Posts Tagged ‘mechanism of myocarditis in acute rheumatic fever’

The answer is  simple . There is no  primary rheumatic myocardial dysfunction .The  LV dysfunction is related to the valvular lesion especially  mitral regurgitation. While this is 100 % true in chronic RHD , surprisingly  it holds good even in acute rheumatic fever as well  .(I have been thinking acute myocarditis is responsible for most cases of cardiac failure in Acute rheumatic fever !)
It is a paradox  to note  myocardits  being   a major  component in acute rheumatic fever (ARF) ,  still it does not persist  long term .It invariably resolves and the injury to the  valves goes on to result in progressive valve damage .
It is heartening to note this phenomenon in ARF  ,  as myocardial involvement behaves  just like joint involvement
Shall we modify  the famous statement  of the canadian Pathologist  William Boyd  Rheumatic fever licks  the joint but bites the heart”
Though ARF  bites the heart  , it  relishes only the valve  tissue and bites it harder ,  while  it simply  licks the myocardium   like the  joints
Is there a chronic indolent myocarditis ?
It was Initially thought there could be process of chronic myocardial inflammation.But now it is almost proven there is no entity like that .
But , it is not uncommon some patients with RHD present with significant LV dysfunction which in all probability unrelated to rheumatic activity .
Assignment for cardiology fellows .
1.Where in the heart  Ascoff bodies  are densely found ?
  1. Mainly over the valve leaflets
  2. Atrial muscle
  3. Ventricular myocardium
  4. Pericardium
2.Does Ascoff  bodies disappear  in  Chronic RHD ?

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