Pathophysiology of Rheumatic Heart Disease

Precipitating Factors Etiology Predisposing Factors

> Cold and damp weather/climate (Group eta!hemolytic "treptococci# > Genetic "usceptiility
> $mproper use of antiiotics/ > Gender (more women% &'(% are
improper antiiotic therapy "treptococci gains entry through rea)s in affected than men% *'(#
the s)in and mucous memranes > Pre+ious infections caused y
G,-H"
$n+ades the pharyn. $n+ades the tonsils $n+ades the s)in Pathogens gain entry in the loodstream
Edema in the syno+ial /oints
Pharyngitis/"trepthroat 0onsillitis $mpetigo Goes to the heart
Pancarditis
1onocytes phagocyti2e the streptococci
1onocytes present pieces of the Endocardium 1yocardium Pericardium
pathogens to Helper 0 cells
Helper 0 cells acti+ate - cells and induce production of antiodies against the cell wall of streptococci
,ntiodies not only react against 31 proteins4% polymers found on the cell wall of G,-H"% ut also react (cross react# with cardiac cardiac myofier%
syno+ial /oints and other connecti+e tissues
Rheumatic Fe+er
- lymphocytes produces immunogloulins and ,cti+ation of serum complement cascade Chemota.is of phagocytes of the immune response
Rheumatic factors of the $gG and $g1 classes
$nfiltration of acti+ated 0 cells
Deposited in the tissues
Pro+ides a arrier against diffusion of
"yno+ial /oints Heart nutrients to the cartilage
5asodilation of lood +essels Formation of granulation tissues at the Production of e.cess syno+ial fluid
in the syno+ial /oints syno+ial lining (,schoff -odies# "yno+ium cartilages is irritated and thic)ens
Production of en2ymes that cause tissue damage
c d
a
a
e
e
a
f g
"yno+ial /oint cells use up all the nutrients 6nderlying one egins to disintegrate 7-C cannot enter as the +al+es of the heart do not actually
recei+e any lood supply of their own
Glucose le+el in the tissues drop E+ident /oint destruction
"treptococci estalishes a hold on the +al+e
"tar+ation and death of cartilage cells
"treptococci attach and enmeshed in the protein% firin% and platelets
5egetate on the margins of the +al+e leaflets
0he leaflets gradually thic)en and shorten $nflamed margins of the +al+e leaflet ecome adherent and fuse along the commissures
and the chordae tendinae fuse and erode
Failure of the mitral +al+e to close completely 5al+ular "tenosis Reduced leaflet motion
Difficulty of lood to lea+e from the left atrium to go tot the left +entricle 8structing the forward flow of lood
Forcing lood to flow ac)ward through the mitral +al+e as the left +entricle contracts -ac) flow of lood into the pulmonary circulation

Pulmonary -P/ Pulmonary congestion

Distention of lood +essels in the pulmonary circulation
7hen pressure in the pulmonary +ein reaches 9:mmHg% the fluids egin to push from the Cardiac output
pulmonary capillary memrane into the interstitial spaces surrounding the al+eoli themsel+es
"ystemic -P
Pulmonary edema Fluids accumulate in the pleural ca+ity Peripheral +asoconstriction occurs to systemic -P

Pleural Effusion

Pressure in the pulmonary capillaries


f
Rheumatoid ,rthritis
g
5al+ular Regurgitation
Heart
1urmurs
Rapid and wea) thready
pulse
8rthopne
a
Paro.ysmal ;octurnal Dyspnea
h i
)
)
Rupture of pulmonary capillaries Fluid coats the al+eolar e.change space
"mall amounts of lood lea) into the al+eoli $nterfering C89<89 e.change
89 saturation of the lood
$schemia HR Di22iness and confusion 7ea)ness Easy fatigaility
myocardial contractility
Cardiac ,rrest
Cardiac output
-lood circulation ceases

Pericardium roughen Fluids accumulate in the pericardial space
pressure in the pericardial space
less lood enters the +entricles
Forces the septum to end to the left +entricle
"tro)e +olume
"hoc)
h
Producti+e cough of lood spec)ed
sputum
i
,ngina
pectoris
5entricular
firillation
Deat
h
d
Friction
ru
/
/
c
Rapid and wea) thready
pulse
)
Pulmonary +al+e stenosis/tricuspid +al+e stenosis
8utput of the right +entricle is less than the lood +olume recei+ed y the right atrium form the +ena ca+a
Congestion of the systermic +enous circulation and cardiac output to the lungs
-ac) pressure to the +ena ca+a
=ess lood goes to the aorta/ systemic circulation
Pressure in the +ena ca+a
Distention of /ugular +eins
)
Peripheral
edema