DISEASES OF ENDOCARDIUM AND CARDIAC VALVES

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Pathology of Endocardium and Valves
Clive R Taylor MD DPhil
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C1
Thirteen year old boy presented with a history of
pain beginning in ankles and then moving to
knees. He had flown in from Peru the week before
to visit relatives. Initially no other symptoms.
Two days later developed redness and erythema
over chest. And then became febrile. He was
brought to the ER because of increasing weakness,
with breathlessness. A faint murmur could be
heard, together with a coarse rub. CXR was
performed.
Courtesy K . Chin MD Medscape
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C2
Thirteen year old boy presented with a history of
pain beginning in ankles and then moving to
knees. He had flown in from Peru the week before
to visit relatives. Initially no other
symptoms. Two days later developed redness and
erythema over chest. And then became febrile.
He was brought to the ER because of increasing
weakness, with breathlessness. A faint murmur
could be heard, together with a coarse rub.
Rheumatic nodules on knuckles
Erythema marginatum
Cardiac dilatation due to myocarditis /-
arrythmias
Courtesy K . Chin MD Medscape
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C3
http//kardiol.com/?p299
www.kardiol.com
S. Venkatesan MD
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C4
Myocardium from another case. With recognition of
the disease, bedrest and monitoring of cardiac
symptoms death is rare.
Anitschkow myocytes
Aschoff Body
Courtesy E. Uthman MD
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C5
DISEASE OF MYOCARDIUM AND ENDOCARDIUM (VALVES)
AND PERICARIDUM
Lymphocytic myocarditis
Aschoff Body
Aschoff Giant cells
fibrinoid
Anitschkow myocytes
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C6
Vegetations difficult to see, and short lived,
but they may cause adhesions, scarring and
contraction of valves, especially with recurrent
attacks.
LA
vegetations
chordae
LV
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C7
vegetation
fibrin
Lymphocytic infiltrate
myocardium
Valve
Vessels- granulation tissue
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C8
Thickened valve margin
Cut valve ring
Cut valve ring
Thickened fused chordae
LV
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C9
thrombus
Valve ring
orifice
Fused cusps
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C10
Dilated L atrium
Laminated thrombus
Stenosed Mitral valve
LV
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C11
Twenty eight year old female presented with a
history of joint pain over several months,
becoming severe in her hands. Subsequently she
had headache, intermittent fevers and increasing
shortness of breath. On examination she had
rashes over hands and face and a diastolic
murmur. Differential diagnosis??
Causes - lupus erythematosus -
endocarditis
www./beltina.org
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C12
Valve cusp
chordae
LV
vegetations
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C13
Twenty seven year old man presented with
confusion, variable fever, arthralgia and
myalgia. He had ill defined rashes on his hands,
legs and feet, together with painful areas. On
examination the hands showed reddened patches,
nodules, petechiae and purpura, with areas of
focal hemorrhage and blackening suggesting
ischemia. He had a distinct systolic murmur and a
fever of 102 C . The patient was admitted as an
emergency. Differential diagnosis??
Multiple blood cultures were positive for MRSAs
Causes - endocarditis - lupus
erythematosus - atrial
fibrillation - thrombotic
microangiopathy
Fortes et al. Braz J Infect Dis. 2008
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LA
Mitral valve
vegetation
chordae
LV
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Coronary ostium
aorta
vegetations
erosion
LV
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aorta
Aortic valve cusps
LV
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vegetations
vegetations
LA
aorta
LV
LV
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C19
LA
vegetations
Fused chordae
LV
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C20
LA
Fused chordae
vegetations
Ruptured chordae
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Coronary ostium
Aortic valve cusp
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Calcified nodules
Mitral valve
chordae
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vessels- Granulation tissue
Vegetation Fibrin Bacteria (blue dots)
myocardium
valve
Eroded Endocardial surface
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LA
vegetations
LV
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C27
A 39 year old female presented with progressive
exercise intolerance, inability to ascend more
than a few stairs, and shortness of breath,
causing her to sleep with raised pillows. Upon
examination her ankles were swollen bilaterally,
and her jugular venous pressure was markedly
elevated. She had both diastolic and systolic
murmurs. Differential diagnosis?
Causes - ischemic heart disease
- cardiomyopathy - multiple valve
disease.
Pitting edema
Cardiomegaly, prominent pulmonary
vessels, Pulmonary edema, effusions
www.radiologyassistant.nl
Elsevier images
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RA
Stenotic aortic valve
Stenotic mitral valve
LV hypertrophy
LA dilated
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Mitral valve ring
Stenosed Incompetent orifice
LA
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3 cusps
fused
fused
Fixed Narrowed orifice
Valve pockets
fused
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Senile-calcific Not fused
Fixed orifice
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Line of failed separation of two cusps in embryo
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Late stage calcification
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LA
LV
Both leaflets of mitral ballooned
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P
Both leaflets of mitral ballooned
Tricuspid also affected
A
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LA
LV
Ruptured chorda
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Myxomatous degeneration
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Breakdown at Suture margin
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Thrombosed non-functional Valve Emboli infective
endocarditis
Endocardial scarring
LV
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Tricuspid - carcinoid syn. Fibromuscular
thickening . mucopolysaccharideses
RA
RV
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LA
MYXOMA
LV
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B47
B47
metastases