic features of rheumatic Fever and the morphology of rheumatic pancarditits
- Appreciate how acute rheumatic fever can lead to chronic rheumatic heart disease
- Compare and contrast acute rheumatic endocarditis and chronic rheumatic heart disease
- Describe how RHD can predispose to subacute infective heart disease
Valve pathologies
The
All of these are associated with murmurs Stenosis failure of a colce to open completely leading to obstruction ot bloof floe
Regurgitation failure of ta valve to colse completetly leading to revefresed blood floe ( volume overload)
Both to once
Functional valve pathology dilation of the left or right centrivla can pull on the papillary muscels downa nd outward preventing proper closure (reguritation?)
Complications from pressure and volume overload
- chamber hypertrophy this is from ppressur eoverleand
eg hypertrphy of the ;eft ventricle due to aortic stenosis
- Chmaber dilation with volume over load dilation of lest atruum dues to mitral reufrtingtion
artiral fibrillaiton is secondary to arrial dilation af predisposes to atrial thrombosis and emolism ultimatiely HF susceptiblibliy ot infecitve endocarditis’
Causes fo VHD
aging (degenerative) calcified aortic stenosis bone matrix proteins are produced valves become rigid mitral valve prolapse lead to systoli cmurmur and possible a diastolic murmur
congenial bicuspid aortic valve 1-2% prone to early and progressive degerative calification leading to stenosis
mitral valve prolapse this can calso be congential
immunological rheumatic heart structure acute rhermatic haert diseae pancarditis during acute rheumatic fever myocarditits endocarditis pericarditis
chornic rheumatic fever residuaela chronic valvular deformities leading to valve dysunction
whta is ARF acute immhunolofically mediated multisust disease that occurs in a few weeks after infection by a group a strep
pathogenesis crossractivity to GAS with seld antifens in the heart
caridiac morpholoft pancarditis
chronic rheumatic heart disease repaeted bouts of RF may progress to chronic RHD
characterised by permanenet valve deformitits due to haelaing by fibrosis after RG
Mitral valve almost always affected anbd mitral stenosis is most common dermoity the aortic calce can be involved as well
ARF is very sigificant in developing countries
mostly 5-14
and really just māori streptococcal infection of pharynx or skin
antibodies are formed against M Proteins
streococci may not be oresetn at onset of RF
high frequency of RD infective infective endocarditis