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20 Cards in this Set
- Front
- Back
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Which organism causes rheumatic fever?
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Group A streptococci
RF = complication of upper RT strep A infxn |
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What are the pathognomonic finding for acute rheumatic carditis? Describe them.
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Aschoff body - area of focal fibrinoid necrosis surrounded by inflammatory infiltrate; resolves to form fibrous scar tissue; found in any of the 3 heart layers
Anitschkow cells - large activated macrophages with amphophilic cytoplasm, central nuclei with irregular chromatin (~caterpillar); can fuse to form giant cells |
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Which areas of the body are primarily affected by acute rheumatic fever?
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- Heart
- Skin - Connective tissue |
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Which inflammatory cells are primarily found in a histopathologic specimen of ARF?
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- Lymphocytes
- Plasma cells - Macrophages *Anitschkow cells |
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Which cells contain caterpillar chromatin?
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Anitschkow cells
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What are the complications of acute rheumatic fever?
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CHF, pericarditis
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Acute RF vs Chronic RF
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Acute - can affect all 3 layers of the heart; Aschoff bodies
Chronic - spread of inflammation to *valvular* endocardium, causing fibrinoid necrosis in cusps and leaflets; *No Aschoff bodies in chronic RF!! |
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Which valve is most affected by chronic RF
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Mitral in 70% of cases
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Which valve is least affected by RF?
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Pulmonic
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What is the time of onset of chronic RF?
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Doesn't present until 10-30 yrs after acute process
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Describe the pathophysiological changes of chronic RF
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- Inflammation causes focal fibrinoid necrosis in cusps/leaflets
- May extend into chordae tendinae - Diffuse fibrosis deforms normal leaflet architecture --> chordae tendinae retract, thicken, & fuse - Verrucae on lines of closure |
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How does chronic RF present?
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- *Valvular stenosis* (causes 99% of mitral stenosis)
- Valvular Regurgitation |
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How does ARF most commonly present?
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chills, fever, fatigue, migratory arthralgias
tachycardia, decreased LV contractility, pericardial friction rub transient murmurs |
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What causes the transient murmurs heard in ARF patients?
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Turbulent blood flow over inflamed valve leaflets
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Acute treatment for ARF?
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High dose aspirin (reduce inflam)
Penicillin (elim strep infxn) |
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Which age groups are most commonly affected by ARF? Why?
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Children and young adults
Most susceptible to group A strep infxn |
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How are ARF recurrences prevented in pts w/ + hx of ARF?
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Low-dose penicillin prophylaxis until early adulthood
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50% of pts with mitral stenosis have what medical hx?
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ARF occurring ~20 yrs prior
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What activities exacerbate sx of MS? Why?
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Exercise
Fever Anemia Hyperthyroidism Pregnancy Rapid arrhythmia (eg. a-fib) Exercise Emotional stress Sex Why: increase blood flow and HR |
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Explain increased HR in anemia
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Because each RBC carries less oxygen to the cells, HR increases to increase Q so that the cells will not be oxygen starved
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