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Rheumatism, Non-rheumatic Endocarditis

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Rheumatism, Non-rheumatic Endocarditis.

Relevance: Rheumatic diseases are a very large and variable group of diseases with infectious allergic origin, and characterize by primary lesions of connective tissue. This group contains diseases such as rheumatism, rheumatic arthritis, scleroderma, lupus, nodular periarteritis, dermatomyositis and other. Knowledge and skills received in class help you understanding the backbone, causes, mechanisms of development, morphologic manifestations of rheumatism and non0rheumatic endocarditis, which are so important to a doctor for understanding the clinical manifestations, modern diagnostics, adequate treatment, prevention and possible complications.

Objective (general): to know how to detect and interpret the macro and microscopic sign of rheumatism and non-rheumatic endocarditis, understand their causes, pathogenesis, outcomes, and use them in clinical practice.

^ Specific objectives:

Objectives of novice level:

To know how to:

1. Detect, interpret, and understand the morphologic substance by macro and microscopic findings of rheumatic endocarditis, myocarditis, pericarditis, non-rheumatic endocarditis.

2. Detect the localization of the changes and interpret them with different abnormalities of the cardio vascular system.

3. Detect and interpret morpho-functional signs of endocarditises of different genesis, including etiology and pathogenesis. Use them in clinical practice.

To know how to:

1. Detect and interpret the normal structure of the heart and its valves.

2.Detect and estimate different types of inflammation especially proliferative and exudative inflammation, by macro and microscopic manifestation of angio-stromal dystrophy.

3. Detect and estimate the different colouring of different structures of connective tissue and heart cells.

Here are some questions to test your initial knowledge.


On an autopsy of a 23 year old male, who suddenly died of trauma, mitral valve was thin, transparent, and elastic. State the status of the valve?

1.A normal valve.

2.A valve with an inherent defect.

3.Pathologically changed valve

4.A valve with a non-rheumatic endocartitis.

5.A valve with an acquired defect.


Heart wall is made of 3 layers. One of which, is made of fibrous connective tissue, with a large amount of elastic fibers and covered with endothelium. The other one is made of two types of myocytes, the third one is made of thin laminae of connective tissue and covered with mesothelium. Which layer do the valves belong to?



3.Parietal endocardium.

4.Valvate endocardium.

5.All of the above.


During a histological exam of an artery wall and the surrounding connective tissue, a structureless areas were found, which are coloured with hematoxylin and eosin in blue. Which type of angio-stromal dystrophy is in this case?



3.Fibrinoid swelling.

4.Fibrinoid necrosis.

5.Mucoid swelling.


During a histological exam of a synovial tunic of a joint, in the connective tissue a disorganized areas was found, which coloured in blue with hematoxylin and eosin. But with toluidine blue – metachromatic. Which process is in this case?


2.Mucoid swelling.

3.Fibrinoid swelling.

4.Fibrinoid necrosis.



During a microscopy, in a myocardium strome, were found: edema, hyperemia, diffuse inflammatory cell infiltration, consisting of lymph cells, histiocytes, plasmatic cells. What type of inflammation is characterized with these changes?

1.Exudative purulent myocarditis.

2.Granulomatous myocarditis.

3.Alterative myocarditis.

4.Productive interstitial myocarditis.

5.Exudative serous myocarditis.

The correct answers: 1-1, 2-4, 3-5, 4-2, 5-4.

All the necessary information, you can find in the following textbooks.

  1. Prives M.G., Lisenko N.I., Bushcovich V.I. – "Human anatomy". 2001

  2. Afanas'yev U.I., Yurina N.A. – "Histology, Cytology and Embryology". 1999

  3. Strukov A.I., Serov V.V. – "Pathologic anatomy". 1985

Theoretic questions for you to prepare for class:

1.Concept of rheumatic diseases. General morphology: disorganization of connective tissue, metabolic and immune disorders.

2.Etiology, pathogenesis of rheumatism.

3.Morphology of rheumatic inflammation, stages.

4.Clinical anatomic forms of rheumatism.

5.Clinical morphologic forms of rheumatic endocarditis: morphology, complication, outcomes, causes of death.

6.Rheumatic myocarditis, macro and microscopic picture, complications, outcomes, causes of death.

7.Rheumatic traits in children.

8.Rheumatic heart defects, morphological forms.

9.Causes of death in rheumatic patients.

10.Non-rheumatic endocarditises: classification, causes, pathogenesis, macro and microscopic picture, complications, outcomes, causes of death.

Primary literature:

1. Strukov A.I., Serov V.V. – "Pathologic anatomy". 1995

2. Lectures on the topic "Rheumatism, non-rheumatic endocarditis"

3. Shlopov V.G. "Pathologic anatomy".2004

4. Graph of logical structure "Rheumatism, non-rheumatic endocarditis" (supplement 1)

5. Algorithm of studying of macro and micro specimens. (supplement 2, 3).

Optional literature:

1. Serov V.V., Yarigin N.Ye.,Paukov N.Ye. "Pathologic anatomy". Atlas"ю 1986

2. Pathologic anatomy. Lecture course. Serov V.V., Paltseva M.O. - 1998

Here are some questions to test what you have learned.


A 55 year old female, who suffered from rheumatism since she was a child, came to the hospital with heart failure and left hand hemiplegia, had died the next day. The autopsy showed that in the right hemisphere a large ischemic infarction, the flaps of the aortic valve were partially adhesion, and sclerosis of the free edge, shortness of the chordal fibers, erosion on the line of closure with trombotic application. What is the most likely mechanism of development of the infraction of the brain in this case?

1.Stasis of blood.






A 47 year old woman, who many years suffered from rheumatism, arrived to the hospital with heart failure and died the next day. On the autopsy, in her brain a large ischemic infarction was found, in her aortic valve adhesion of the cusp and sclerosis of the free edge, shortness of the chordal threads, erosion on the side of link with a thrombotic application. What type of clinico-morphologic form of rheumatism does the patient have?







On an autopsy of a 48 year old woman, who had died of cardiac failure, was found that the cusps of the mitral valve were adnated, thickened, not transparent. The chordal threads are shortened, on the line of closer of the cusps were found rounded grey, flabby application, 0.2-0.3cm in diameter. Your diagnosis?

1.Diffuse endocarditis. .

2.Acute verruciform endocarditis.

3.Recurrent verruciform endocarditis..

4.Constrictive (fibroplastic) endocarditis.

5.Polyp-ulcerative endocarditis.

Q. 4.

On an autopsy of a 53 year old male, who had died of cardiac failure, was found that the cusps of the mitral valve are very thickened and adnated. They are not transparent, the chordal threads are shortened, on the line of closer of the cusps were found rounded grey, flabby application, 0.1-0.2cm in diameter. Microscopically were found areas of Mucoid swelling. What specimen we should use to colour the tissue to confirm the diagnosis?

1.Congo rot (red).

2.Sudan 3.

3.Toluidine blue.

4.Impregnation with silver salt.

5.By vanGizon.


On an autopsy of a 9 year old child, who had died of progressive rheumatism, it was found that the mitral valve was swelled, microscopically were found areas of Fibrinoid swelling. The myocardium is hyperemic, flabby, microscopically in the interstitium is a diffuse lymphocyte infiltration. Pericardium is thick because of a thread like formation of grey colour, hyperemic. Manifestation of what are these changes in the heart?





5.Cardio sclerosis.


On an autopsy of a 35 year old woman, who had suffered of a bacterial endocarditis with thrombus on the surface of the aortic valve, in the kidney were found several areas triangular form, structureless flabby, white-yellow colour. What complication had developed?

1.Colliquative necrosis.

2.Adipose dystrophy.

3.Hemorrhagic infarction.

4.Ischemic infarction.

5.Local anemia.


On an autopsy of a 32 year old woman, in her mitral valve were found a large amount of deep defects with thrombotic application 2-3cm in size. Microscopic exam on the periphery of necrosis was an intensive lymphocyte infiltration. In the thrombus there is a large colonies of microbes. What type of endocarditis is in this case?

1.Diffuse endocarditis. .

2.Acute verruciform endocarditis.

3.Recurrent verruciform endocarditis..

4.Constrictive (fibroplastic) endocarditis.

5.Polyp-ulcerative endocarditis.


On a autopsy of a 6 year old chilled, who had died of progressive rheumatism with expressed allergic reactions, in the spatium of pericardium was found 150ml of semitransparent liquid. The pericardium is thickened because of a thread like formation grey colour, hyperemic. What form does this change in the pericardium characterize?

1.Serosal pericarditis.

2.Catarrhal pericarditis.

3.Fibrinogenous pericarditis.

4.Purulent pericarditis.

5.Constrictive (fibroplastic) pericarditis.


On an autopsy of a 15 year old girl, who had suffered from rheumatism, was found a slight thickness of the aortic valve, which is cloudy, semitransparent. On a histological exam were found areas with swelled intercellular substance, dyes in violet-pink (toluidine blue), light blue with hematoxylin eosin. What process was found in the aortic valve?

1. Mucoid swelling.

2. Fibrinoid swelling

3. Cellular reactions.

4. Sclerosis.

5. Hyalinosis.


A 27 year old who had suffered from sepsis, and died of cardiac failure. The autopsy showed in the mitral valve a large amount of deep defects with thrombotic applications. The coroner had diagnosed polyp-ulcerative endocarditis. What is the reason of an acute cardiac failure?

1.Myocardial infarction.

2.Thrombo-embolism of pulmonary artery.

3.Dystrophic changes in cardiomyocytes.

4.Rupture of the valve with an acute failure.

5.Interstitial purulent myocarditis.

Methodic instructions for students on a theme "Rheumatism, non-rheumatic endocarditis"

In the beginning of the class you will be tested on your homework. Then you will be tested to see how well did you prepare for class. Individually you should study the micro and macro specimen. And answer situational question. You mast study the next specimens: "Acute verruciform endocarditis", "Recurrent verruciform endocarditis", "Fibroplastic endocarditis", "Fibrinogenous pericarditis", "Acute bacterial endocarditis", "Inherent heart defect", "A heart with artificial valve"

Microscopic features of rheumatism and non-rheumatic endocarditis are studied on micro slides dyed with hematoxylin and eosin, toluidine blue.

While using microphotographs, tables, you should know the microscopic features of rheumatism and non-rheumatic endocarditis. Your acquired knowledge will be tested at the end of the class.

^ Technologic map of the class.



Session (min.)

Educational visual aid, means of training


Place of holding


Testing and correction of initial state.


Multiple choice questions

Study room


Individual work. Description of macro- and micro- preparations.


Supplement # 1. Algorithm of study macro and micro preparations.

Microscope, macro and micro preparations Microphotographs.


Self testing and correction of the learned material.


Target educational tasks


Final test control


Test collection


Summery of the class


^ Supplement №1.

Graph of logical structure "Rheumatism, non-rheumatic endocarditis"

Rheumatism and bacterial endocarditis



General morphology

Mucoid swelling

Fibrinoid swelling

Cell reactions


Localization of changes









Heart defects


Локализация изменений

Сосуды Серце Мозг Суставы

Cardio sclerosis

Infarctions of organs

Cardiac failure

Supplement 2

Bacterial endocarditis










Acute polyp-ulcerative endocarditis

Acute purulent inflammation with thrombosis



Rupture of aneurism

Septic infarctions of organs

Acute cardiac defect

Polyp-ulcerative endocarditis of the valve

Medium, different degree of prescription, persistent purulent inflammation


Trombo-embolism, infarctions.

Cardiac defects

Post infectious glomerulonephritis, uremia.

Microbes on valve wall, purulent inflammation, necrosis, ulcer, thrombosis.

Algorithm of study of micro slides.

Define an organ. State its shape, size, and surface, thickness of walls, diameter A-V opening, and picture on cut set. Define the heart disease.

Дополнение 3.

Алгоритм изучения микропрепаратов.

Определить слои клапана . Найти поля зрения с патологическими изменениями в соединительной ткани. Указать какие морфологические изменения имеют место в данном случае. Определить заболевание и стадию процесса.

Дополнение 3.

Rheumatic endocarditis

Valve slightly thickened, cloudy, flashy surface, tendinous fibers are thin.

Valve is much thickened, white, on external line of closure small thrombus. Threads short, thick.

Valve is thick, short, white. Threads short, thick.

Diffuse endocarditis

Acute verruciform

Recurrent verruciform


Valve slightly thickened, cloudy, on external line of closure tendinous threads, small thrombus.

Valve is thick, layers are not discernible.

Valve thick. Desquamation of epithelium. On surface small thrombus, areas of Mucoid and Fibrinoid swelling. Proliferation of connective tissue cells.

Valve is thick, layers are not discernible, sclerosis

Desquamation of epithelium. Thrombus of surface.

Surface is smooth


Rheumatism, Non-rheumatic Endocarditis iconRheumatism, infective endocarditis prof. Vatutin N. T

Rheumatism, Non-rheumatic Endocarditis iconДокументи
1. /МЕД___курс_МОДУЛЬ 1/Acute Cholecystitis, Авершина/Ключ. к мет. ук..doc
Rheumatism, Non-rheumatic Endocarditis iconRheumatic Fever Associate professor Masyuta D. I

Rheumatism, Non-rheumatic Endocarditis iconMethodical working out for students a theme: «Rheumatic diseases»

Rheumatism, Non-rheumatic Endocarditis iconFlow Chart Diagramme of Acute Rheumatic Fever

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