Chronic Rheumatic Heart Disease; Left Ventricular Hypertrophy

Clinical History

This 51 year old patient with a past history of rheumatic fever had recurrent episodes of angina and syncope. He was admitted with acute shortness of breath. Examination showed signs of acute left heart failure, a heaving displaced apex beat and a rough ejection systolic murmur accompanied by a thrill in the aortic area radiating to the neck. He died soon after admission.

Pathology

The heart has been opened to display the left ventricle and aortic and mitral valves. The left ventricular wall is greatly hypertrophied and the cavity dilated. The aortic valve shows fusion of the cusps with nodular thickening and calcification. The anterior cusp of the mitral valve (upper left) shows similar irregular thickening. This is chronic rheumatic endocarditis of the aortic and mitral valves.

Note

See Note AH 3