Interstitial Inflammation
INTERSTITIAL INFLAMMATION .HEART
-affected can be endocardium, myocardium (and pericardium) -two reasons: 1.) Rheumatic fever 2.) Infectious endocarditis
Rheumatic Fever
Characteristics
polyarthritis migrans
erythema marginatum
rheumatic knots under skin
chorea minor: meningoencephalitis
HEART DEFECT is the most serious late defect
Morphology
acute heart disease : PANKARDITIS
pericarditis, serous or serofibrous
myocarditis
microscopic nodules within stroma along small veins, with fibrinoid necrosis in center of nodule and in periphery we see inflammation cells and neutrophilic granulocytes and some histiocytes later. The result is ASCHOFF Cells and ANITSHKOV cells. —-> Ashoff nodules. During its course these nodules will regress and become smaller with small scars.
endocarditis
mitral and aortic valves. edema and fibrinous growths
GRANULATION onset is seen here! this is unspecific granulation tissue.
chronic heart disease : VALVULAR
fibrohyaline valve thickening, adhesions among commissures, „leaflet retraction“, calcifications, pathological vascularization (usually walls are avascular, but here we develop vessels)
this leads to : insufficiency, stenosis, combined effect
Diagnostic: take a fibrin clot and search for infectious agent!!
Infectious Endocarditis
Characteristics
presence of thrombi with infectious agents on the endocardium, usually valvular
bacteria or fungi
requires penetration of infectious agents into the blood wedge??
FORMS
Acute and subacute form
usually affecting already damaged valves (congen. malformations, post rheumatic
MOSTLY LEFT SIDE INVOLVED (90%)
but in drug users, right side primarily
Morphology:
Macro: surface of endocarditis, mitral valve affected, fibrin and blood clot seen (look at pic)
Micro: Search for infectious agent, we see accumulated granulocytes (pic.)
MYOCARDIUM
MYOCARDITIS - infrequent, younger individuals,
idiopathic (giant cell, Fiedler)
infectious
mostly viral
bacterial ( Lyme disease related is common! )
fungal
parasitic (toyoplasmosis)
BLOOD VESSELS ***next class about this Angiitis = general term including aortitis, arthritis, arteriolitis, vasculitis, phlebitis allergic vasculitis heterogenous, could have many different reasons, like SLE, RA, drug reactions, Hennoch Schönelein purpura, Goodpasture morphology: fibrinouid necrosis of vessel walls, dusting, leukocytolastic changes polyarthritis nodosa disease which causes dilation of blood vessel wall aneurysms, multiple aneurysms in walls („rosary form“) various histological changes, mostly fibrinoid necrosis in blood vessel walls „Kawasakis children disease“ is very characteristic, mostly coronary vessels granulomatous inflammation most common is temporal arteritis (giant cells, thrombosis). Takayasu disease OTHER Bürger disease: Mostly veins of lower limbs involved, common in Smokers,can spread to neurovascular bundle luetic aortitis