Chronic Rheumatic Heart Disease

Clinical History

The patient, a man of 40, had rheumatic fever in childhood. He had always restricted his effort and had become increasingly breathless prior to admission when he had several haemoptyses. He was admitted in congestive heart failure, had apical systolic and diastolic murmurs and died within 24 hours.

Pathology

The heart has been opened to display the mitral valve with adjacent atrium and ventricle. The left ventricular myocardium is considerably hypertrophied. There is irregular thickening, calcification and stenosis of the mitral valve. The cordae tendinae are thickened and shortened. Superiorly there is a stenosed aortic valve with thickened calcified cusps. This is chronic rheumatic endocarditis of the aortic and mitral valves.

Note

Acute rheumatic fever occurs most often between the ages of 2 and 16 years, although occasionally a first attack occurs in middle age or later. Some patients suffer recurrent attacks which may lead to fibrosis, distortion and thickening of the heart valves. This condition is known as chronic rheumatic endocarditis, or chronic rheumatic heart disease. In these chronic cases, the most severely affected part of the heart is the endocardium of the valves.