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5.heart pathology; valvular heart diseases


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5.heart pathology; valvular heart diseases

  1. 1. Heart -Pathology Valvular Heart Diseases  Types  Stenosis= failure to open completely  Regurgitation= failure to close completely  Causes congenital or acquired Acquired = MC ( mostly affect left side)  Clinically abnormalities of flow ⇒ abnormal heart sounds ⇒ Murmurs MC Valvular problem in world ⇒ AS MC Valvular heart problem in industrialized world ⇒ MVP  Mitral Annular Calcification =⇒ Female >60 yr., lead to MS, MR, Thrombo – Embolism 1 Dr. Krishna Tadepalli, MD,
  2. 2. Heart -Pathology Valvular Heart Diseases  MVP  Myxomatous degeneration due to Deposition of proteoglycans  Seen in Marfan syndrome  Diagnosis  systolic click followed by systolic murmur  Complications ( MR, IE, Stroke) seen in (3%) 2 Dr. Krishna Tadepalli, MD,
  3. 3. Heart -Pathology Valvular Heart Diseases  Rheumatic Heart Disease (RHD)  Rheumatic Fever (RF) Acute, immune-mediated multi-system disease occurring a few weeks after an episode of group A streptococcal pharyngitis  MC in children 5-15 yrs old  RF ⇒ RHD (deforming fibrotic valvular disease)  After first attack - ↑ susceptibility to reactivation of RF with subsequent pharyngitis 3 Dr. Krishna Tadepalli, MD,
  4. 4. Heart -Pathology Rheumatic Heart Diseases Types Feature Rheumatic Fever (RF) Rheumatic Heart Disease (RHD Onset Acute Chronic Age Children ( 5 – 15 yrs) Adults Pathology Carditis, arthritis, chorea Valvular disease ( MS, MR) Aschoff bodies Pathognomonic Not seen Diagnosis John’s criteria Not applicable 4 Dr. Krishna Tadepalli, MD,
  5. 5. Heart -Pathology Rheumatic Heart Diseases 5 Dr. Krishna Tadepalli, MD,
  6. 6. Heart -Pathology Rheumatic Heart Diseases  Etiopathogenesis  Hypersensitivity ( immunological) reaction to “M” protein of Group A streptococci  RF develops weeks after Streptococcal pharyngitis  Antibodies against “M” protein cross react with  Cardiolipins of Heart Rheumatic disease  GBM of Kidney  Post – streptococcal Glomerulonephritis (PIGN/PSGN/ Acute nephritic syndrome)  Morphology  Acute (RF) Aschoff bodies (Myxoid degerantion with surrounding inflammation), Pancarditis, Anitschkow cells (macrophages with caterpillar like nucleus)  Chronic (RHD) fibrosis of valve cusps, fusion of commisures, 6 Dr. Krishna Tadepalli, MD,
  7. 7. The Jones Criteria for Rheumatic Fever, Updated 1992 Major Criteria Minor Criteria   Carditis Clinical   Migratory polyarthritis Fever   Sydenham's chorea Arthralgia   Subcutaneous nodules Erythema marginatum Laboratory   Elevated acute phase reactants   Prolonged PR interval   plus Supporting evidence of a recent group A streptococcal infection (e.g., positive throat culture or rapid antigen detection test; and/ or elevated or increasing 7 streptococcal antibody test) Dr. Krishna Tadepalli, MD,
  8. 8. Heart -Pathology Rheumatic Heart Diseases ? cells pathognomonic 8 Dr. Krishna Tadepalli, MD,
  9. 9. Heart -Pathology Rheumatic Heart Diseases Commissural fusion 9 Dr. Krishna Tadepalli, MD,
  10. 10. Heart -Pathology Rheumatic Heart Diseases Commissural fusion 9 Dr. Krishna Tadepalli, MD,