Chronic Rheumatic Heart Disease

Clinical History

A man of 35 with spastic paralysis of the left arm and chronic rheumatic heart disease with atrial fibrillation collapsed suddenly and died the following day.

Pathology

The heart has been sliced transversely and mounted to display the mitral and tricuspid valves from above. The cusps of these valves are fused and thickened and there is marked stenosis of the mitral valve. There is irregular nodular thickening of the fused cusps of the stenosed aortic valve. Both ventricles are hypertrophied (see back of specimen) and in the left ventricle and septum there are areas of haemorrhage. Histologically the left ventricle showed early infarction. Necropsy revealed recent thrombo-embolus in the left coronary artery and an old infarct in the right parietal lobe.