What are the characteristic histologic features of rheumatic heart disease?

What are the characteristic histologic features of rheumatic heart disease?

• A. Aschoff bodies (granulomatous myocarditis) and verrucae along lines of closure; mitral is most commonly affected, followed by aortic.
• B. Myxomatous degeneration of the valves.
• C. Calcific nodules on the leaflets.
• D. Fibrinous pericarditis on the epicardium.

Answer: (A)

Rheumatic heart disease arises from an autoimmune reaction after a streptococcal throat infection, leading to pancarditis with characteristic valve and myocardial lesions. The hallmark myocardial lesion is an Aschoff body—a focal granulomatous area with Anitschkow cells and central fibrinoid necrosis. On the valves, you get small sterile vegetations called verrucae along the lines of closure, most often affecting the mitral valve, with the aortic valve involved next. Over time these inflammatory lesions heal by scarring and fusion of valve commissures, producing the classic valvular dysfunction. Other patterns described—myxomatous degeneration, calcific nodules, or fibrinous pericarditis—reflect different disease processes and are not the defining histologic features of rheumatic heart disease.

Rheumatic heart disease arises from an autoimmune reaction after a streptococcal throat infection, leading to pancarditis with characteristic valve and myocardial lesions. The hallmark myocardial lesion is an Aschoff body—a focal granulomatous area with Anitschkow cells and central fibrinoid necrosis. On the valves, you get small sterile vegetations called verrucae along the lines of closure, most often affecting the mitral valve, with the aortic valve involved next. Over time these inflammatory lesions heal by scarring and fusion of valve commissures, producing the classic valvular dysfunction. Other patterns described—myxomatous degeneration, calcific nodules, or fibrinous pericarditis—reflect different disease processes and are not the defining histologic features of rheumatic heart disease.