Rheumatic Fever and Acquired Valvular Heart Diseases

28 Rheumatic Fever and Acquired Valvular Heart Diseases


With Christian J. Kellenberger and Kevin S. Roman


Definition and Etiologic Consideration



  • image Rheumatic fever is a nonsuppurative diffuse inflammatory disease of connective tissue involving the heart, blood vessels, joints, central nervous system, and skin occurring as a delayed sequela postpharyngitis with rheumatogenic strains of group A β-hemolytic Streptococcus.

    • • Jones criteria for diagnosis of acute rheumatic fever:

      • – Major criteria: carditis, arthritis, chorea, erythema marginatum, subcutaneous nodules
      • – Minor criteria: previous rheumatic fever, arthralgia, fever, elevated erythrocyte sedimentation rate, elevated white blood cell count, prolongation of PR interval, presence of C-reactive protein

    • • Cardiac manifestations of acute rheumatic fever include pancarditis, pericarditis, and significant valvular inflammatory disease.
    • • Approximately 25% of children with rheumatic fever develop chronic disease resulting in rheumatic heart disease due to thickening and scarring of the valves.

  • image Acquired valvular heart disease:

    • • Rheumatic heart disease is the most common cause often associated with mitral valve disease. Mitral valve involvement occurs in approximately 75% and aortic valve involvement in 25% of all rheumatic heart disease.
    • • Infective endocarditis is a less common cause of acquired valvular heart disease, which may affect congenitally deformed valves and less commonly a normal valve.
    • • Traumatic injury
    • • Conditions dilating the ascending aorta can result in aortic valve disease. Etiologies include the following:

      • – Aortitis from a variety of conditions
      • – Cystic medial necrosis often in association with Marfan syndrome, Loeys-Dietz syndrome, and idiopathic annuloaortic ectasia or associated with hypertension and dissecting aneurysm.

    • • Conditions dilating a ventricle can result in valvar regurgitation.

Pathophysiology


Jan 14, 2016 | Posted by in RESPIRATORY IMAGING | Comments Off on Rheumatic Fever and Acquired Valvular Heart Diseases
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