1. Pathophysiology BMS 243 Rheumatic Heart Disease
Lecture III
Rheumatic Heart Disease
Cardiac Valves Diseases
Dr. Aya M. Serry
2016

2. Rheumatic Fever What Is Rheumatic Fever?
A rare but potentially life-threatening disease, rheumatic fever is a complication of untreated strep throat caused by bacteria called group A streptococcus (Streptococcus Pyogenes)
Rheumatic fever results from an inflammatory reaction where the body produces antibodies to fight the bacteria, but instead the antibodies attack a different target: the body's own tissues. The antibodies begin with the joints and often move on to the heart and surrounding tissues.

3. Rheumatic Fever What Is Rheumatic Fever?
 It primarily affects children between the ages of 6 and 16, About 5% of those with untreated strep infection will develop rheumatic fever.
Within 2-4 weeks after an acute attack of Streptococcus Pyogenes, anti-streptococcal antibodies are formed and attack the heart valves and the extra-cardiac sites.

4. Antibody cross-reaction
Strep throat
Antibody
production
Antibody cross-reaction
with heart
pericarditis
vegetations
Aschoff body

5. Rheumatic Heart Disease
The disease passes into two phases;
A. Acute phase:
 acute rheumatic pancarditis (inflammation of endocardium, myocardium and pericardium)
Myocarditis : the heart muscle itself .
Pericarditis: the pericardial, or exterior, heart surface.
Endocarditis: endocardial, or interior, heart surface.

6. Rheumatic Scarring of heart valve
Rheumatic Heart Disease
B.Chronic phase:
Acute changes may resolve completely or progress to scarring and development of chronic valvular deformities many years after the acute disease.
Chronic scarring of the valves constitutes the most important long-term problem of rheumatic fever, and usually becomes clinically manifest decades after the acute process.
Other cardiac complications:
Bacterial endocarditis.
Arrhythmia.
Chronic heart failure.
Rheumatic Scarring of heart valve

7. Cardiac Valves
Diseases

8. Cardiac Valves Diseases
Cardiac Valves Diseases are classified into:
Stenosis
Regurgitation
(Insufficiency)

9. A) Valve Stenosis

10. A) Valve Stenosis

11. Cardiac Valves Diseases
A) Valve Stenosis
This occurs when a heart valve doesn't fully open due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it.
All four valves can develop stenosis; the conditions are called tricuspid stenosis, pulmonic stenosis, mitral stenosis, or aortic stenosis

12. 1. Aortic Stenosis
Definition: Aortic stenosis occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body.
Normal Aortic Valve Area: 3-4 cm2
Symptoms: Occurs when valve area is 1/4th
of normal area.

13. Causes of Aortic Stenosis
Congenital
Rheumatic
Degenerative
Patients under 70: >50% have a congenital cause
Patients over 70: 50% degenerative

14. Pathophysiology of Aortic Stenosis
A pressure gradient develops between the left ventricle and the aorta.
LV function initially maintained by compensatory pressure hypertrophy
When compensatory mechanisms exhausted, LV function failure.
This will lead to (Symptoms) :
1.Syncope
2.Angina: (increased myocardial oxygen demand; demand/supply mismatch)
3.Dyspnea: on exertion due to heart failure (systolic and diastolic)
4.Sudden death

15. 2. Mitral Stenosis Definition:
Obstruction of LV inflow that prevents proper filling during diastole.
Normal MV Area:
4-6 cm2
symptoms begin at areas less than 2 cm2
Rheumatic carditis is the predominant cause
Prevalence and incidence:
decreasing due to a reduction of rheumatic heart disease.

16. Causes of Mitral Stenosis
Rheumatic heart disease: 77-99% of all cases
Infective endocarditis: 3.3%
Mitral annular calcification: 2.7%
Symptoms:
Shortness of breath
Fatigue
Swollen feet or legs
Heart palpitations
Dizziness or fainting
Heavy coughing, sometimes with blood-tinged sputum
Chest discomfort or chest pain

17. Pathophysiology of MS Narrowing of mitral valve  left atrial pressure
 blood flow to left ventricle
 pulmonary pressure CO
pulmonary congestion
Fatigue
Left ventricular atrophy
O2/CO2 exchange
(fatigue, dyspnea)
Right-sided failure

18. B) Valve Regurgitation
Cardiac Valves Diseases
B) Valve Regurgitation
Also called insufficiency or "leaky valve", this occurs when a valve does not close tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body.
Depending on which valve is affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, or aortic regurgitation

19. B) Valve Regurgitation

20. B) Valve Regurgitation

21. 1. Aortic Regurgitation Definition:
is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.
Endocarditis is the main cause

22. 1. Aortic Regurgitation

23. Treatment of Aortic Regurgitation
Surgery -Your aortic valve may need surgical repair or replacement
Because mechanical valves are made from metal, they are durable, but carry the risk of blood clots forming. (you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots)
Medications that control Blood Pressure

24. 2. Mitral Regurgitation (MR)
Definition:
It is the abnormal leaking of blood from the left ventricle, through the mitral valve, and into the left atrium, when the left ventricle contracts, i.e. there is back flow of blood into the left atrium during systole.
 MR is the most common form of  Cardiac valves diseases
The most common Cause of MR include MV prolapse (MVP), rheumatic heart disease and infective endocarditis

25. 2. Mitral Regurgitation (MR)
Symptoms of MR
Blood flowing turbulently through your heart (heart murmur)
Shortness of breath (dyspnea), especially with exertion or when you lie down
Fatigue, especially during times of increased activity
Heart palpitations

26. Treatment of Mitral Regurgitation (MR)
Surgery -Your Mitral valve may need surgical repair or replacement
Medications can't correct a mitral valve deformity. But some medications can be used such as :
Diuretics can relieve fluid accumulation in your lungs or legs.
Anticoagulants, which can help prevent blood clots
High blood pressure makes mitral valve regurgitation worse, so if you have high blood pressure, your doctor may prescribe medication to help lower it.

27. Pathophysiology of MR Right-sided heart failure
Incomplete closure of mitral valve
Backflow of blood to the left atrium
 vol. of blood ejected by left ventriclee
 Left atrial pressure
 CO
Left atrial hypertrophy
 Pulmonary pressure
Right-sided heart failure
 Right ventricular pressure

29. Aortic Mitral . Treatment: Stenosis Regurgitation
Definition: Aortic stenosis occurs when the heart's aortic valve narrows
Occurs when valve area is 1/4th of normal area
Causes: Congenital, Rheumatic, Degenerative
Symptoms:
Syncope
Angina
Dyspnea
Sudden death
Definition: Obstruction of LV inflow that prevents proper filling during diastole
symptoms begin at areas less than 2 cm2
Main Cause: Rheumatic Carditis
Shortness of breath
Fatigue
Swollen feet or legs
Heart palpitations
Dizziness or fainting
Heavy coughing
Chest discomfort or chest pain
Definition: is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.
main cause : Endocarditis
. Treatment:
. Surgery -Your aortic valve may need
surgical repair or replacement
. Medications that control Blood
Pressure
. Anticoagulants
Definition: The abnormal leaking of blood
from the left ventricle, through the mitral
valve, and into the left atrium, when the left
ventricle contracts, i.e. there is back flow of
blood into the left atrium during systole
.The most common Cause of MR include MV
prolapse ,rheumatic heart disease &endocarditis
Surgery -Your Mitral valve may need surgical repair or replacement
Medications such as :
. Diuretics
. Medications that control Blood pressure
Symptoms of MR
Heart murmur
Dyspnea)
**MR is the most common form of  Cardiac
valves diseases
Stenosis
Regurgitation