Questions:

1. Differentiate acute rheumatic fever from rheumatic heart disease (RHD).

2. Discuss the pathophysiology and correlate it with the signs, symptoms and laboratory
results.
3. Discuss the gross and microscopic findings in the picture.


acute Rheumatic
fever ( group A
streptococci)
Immune responses
to Group A
streptococci
Cross react with
host tissue
Antibodies directed against the M proteins of
streptococci,
CD 4 + T cells specific for streptococcal peptides,
(also react with self proteins in the heart)
Production of cytokines that activates the macrophage
(such as those found in Aschoff bodies)
Damage to heart
tissue
ACUTE RHEUMATIC FEVER RHEUMATIC HEART DISEASE
DEFINITION Acute, immunologically
mediated, multisystem
inflammatory disease
Occurs a few weeks after an
episode of group A
streptococcal pharyngitis
Complication of rheumatic
fever, refers to the chronic
heart damage that can occur
after a person has had an
episode of acute rheumatic
fever, that can eventually lead
to heart failure
Clinical presentation rheumatic carditis
(+) aschoff bodies
- Lymphocyte (primarily T
cells)
- Plasma cell
- Plump activated
macrophages
(AITSCHKOW cells)
pathognomonic for RF
(+) diffuse inflammation
- Pericarditis
- Myocarditis
- Endocarditis
Deforming fibrotic valvular
disease, particularly mitral
stenosis
Arrhytmias (particularly atrial
fibrillation)
Thromboembolic complication
Infective endocarditis