One moment…
The module we start with is the pathology of the cardiovascular system, and the first topic is inflammatory disorders of the heart.
Inflammatory disorders of the heart are a group of heart diseases characterized by an inflammatory reaction, occurring in one or more of the three layers of the heart: the pericardium, myocardium, and endocardium.
Endocarditis is inflammation affecting the inner lining of the heart (endocardium) and usually involves the heart valves, and it can be an isolated inflammation or associated with other diseases.
Dear students, future doctors, welcome to the beginning of the new academic year.
I hope it will be a year full of seriousness and diligence, crowned with success, excellence, and full marks in all modules, God willing.
Today we will start the pathology module of the cardiovascular system.
With the first topic, an easy and simple topic that requires focus; if we understand it, we can mention it once and the topic will be easy afterwards.
The topic is titled Inflammatory disorders of the heart.
It is a group of Cardiac Diseases characterized by Inflammatory Reaction.
Therefore, we call them Inflammatory disorders of the heart.
So where does this inflammation happen, doctors? It happens in one or more of the layers of the heart.
So what are the layers of the heart?
They are the pericardium, myocardium, and endocardium.
We have the endocardium, myocardium, then pericardium from inside to outside.
Therefore, today we will talk about the main types of endocarditis.
We will talk in detail about the vegetations that occur in each type of endocarditis.
We will talk about one of the most important topics in the whole module.
Which is Acute Rheumatic Fever.
Therefore, we will talk.
We will discuss in detail the etiology, pathogenesis, and pathological disorders.
Ending with the complications.
At the end of the lecture, we will quickly review pericarditis, myocarditis, and cardiomyopathy.
All these titles fall under the heading inflammatory orders of the heart.
This carditis is mostly a group of inflammatory orders of the heart.
So according to the layer which is unfulfilled, we name it.
Meaning if you take the endocardium, which is the endomuscular of the heart, we call it endocarditis.
If you take the serum, it becomes myocarditis; if you take the pericardium, it becomes pericarditis; if you take the serous, you call it pancarditis. Pancarditis means say carditis, so what is it? Inflammation of the heart. Okay, what is endocarditis? If you define it, it is inflammation of the heart.
The heart is what? The essential things in it I have and I have and I have.
Valves, okay? And each of them has endocarditis usually takes.
Endocarditis can be isolated primary endocarditis as.
Happens in or uh the disease which is endocarditis named after the one.
Where the problem happened. And it can happen with what we call it happens in.
A very important famous disease. And the question so you don't forget it, we said.
Its abbreviation is three letters. Therefore, you take the three layers. And the pericardial.
What is the pericardial layer? So it remains three letters taking the three.
And many, okay. Endocarditis has many causes. The most famous cause.
Known and named is, I mean, I mean.
According to this area, it is usually possible to happen others, but.
It depends on and depends on the case before.
Acute endocarditis is rapid and severe, often caused by highly virulent organisms like Staph aureus, characterized by the formation of vegetations on the valves, with complications such as embolism.
Subacute endocarditis is less severe, often caused by Streptococci, characterized by milder valve damage, and can lead to chronic complications.
It happens, you hope to leave endocarditis long. Acute endocarditis.
And fast. Okay? And strong. And I have endocarditis. What is the difference?
Between them, doctors? The difference between them is that what governs.
Or you say this or you say that is the strength and control. Meaning.
What is the strength of the organism? The strength of the organism on inflammation and destruction.
If fully virulent, it can cause acute.
What is its steady state? Either normal, healthy, or abnormal and weak.
Normal is what we know; it can be abnormal, why?
Number one, it had infection before because of rheumatic heart disease.
There can be rheumatic.
Which happens with it.
Infective endocarditis in this case is an acute infection.
Two, the valve can be congenital.
In anomaly in the newborn.
Three, there can be a problem and we have to do surgery.
And replace this valve with a prosthetic valve.
Which is the valve replacement.
Okay, so.
The comparison table is easy.
What, doctor?
It is a virulent agent and normal valve before the infection occurs.
What is the receptor virulent agent in Infective Endocarditis? This is a question by the way, pay attention.
Which are Staph aureus and Group A and Group E Streptococci.
Okay?
Therefore, the course will be fulminant, fast.
And unfortunately can reach mortality.
Okay.
While Staph acute is the opposite of that.
Or not the opposite, a lesser degree than that.
That the organism is not virulent; the most famous is strept in redness.
After that in the flow.
There are patients straight or straight.
This can be rheumatic or prosthetic.
Here there is a fulminant course but previously it was more chronic.
From the pathophysiology, stronger transmission causes strong destruction.
There will be valve perforation.
And perforation can occur.
As a result of this perforation, thrombus formation will occur.
And in the myocardium.
Deformation occurs.
And abscess and edema.
Valve perforation can occur not only in the myocardium.
But it can reach the blood.
It causes the complication called pyemia.
Where did the spread happen? Spread in the blood.
But the topic is a bit calmer.
For the severe valve destruction.
I find thrombus formation.
But I find it fragile and friable.
We call them vegetations.
We call them what?
These vegetations in the class.
Acute infective endocarditis.
They are wrapped around the valve leaflets.
And important for me is that there is no.
Look, there is no abscess.
Nor edema.
What can happen as a complication?
Embolic lesions.
They send small messages to other organs.
What? Because what happened? Because it is what? Simply.
So these emboli will go to the hand. If they go or will cause. If they go, they can.
Cause. And if they go, they will cause what is called mycotic what? This is.
This is the blood normally quickly.
The emboli went here.
Therefore, fibrosis occurred.
So the valve, which was vascular tissue.
Became fibrosis, which is weaker.
Therefore, due to blood pressure.
And due to heart pumping.
There will be dilation in this part.
It will cause an aneurysm like this.
Okay, doctors.
So this valve.
From damage to damage at the end of the topic, unfortunately, it can cause rupture and cause what? Okay, very much, okay.
These two pictures are very beautiful and easy, God willing, in the work here clear.
Meaning simple reaction, very mild destruction.
As you see, what, doctors? We have vegetations, of course, present.
But we said if they lose attachment, they can cause detachment and thus cause embolization.
So they go fragile, what? Fragile and fallen.
Easy Infective Endocarditis.
The most important thing in it, doctors, point 2.
When to say Acute and when to say Sub-Acute.
What are the complications in Acute? Very important.
And what are the complications in Sub-Acute? They might ask you.
Enumerate 4 complications of Sub-Acute Infective Endocarditis.
This is the first topic.
The second title we said is one of the most important topics.
In pathology of the cardiovascular system, the whole module.
Easy because the topic unfortunately is serious and unfortunately still common.
Acute Rheumatic Fever is the acute rheumatic fever.
Acute rheumatic fever is a multisystem inflammatory autoimmune disease occurring after pharyngitis caused by beta hemolytic Streptococcus A bacteria, primarily affecting the heart.
In rheumatic fever, an immune reaction occurs where the body produces antibodies attacking the bacteria, but they also cross-react with heart tissues due to similarity between bacterial antigens and heart tissues (cross reaction).
Easy and simple, hi.
Okay, if I want to define it, what would I say?
I would say it is acute, sharp, okay, easy.
Immunologic mediated, meaning immunity has a role in the topic, not direct infection.
Not direct, multi-system taking several organs including the heart, that's why we.
Have it in the module of the cardiovascular system, meaning.
The topic happened, okay, let's continue inflammation in the pharynx.
Was this inflammation caused by viral? No, it was caused by group what? Beta.
Streptococci.
Therefore, doctor.
Every word in it has importance.
And we must pay attention and understand it well.
So.
Acute immune mediated multisystem inflammatory disease.
It's so called as a complication of pharyngitis.
it's so called as a complication of pharyngitis
cause the by beta hemolytic strepto A coca
Okay, was there pharyngitis?
With a specific organism?
What entered the heart?
And entered several systems in the topic?
And he said this is called pathogenesis.
And the doctor always tells you pathogenesis.
For your understanding.
Whoever doesn't understand pathogenesis,
medicine will be very difficult for him.
Okay, come focus with me.
I have an organism that entered the body and caused infection.
What is its name? Beta hemolytic streptococcus.
Okay, the immunity should respond with what?
This organism is an antigen.
The immunity should perform destruction of this organism.
To get out of the topic and do what?
It produces antibodies.
The antibody comes out with a specific stamp.
It goes to the antigen and finds the same beta on it.
It goes and attacks it and kills it.
So the topic is easy and simple, and what happened to the doctors?
They said, by God, this antibody,
when it attacks the antigen of beta streptococcus, a cross-reaction happened.
The antigen resembled it.
From attacking the bacterial antigen, it attacked the self antigen in the serum and in other organs.
This is called pathogenesis.
But is there another possible way?
They said the antigen-antibody attacked the antigen of whom?
Of the organism, but both formed a complex.
Because it is a virulent organism, it couldn't be destroyed.
So what did it do? It formed a complex.
What happened? This complex deposited in these organs.
Okay, that's enough.
Now, what is the clinic of the child coming to me like?
I find a child from 5 to 15 years old.
Generally, he came from a low socioeconomic area, yes, just recently, unfortunately.
Low socioeconomic to take his time and spread.
And thus you find disease, but if the child at first says pharyngitis,
he is examined well and we tell him not to get close to his siblings, no, it won't happen.
Okay, doctors, okay, and if it still exists, what in rheumatic heart disease? What happened?
I had pharyngitis in a low socioeconomic area, and there is, okay?
He said after ten to after ten days to six weeks, okay? Happened or
Or I find more than one happened to them, each one of course will give me a certain symptom.
What? On top of them. And the joint. The joint, by the way,
is the first and most famous one that affects acute rheumatic and then
and what? And we also have in the jungle as the explanation will come later.
Okay? So the child will come to me, okay, focus now on every word I will say.
Starting from now. Okay? This is what? They call it what? Number one.
Clinical symptoms of rheumatic fever include migratory arthritis affecting large joints asynchronously, transient skin redness, and involuntary movements (rheumatic chorea).
They said you will find arthritis, by God, I had it before, meaning inflammation
of the joints. What does it mean? When? They said it is migratory or shifting. What does it mean,
doctor? They said the arthritis that happens first takes
the large joint not at the same time.
Not simultaneous.
Meaning it takes the knee and takes the hip.
And takes the shoulder, for example.
It does not take them all together at the same time.
No, the mother tells you, by God,
the knee joint had edema.
And had redness.
And suddenly there was a dramatic response and it got better.
After a while I found the shoulder.
After it got better, I found the hip.
And so on. Two, which is all our symptoms, doctor.
Of course, we will come to it in detail because we are, in fact, okay? So what else?
It may happen in God, two things. And what happens is redness.
Be careful, the redness in it is always temporary, not what? I mean,
the mother tells you it was present at night only, but as I told you, doctor,
and so you must ask about it because usually the mother doesn't remember it and says
to the mother, wait a moment so if it appears, inform her. Okay, doctor? Last organ, please?
It may happen that the jungle, the jungle, if it has
inflammatory movements, it causes what is called involuntary movements. But in
rheumatic chorea, we have two important things. That the involuntary movements
are rapid and purposeless.
Rapid does not equal
We also have athetosis.
It is weak and fast.
Purposeless.
Meaning he did not intend
and holds the pen.
As happens in ataxia.
He holds the pen and it shakes.
No, this is the child sitting suddenly.
Suddenly the movement happens.
It is called rheumatic chorea.
We come in detail to
the pathological disorder.
By God, we took most of the information but we will summarize and organize it.
The first thing is that it takes all the layers, we said what? Rheumatic heart disease takes 3 layers.
Inflammation in rheumatic fever affects all three layers of the heart, with characteristic lesions such as Aschoff bodies containing distinctive inflammatory cells.
In chronic rheumatic fever, fibrosis and destruction occur in the heart valves, leading to stenosis or regurgitation of the valves, especially the mitral and aortic valves, with changes in the valve ring.
Okay, endocarditis, we said blood comes from inside to outside, the blood inside.
Okay, endocarditis always happens what in all layers of rheumatic?
But myocarditis happens in severe cases only.
Certain things, yes, you will find certain things, I will focus now on certain things because this is
the pathological disorder that happens in rheumatic carditis, I want to see diagnostic
microscopic, he said if you see under the microscope the body that
I will describe to you immediately, you will diagnose rheumatic fever and start treatment.
Do not wait for anything else.
Okay, what is this body?
First, you will find it paravascular around the blood vessel.
Its size is 1 to 2 millimeters.
No problem.
But the most important is the slide.
You will find first,
you will find granular fibrinoid material.
A large material full of granules and fibrin.
Surrounded by cells, the most famous of them is the histiocyte.
And if giant, we call it giant cell.
And lymphocytes, plasma, and fibroblasts are essential.
With collagen to connect the bodies together.
It happens in what to tell you from where you take the sample?
In connective tissue, especially the subendocardial region and myocardial interstitium.
And this is the clear microscope for me, all the years present, okay? The clear one.
Present in what? In Aschoff bodies. Don't forget, doctor. Okay. So I will find it
Where? Of course, it mostly happens in. Let's relax a bit. I have
an endocardial site with more action, the left.
And therefore,
are affected more.
The mitral before the aortic.
The left before the right.
And the mitral before the aortic.
Okay, doctor.
So what will I find on the valve?
What will I find and describe?
What will I find?
We took
Doctors get angry.
Focus now with me.
Because we will make a simple comparison.
The first thing related to the valve is thrombi composed of fibrin and platelets.
Present in endocardial sites of damage and destruction due to inflammation.
Present more in the opposition or free edge of the valve.
When we close this area,
both become adherent and maximum trauma happens in them.
When you look for it in this area,
you will find vegetation.
The most important point.
The point of the chapel.
Do not make an embolus.
And therefore you will not find organ
It will not go to the kidney or liver or anything.
It can take the death in severe cases.
And do not forget, doctor, focus on rheumatic, on rheumatic carditis.
And in detail on two points.
On the Aschoff body, the glostick.
And on the vegetations.
Because it gives you a comparison with subacute infectious endocarditis vegetations.
Myocarditis is simple.
Myocarditis itself had inflammation.
You will find many Aschoff bodies in it, okay?
The kids will come with tachycardia and tests done, I will find in
dilation in the heart. The problem if it happened means this case is what?
Severe. And therefore it can reach what? Doctors, death.
How will it die?
Tachycardia will cause arrhythmia. And dilation will cause cardiac
failure. And therefore cardiac in the heart. So these are what? These are causes of death.
Question. Do not forget the question topic. Okay?
So this is the cause of what?
They can cause death in rheumatic myocarditis.
Cardiac failure and arrhythmia.
Okay, the pericarditis, by God, the pericardium after being nice,
no, it became inflamed.
And fibrous deposits happened.
Of course, it happens, yes, it happens in kids.
With severe chest pain.
And put the stethoscope, you hear pericardial rub.
Of course, it happens, it happens in the kids' spleen
Severe stabbing pain in the chest
Put the stethoscope and listen to the pericardial rub
After the movement of the heart with the precordium
Soft blessing and it has no sound
The surfaces became rough, and thus with friction, a sound occurs which we call pericardial friction rub.
The hardest thing that can happen or the complications that can occur is called
effusion. Oh, this is a serious matter, or the eye is like this, the one
rheumatic heart disease has a special feature in a surprise. That the patients are completely fine without any
problems within six weeks. I have seen the term six weeks before.
Connect it, doctor, there is a lot of information and we must, yes, we must connect the dots. We said the interval between pharyngitis and the appearance of acute rheumatic symptoms is about two to six weeks, and the patient recovers within six weeks. Only one percent die because of what? And the name is rheumatic heart disease.
It is the loss or also the age of the eye capable of building.
It became dedicated that infective carditis is bad, acute bacterial endocarditis.
The smart one is the one who does not answer the question.
Why did we say that the patient here has become septic with the lesion?
acute bacterial endocarditis
And we did not say that acute bacterial endocarditis will occur in him.
Answer the question like this and tell us.
Alright, doctors.
Alright.
Let's not enter chronic rheumatic heart disease.
Acute rheumatic takes the heart and may take another organ.
After valve inflammation, fibrosis occurs causing incomplete closure, leading to enlargement and dilation of the valve ring with thickening and shortening of the muscles that close the valve, resulting in regurgitation.
And the skin and the CNS and before all that, but chronic is only the heart that
happens because we said mostly after that, meaning it is the one affected more, about
fifty percent, where does it happen after? It happens in
and it has a patch that comes after that, but this is the high one from what was discovered called McCallum, so it is called McCallum patch.
He said that fibrosis occurs in the valve that used to close the valve.
Unfortunately, the valve instead of closing well became rigid and there will also be narrow orifice present.
And of course, in the end, there will be fuller stenosis which we call the buttonhole appearance.
Appearance of what? The buttonhole. Alright? So what? There are open holes.
And it has a patch. Alright, doctors? The valve apparatus unfortunately underwent
severe destruction. And thus valve ring dilatation occurred. Meaning
the valve was affected but its ring is more dilated.
And why? And as a result of what? As a result of thickening and shortening. I remembered Donal
who said what? The slight muscle that was pulling on
to close the valve. And thus the blood instead of
going all to the aorta, no, part of it
goes to the aorta and unfortunately part goes back where? It causes what? It causes regurgitation.
Alright? So consequently it happened and also what else? What else?
Regurgitation. Alright? Either one alone or both. Alright.
The damaged valve becomes deformed and rough, showing clear vegetations, with inflammation in the pericardium (pericarditis) appearing on its surface as fibrin.
The pericardium is a membrane surrounding the heart allowing its movement, and when inflamed, fibrin accumulates, leading to characteristic sounds heard on auscultation.
Pericarditis can be acute or chronic, caused by multiple factors including bacterial and viral infections, autoimmune diseases like lupus and rheumatoid arthritis, trauma, surgery, and radiation therapy.
Do you see this image beautiful and pleasant?
First thing we should focus on this image and enlarge it a bit.
Do you see mitral valve in it?
This is a cross picture.
Vegetation
You see the valve here unfortunately is completely deformed, this is not its beautiful shape. The
soft surface. And it has of course the belly, what? The belly is what?
The belly is what? The McCallum patch is clear, doctor. The one in the left
pericarditis is clear rheumatic pericarditis, its surface is all fibrin.
Fibrin. Alright, this is all fibrin. Alright, doctor. So now we have
one of the most important topics. We must know what we diagnose with. And we must know
what happens in the heart in detail. Then the causes of death, all these are necessary topics.
Pericarditis in brief, doctors, is inflammation of the pericardium.
The pericardium is what? Just to make things easy to understand and memorize.
It is a layer of real tissue that surrounds the heart to allow it to move like this, but what?
Alright? It leads to what?
There was fibrin formation.
And when we put the stethoscope, what will we hear, doctors? What will we hear? Alright, alright.
Two types, either because of or we will see them later.
Chronic causes constrictive pericarditis. It causes adhesions. What happened in it?
Adhesion. So what can it do? It can do, well, the first thing it causes is the opposite of what? Like what? And the echovirus.
The viruses that cause it are coxsackie virus and influenza, I remember two or
three. But I have a case called
autoimmune material that affects the pericardium directly.
Or I had lupus present in the lungs or pleura.
And they went to the pericardium as well. The most famous of all
is streptolysin, staph, and gram-negative.
But God.
So no infection, and what did it do?
Inflammation of the pericardium or maybe.
The first thing it said is acute rheumatic fever because of immune-mediated.
And some connective tissue diseases especially lupus erythematosus.
And rheumatoid arthritis.
Of course, if there is malignant aneurysm it can cause.
And also if there is trauma.
Or after surgery.
Or after radiology radiation therapy.
And these are causes that cause acute non-infectious pericarditis.
We said acute traumatic fever and cardiac.
Or systemic lupus.
Or neoplasm or some trauma.
Or after what? Alright, doctors, alright. So what happens in the pericardium?
What I call it became tried to be alright, yes, and there is a lot of edema.
Yes, after yes, and it turned into what color? Yellowish. I have and I have what?
The exudates became loose unfortunately and their types differ between white
and brown. We call this appearance under the microscope, we call it, alright?
Of course, the result could be mild and cause no problems, it could be
to the extent that it could reach what? The fluid that should be
and very fast, yes? But if it could happen. It could happen
from what? Three cases, doctors. And also because of because of because of
the toxin. So this is a question, don't forget. Alright? It says that it is
And we review pericardial effusion.
is most commonly occurring in
renal failure
or benign neoplasm
or biogenic
pneumonia
Like this.
This is a topic together.
And we say that after adhesion
after recovery from acute
fibrous plaques occurred.
The valve was stuck in the fissures.
And caused adhesion.
The constrictive type.
That is the development of the heart in the past before the development of antibiotics.
Chronic pericarditis leads to fibrosis and stiffening of the membrane surrounding the heart, causing restriction of heart movement and difficulty in its expansion and contraction, and calcification of the pericardium may occur.
Complications of pericarditis include the heart's inability to expand properly, leading to heart failure and accumulation of fluid around the heart (pericardial effusion).
Myocarditis does not occur only due to rheumatism, but has other causes such as viral infections, toxins, and other diseases, leading to heart enlargement and decreased pumping ability.
It can do that.
It causes trapping of the heart.
It cannot move and it stretches and contracts.
Why is the heart trapped due to fibrotic thickening of the pericardium? Because the condition is chronic and constrictive.
It causes constriction of the heart movement.
Chronic inflammatory cells.
are frequently present.
And it has calcification.
The first thing we take in calcification in the heart.
Unfortunately destructive what?
Calcification.
And of course in the end.
And also it causes imitation of assistance on the middle assistance.
Pericarditis complication we said completely the heart cannot expand and thus cannot move well.
And thus cardiac lock occurs and finally acute heart failure may occur as a result of what is called accumulation of fluid.
Does myocarditis occur only in rheumatic as we said or in other causes? Myocarditis, no, I tell you the most common cause of myocarditis is the serum itself and viral.
And it can of course as we said in detail and it can be due to toxic.
And it can be due to what? What does it mean? Of course, we covered the two topics that are in
the end we take them just an idea about them, we will take them in detail in other models later. Meaning what? Just
It means it tells you inflammation in the myocardium. Its cause? Well, it can
have a cause? And it can have a cause? Which has no cause, it has three
Myocarditis may cause significant heart enlargement, compressing its internal volume and affecting the heart's ability to fill and pump, and in some cases, it may be due to a malignant disease.
types. Either the serum occurred in it, alright? Instead of it occurring in it, see
the size became what? Became very large. Or the serum itself pressed on the size.
It cannot fill. Or what happened in it? Also not what? Its contraction.
So this is why you should be careful, doctors, it may say to me that I have a myocardial.
Can't fill. Or what happened to it? Also not what? Its pump
So why does this start, be careful doctors, they might tell me that I am sick
Or if it's malignant, tell me what I didn't say and what won't happen, doctors, tell me.
Two with disease, this is also a topic, what topic? A question if someone means what?
Ah, I mean if it's a bit difficult, maybe okay doctors, but I think it's easy.
And simple. Kardo simplifies or it's daily letter, okay? Okay? And it is with myocarditis and amyloidosis.
God willing, I will upload a simple summary after you understand the lecture well.
And then I will upload questions on it, God willing.
Thank you very much and see you in the next lecture.
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