rheumatic heart disease

Rheumatic heart disease (not to be confused with rheumatoid heart disease) may refer to either the acute cardiac involvement or chronic cardiac sequelae following rheumatic fever. Carditis is a major Jones criterion of rheumatic fever.

Epidemiology

Risk factors include:

• socioeconomic factors eg; overcrowding, poverty, poor access to healthcare
• recurrent group A streptococcus infections
• an increased prevalence in females has been reported

Pathology

Initial inflammatory events are precipitated by a group A Streptococcus pyogenes infection that causes a type 2 hypersensitivity reaction where antibodies to the bacteria exhibit molecular mimicry to human tissues. The presence of Aschoff cells is a histological diagnostic feature.

Myocardial involvement

The Initial acute phase may result in a myocarditis which may progress to a dilated cardiomyopathy as later sequelae.

Pericardial involvement

Initially results in a pericardial inflammation and an effusion. A fibrinous pericarditis can occur. Pericardial calcification may occur as a later sequelae.

Valvular involvement

Valvular involvement is related to an endocarditis and can result in either stenosis and/or insufficiency, which can manifest either acutely or several years to decades after the initial onset of rheumatic fever. Most commonly the mitral valve is affected, producing a stenosis in later disease . Aortic regurgitation can also occur. Pathologically commissural fusion of valve leaflets is a characteristic feature.

Valvular disease can develop after either a single severe episode of acute rheumatic fever or after multiple episodes .

Radiographic features

Plain radiograph

• pericardial calcification
• pulmonary edema
• pulmonary ossification: due to mitral valve disease
• cardiomegaly
  • global cardiomegaly from a dilated cardiomyopathy
  • left atrial enlargement (particularly appendage) from mitral valve disease
• valvular calcification
• diffuse alveolar hemorrhage can result from severe mitral stenosis

CT

• valvular or pericardial calcification
• dilated ventricles and atria

MRI

• dilated cardiac chambers
• pericardial inflammation
• pericardial effusion
• myocardial inflammation

Siehe auch:

• Perikarderguss
• Lungenödem
• Dilatative Kardiomyopathie
• fibrinous pericarditis
• Pericarditis calcarea
• rheumatic fever
• chronic rheumatoid heart disease
• diffuse Alveolarblutung

und weiter:

• Mitralklappenstenose