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Definition:

• Cardiac inflammation and scarring triggered by autoimmune reaction.

• The most common form of long-term damage from scarring and fibrosis of the valve tissue of the heart is mitral stenosis.

• Symptoms of the valvular dysfunction manifest 10 to 30 years after ARF has subsided.

 

Epidemiology:

• Accourding to a study of the western district, the prevelance is 24 in 10,000.

  • Females > Males.

  • More common in rural areas.

• ​Estimated number of 12 million individuals suffered from RF and RHD worldwide.

 

Pathophysiology:

1. Acute rheumatic heart disease:

   • Pericarditis, myocarditis, and endocarditis (common from the inside-out).

   • Endocarditis typically affects the mitral and aortic valves (fibrin vegetations)

   • May cause left atrial thickening (McCallum plaques).

   •  Myocardium will have Aschoff bodies (fibrinoid necrosis surrounded by Macrophages).

2. Chronic rheumatic heart disease:

   • Primary manifestation is valvular stenosis.​

   • Aschoff bodies are replaced with fibrous scar in CRHD.

   • Acute interstitial valvulitis -> valvular edema (untreated) -> valve thickening, fusion, calcium deposition.

   • Chordae tendineae -> shorten, thicken, or fuse (adding to the damage of valves or causing regurgitation of an otherwise healthy valve).

   • The mitral, aortic, tricuspid, and pulmonic valves are affected, in order.

   • Regurgitation and stenosis are the usual effects on the mitral and tricuspid valves; the aortic valve generally becomes regurgitant initially and stenotic much later. 

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Clinical Presentation:

• Mitral valves stenosis and/or regurgitation.

  • Symptoms of MS

    • ​Breathlessness.

    • Chest pain.

    • Cough and/or Hemoptysis.

    • Fatigue.

    • Edema and ascites.

    • Palpitation.

    • Thromboembolic complications (stroke, ischemic limb)

  • Signs of MS:

    • Mitral facies.

    • Atrial fibrillation.

    • Mid-diastolic rumble at the apex

  • Other valves stenosis and/or regurgitation.

  • Infective endocarditis.

  • Congestive heart failure.