Difference between revisions of "Rheumatic heart disease"

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#redirect [[Heart_valves#Rheumatic_heart_disease]]
'''Rheumatic heart disease''', abbreviated '''RHD''', is a relatively uncommon [[heart valve]] pathology that follows ''rheumatic fever''.


==General==
*Classically leads to mitral valve stenosis.
**Rheumatic fever accounts for 99% of mitral stenosis.<ref name=Ref_PBoD594>{{Ref PBoD|594}}</ref>
***Caused by ''Streptococcus pyogenes''.<ref name=pmid18306530>{{Cite journal  | last1 = Chopra | first1 = P. | last2 = Gulwani | first2 = H. | title = Pathology and pathogenesis of rheumatic heart disease. | journal = Indian J Pathol Microbiol | volume = 50 | issue = 4 | pages = 685-97 | month = Oct | year = 2007 | doi =  | PMID = 18306530 }}</ref>
*Disease less frequent today - as streptococcal pharynigits is treated with antibiotics.
==Gross==
*"Fish-mouth appearance".
**Slit-like morphology; elliptical cross-sectional flow area (mitral valve) has an abnormally small semi-minor axis<ref>URL: [http://en.wikipedia.org/wiki/Ellipse http://en.wikipedia.org/wiki/Ellipse]. Accessed on: 13 November 2010.</ref> axis due to valve thickening.
**Image: [http://www.principia-eng.com/services/construction/IMG_3098.jpg Fish-mouth appearance - pipe (principia-eng.com)].
*Significant valvular thickening.
*Thickening and shortening of the cordae tendinae.
DDx:
*Thickening of the cordae tendinae due to micronodular [[cirrhosis]].<ref name=Ref_AoGP25>{{Ref AoGP|25}}</ref>
===Images===
<gallery>
Image:Rheumatic_heart_disease,_gross_pathology_20G0013_lores.jpg | RHD - showing valvular thickening and thickening of the cordae tendinae. (WC)
Image:Aortic_stenosis_rheumatic,_gross_pathology_20G0014_lores.jpg | RHD - showing valvular thickening - aortic valve. (WC)
</gallery>
==Microscopic==
Features:<ref name=Ref_PBoD593>{{Ref PBoD|593}}</ref>
*Caterpillar cells ([[AKA]] Anitschkow cells)
**Abundant eosinophilic cytoplasm.
**Moderately-poorly defined cell border.
**Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some imagination.
**Pathognomonic for rheumatic fever.
*Aschoff bodies - usually in the heart itself:
**Jumbled collagen, eosinophilic.
**Surrounded by lymphocytes (T cells) +/- plasma cells.
Notes:
*Anitschkow cells are thought to be histocytes and Aschoff bodies are thought to be [[granuloma]]s.<ref name=pmid3070554>{{Cite journal  | last1 = Love | first1 = GL. | last2 = Restrepo | first2 = C. | title = Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin. | journal = Mod Pathol | volume = 1 | issue = 4 | pages = 256-61 | month = Jul | year = 1988 | doi =  | PMID = 3070554 }}</ref>
**This is disputed.<ref name=pmid10399163>{{Cite journal  | last1 = Stehbens | first1 = WE. | last2 = Zuccollo | first2 = JM. | title = Anitschkow myocytes or cardiac histiocytes in human hearts. | journal = Pathology | volume = 31 | issue = 2 | pages = 98-101 | month = May | year = 1999 | doi =  | PMID = 10399163 }}</ref>
===Images===
<gallery>
Image:Rheumatic_heart_disease_-_intermed_mag.jpg | RHD - intermed. mag. (WC/Nephron)
Image:Rheumatic_heart_disease_-_3_-_high_mag.jpg | RHD - high mag. (WC/Nephron)
Image:Rheumatic_heart_disease_-_3b_-_very_high_mag.jpg | RHD - very high mag. (WC/Nephron)
Image:Aschoff_Body_in_Rheumatic_Myocarditis.jpg | Aschoff body (WC/Uthman)
Image:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg | Anitschkow myocytes (WC/Uthman)
</gallery>
===IHC===
Features (Aschoff bodies & Anitschkow cells):<ref name=pmid3070554>{{Cite journal  | last1 = Love | first1 = GL. | last2 = Restrepo | first2 = C. | title = Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin. | journal = Mod Pathol | volume = 1 | issue = 4 | pages = 256-61 | month = Jul | year = 1988 | doi =  | PMID = 3070554 }}</ref>
*S100 -ve.
*Muscle specific actin -ve.
*Desmin -ve.
*NF -ve.
*Vimentin +ve.
*CD45 +ve (weak).
==See also==
*[[Heart valves]].
==References==
{{Reflist|1}}
[[Category:Cardiovascular pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 01:14, 26 July 2016

Rheumatic heart disease, abbreviated RHD, is a relatively uncommon heart valve pathology that follows rheumatic fever.

General

  • Classically leads to mitral valve stenosis.
    • Rheumatic fever accounts for 99% of mitral stenosis.[1]
      • Caused by Streptococcus pyogenes.[2]
  • Disease less frequent today - as streptococcal pharynigits is treated with antibiotics.

Gross

  • "Fish-mouth appearance".
  • Significant valvular thickening.
  • Thickening and shortening of the cordae tendinae.

DDx:

  • Thickening of the cordae tendinae due to micronodular cirrhosis.[4]

Images

  • RHD - showing valvular thickening and thickening of the cordae tendinae. (WC)

  • RHD - showing valvular thickening - aortic valve. (WC)

Microscopic

Features:[5]

  • Caterpillar cells (AKA Anitschkow cells)
    • Abundant eosinophilic cytoplasm.
    • Moderately-poorly defined cell border.
    • Well-defined central ovoid nucleus with a prominent wavy ribbon-like chromatin -- looks vaguely like a caterpillar with some imagination.
    • Pathognomonic for rheumatic fever.
  • Aschoff bodies - usually in the heart itself:
    • Jumbled collagen, eosinophilic.
    • Surrounded by lymphocytes (T cells) +/- plasma cells.

Notes:

  • Anitschkow cells are thought to be histocytes and Aschoff bodies are thought to be granulomas.[6]
    • This is disputed.[7]

Images

  • RHD - intermed. mag. (WC/Nephron)

  • RHD - high mag. (WC/Nephron)

  • RHD - very high mag. (WC/Nephron)

  • Aschoff body (WC/Uthman)

  • Anitschkow myocytes (WC/Uthman)

IHC

Features (Aschoff bodies & Anitschkow cells):[6]

  • S100 -ve.
  • Muscle specific actin -ve.
  • Desmin -ve.
  • NF -ve.
  • Vimentin +ve.
  • CD45 +ve (weak).

See also

References

  1. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 594. ISBN 0-7216-0187-1.
  2. ↑ Chopra, P.; Gulwani, H. (Oct 2007). "Pathology and pathogenesis of rheumatic heart disease.". Indian J Pathol Microbiol 50 (4): 685-97. PMID 18306530.
  3. ↑ URL: http://en.wikipedia.org/wiki/Ellipse. Accessed on: 13 November 2010.
  4. ↑ Rose, Alan G. (2008). Atlas of Gross Pathology with Histologic Correlation (1st ed.). Cambridge University Press. pp. 25. ISBN 978-0521868792.
  5. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 593. ISBN 0-7216-0187-1.
  6. ↑ 6.0 6.1 Love, GL.; Restrepo, C. (Jul 1988). "Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin.". Mod Pathol 1 (4): 256-61. PMID 3070554.
  7. ↑ Stehbens, WE.; Zuccollo, JM. (May 1999). "Anitschkow myocytes or cardiac histiocytes in human hearts.". Pathology 31 (2): 98-101. PMID 10399163.
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