Page 356 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

312 SECTION III CARDIOvASCuLAR ``CARdIOvASCulAR—PATHOlOGY CARDIOvASCuLAR ``CARdIOvASCulAR—PATHOlOGY

Rheumatic fever A consequence of pharyngeal infection with J♥NES (major criteria):
group A β-hemolytic streptococci. Late Joint (migratory polyarthritis)
A
sequelae include rheumatic heart disease, ♥ (carditis)
which affects heart valves—mitral > aortic >> Nodules in skin (subcutaneous)
tricuspid (high-pressure valves affected most). Erythema marginatum (evanescent rash with
Early lesion is mitral valve regurgitation; late ring margin)
lesion is mitral stenosis. Sydenham chorea
Associated with Aschoff bodies (granuloma with
giant cells [blue arrows in A ]), Anitschkow
cells (enlarged macrophages with ovoid,
wavy, rod-like nucleus [red arrow in A ]), 
anti-streptolysin O (ASO) and  anti-DNase B
titers.
Immune mediated (type II hypersensitivity);
not a direct effect of bacteria. Antibodies to
M protein cross-react with self antigens, often
myosin (molecular mimicry).
Treatment/prophylaxis: penicillin.

Syphilitic heart 3° syphilis disrupts the vasa vasorum of the Can result in aneurysm of ascending aorta or
disease aorta with consequent atrophy of vessel wall aortic arch, aortic insufficiency.
and dilation of aorta and valve ring.
May see calcification of aortic root, ascending
aortic arch, and thoracic aorta. Leads to “tree
bark” appearance of aorta.

FAS1_2019_07-Cardio.indd 312 11/7/19 4:24 PM