Rheumatic Carditis

Clinical History

This patient was admitted with a history of nausea, vomiting and swelling of the legs for 4 months. This was of slow progression. When examined the patient was afebrile, pulse 72, BP 120/75 mm Hg. The urine contained leukocytes and erythrocytes but no casts. SG 1.010, albumin ++, alkaline reaction. The apex beat was heaving in character, and 12.5 cm from the mid sternal line. An apical systolic bruit was present, heard in all areas together with a low rumbling diastolic murmur medial to the apex beat. Right and left pleural effusions, ascites and oedema were present. The provisional diagnosis was acute nephritis. Patient steadily deteriorated and died quietly.

Pathology

The specimen is a heart sliced open to display the left atrial and ventricular cavities and mitral valve. Along the line of closure of the mitral valve was a fine ruffling of the endothelium but no actual vegetation formation. Attached to several chordae are friable thrombi and beneath the posterior leaflet of the mitral valve similar material may be seen. The left ventricle is 12-15 mm in thickness.