127. Rheumatism: definition, clinical and morphological forms, pathoanatomical changes in the heart, joints, skin, nervous system.

Rheumatism (Sokolsky- Buyo disease) is an infectious and allergic disease with predominant damage to the heart and blood vessels, undulating course, periods of exacerbation and remission.

There are 4 forms of rheumatism:

 Cardiovascular,

 Articular

 Skin

 Nervous

Heart damage: Heart - Pronounced dystrophic and inflamed changes in the heart develop in the connective tissue of all its layers and in the myocardium.

Endocarditis, myocarditis and pericarditis.

Endocarditis is an inflammation of the endocardium. By localization, valvular, chordal and parietal endocarditis are distinguished. The most pronounced changes develop in the mitral or aortic valve.

Types: Diffuse, Acute warty, Fibroplastic, Recurrent warty endocarditis

Myocarditis is an inflammation of the myocardium, which is always observed in rheumatism. There are 3 forms of rheumatic myocarditis.

Types: Nodular productive (granulomatous), Diffuse interstitial exudative, Focal interstitial exudative myocarditis

Pericarditis has the character of serous, serous-fibrinous or fibrinous inflammation and often ends in the formation of adhesions. Obliteration of the pericardial cavity and calcification of the connective tissue formed in it — the "armored heart" - are possible

Damage to all three membranes of the heart is called rheumatic pancarditis.

Damage to the endocardium and myocardium is called carditis

Joint lesions:

Mainly large joints are affected: knee, elbow, shoulder, hip, ankle. Serous or serous fibrinous inflammation occurs in the joint cavity. Mucoid swelling and vasculitis develop in the synovial membrane. Articular cartilage is not involved in the pathological process, therefore deformities and ankylosis are not characteristic.

Skin lesions:

It is characterized by the appearance of painless nodules under the skin in the periarticular tissues, represented by foci of fibrinoid necrosis surrounded by lymphoid-macrophage infiltration. Erythema nodosum occurs in the skin. With a favorable flow, small scars remain in place of the nodes.

Defeats of the NS:

It is typical for children. It is associated with rheumatic vasculitis. In the brain, there are dystrophic changes in nerve cells, foci of destruction of brain tissue, hemorrhages. It is manifested by chorea - involuntary muscle movements.

128. Rheumatic endocarditis: definition, types, pathological anatomy, outcomes, complications, causes of death in patients.

Endocarditis is an inflammation of the endocardium. By localization, valvular, chordal and parietal endocarditis are distinguished. The most pronounced changes develop in the mitral or aortic valve.

Depending on the ongoing processes, 4 types of rheumatic valvular endocarditis can be distinguished.

Diffuse endocarditis is a diffuse lesion of the valve flaps without changes in the endothelium and thrombotic overlays.

Acute warty endocarditis is accompanied by damage to the endothelium and the formation of thrombotic overlays in the form of warts along the closing edge of the valves.

Fibroplastic endocarditis — develops as a consequence of the two previous forms of endocarditis with a special tendency of the process to fibrosis and scarring.

Recurrent warty endocarditis is characterized by repeated disorganization of the connective tissue of the valves, changes in their endothelium and thrombotic overlays against the background of sclerosis and thickening of the valve flaps.

Complications – thromboembolism, stenosis.

As a result of endocarditis, sclerosis and hyalinosis of the endocardium develop, which leads to its thickening and deformation of the valve flaps, i.e. to the development of heart disease.