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
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Dr. Krishna Tadepalli, MD, www.mletips.com

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%)
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Dr. Krishna Tadepalli, MD, www.mletips.com

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, www.mletips.com

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, www.mletips.com

5. Heart -Pathology
Rheumatic Heart Diseases
5
Dr. Krishna Tadepalli, MD, www.mletips.com

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,
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Dr. Krishna Tadepalli, MD, www.mletips.com

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
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streptococcal antibody test)
Dr. Krishna Tadepalli, MD, www.mletips.com

8. Heart -Pathology
Rheumatic Heart Diseases
? cells
pathognomonic
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Dr. Krishna Tadepalli, MD, www.mletips.com

9. Heart -Pathology
Rheumatic Heart Diseases
Commissural fusion
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Dr. Krishna Tadepalli, MD, www.mletips.com

10. Heart -Pathology
Rheumatic Heart Diseases
Commissural fusion
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Dr. Krishna Tadepalli, MD, www.mletips.com