Question
A 34 year old female presenting to the OPD with migratory arthritis and examination revealed a pan systolic murmur. ECHO was performed which is suggestive of mitral regurgitation. Biopsy image is provided. Diagnosis will be
| A. |
Infective endocarditis
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| B. |
Rheumatic heart disease
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| C. |
B2 SABE
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| D. |
Cardiac failure
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Show Answer
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Correct Answer � B
Explanation
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An endomyocardial biopsy performed at cardiac catheterization demonstrated and Aschoff’s body in the endocardium and thus confirmed a clinical suspicion of active carditis.
Aschoff bodies are nodules found in the hearts of individuals with rheumatic fever. They result from inflammation in the heart muscle and are characteristic of rheumatic heart disease.
A. Infective Endocarditis:
Vegetations: These are the hallmark of infective endocarditis and are composed of fibrin, inflammatory cells, platelets, and microorganisms.
Bacteria or fungi can be seen within the vegetations using special stains like Gram stain or silver stain.
Neutrophilic infiltration is common, especially in acute cases.
There may be evidence of valvular destruction or necrosis, especially in aggressive infections.
C. SABE (Subacute Bacterial Endocarditis):
Vegetations: These are less destructive than in acute bacterial endocarditis. They are composed of fibrin, platelets, and bacteria.
The bacteria within the vegetations in SABE are often organized in a “layered” manner, reflecting the slow accumulation of material over time.
Less inflammation and tissue destruction compared to acute bacterial endocarditis.
Granulomatous inflammation may be present.
D. Cardiac Failure:
Myocyte hypertrophy: The cardiac muscle cells may be enlarged due to increased workload.
Interstitial fibrosis: There is an increase in the connective tissue between the muscle fibers.
Myocyte necrosis: Dead or dying cardiac muscle cells may be seen in cases of ischemic cardiac failure.
In dilated cardiomyopathy, which can lead to heart failure, there is dilation of the cardiac chambers with thinning of the walls.
In hypertrophic cardiomyopathy, there is thickening of the myocardium, especially the ventricular septum, and myocyte disarray (haphazard arrangement of muscle fibers).
