6 Questions - Acute Rheumatic Pancarditis

1. Following rheumatic fever, what causes the mitral valve to become insufficient?

Answer: As a result of the inflammatory process involving the mitral valve with possible development of vegetations, there is damage to the valve resulting in eventual scarring and deformity of the valve. This causes the cardiac valve to become incompetent and results in mitral insufficiency (regurgitation).



2. What is the most common disease process causing constrictive pericarditis?

Answer: Constrictive pericarditis can be caused by acute rheumatic heart disease. The most common cause of pericarditis is idiopathic and may be secondary to an inflammatory process such as viral disease.



3. During the acute phase of rheumatic fever, do the valvular lesions, themselves, cause valvular insufficiency or stenosis? Why?

Answer: During the acute phase of rheumatic fever, the valvular lesions generally cause valvular insufficiency as a result of the active inflammatory process interfering with valvular function. In chronic rheumatic heart disease, there is significant scarring with resultant rigid deformed valves leading to valvular stenosis.



4. Besides the heart, name two other organs which can be affected by immunologic reaction occurring during a streptococcal infection?

Answer: Two other organs that can be affected by an immunologic reaction in rheumatic fever are the joints and central nervous system. This is result of probable cross reactivity of the anti-streptococcal antibody with antigens in the heart, joints and central nervous system.



5. What causes the affected valve to become stenotic?

Answer; The affected valve becomes stenotic as a result of inflammation leading to fibrous scarring of the valve and a narrowed valve orifice.



6. Why are no bacteria found in these lesions?

Answer: Bacteria are not found in acute rheumatic valvular disease. The vegetations that form consist of inflammatory cells, fibrin and platelets without organisms. The process is not caused by infectious organisms

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