Rheumatic Heart Disease

Rheumatic heart disease ( not to be confused with rheumatoid heart disease ) may refer to either the acute cardiac involvement or chronic cardiac sequelae following rheumatic fever. A carditis is a major Jones criterion of rheumatic fever.


An increased prevalence in females have been reported 4.


Initial inflammatory events are precipitated by a group a Streptococcus pyogenes infection. This is followed by an autoimmune cross reaction. The presence of Aschoff cells are a histological diagnostic feature.

Myocardial involvement

The Initial acute phase may result in a myocarditis which may progress to a dilated cardiomyopathy as later sequelae.

Pericardial involvement

Initially results in a pericardial inflammation and an effusion. A fibrinous pericarditis can occur. Pericardial calcification may occur as a later sequalae.

Valvular involvement

Valvular involvement is related to an endocarditis and can result in either stenosis and / or insufficiency which can manifest either acutely or several years to decades after the initial onset of rheumatic fever. Usually affects the aortic and mitral valves with stenosis of the latter being most frequency caused by rheumatic heart disease 2. Pathologically commisural fusion of valve leaflets is a characteristic feature.

Radiographic features


* pericardial calcification
* pulmonary oedema
* pulmonary ossification (due to mitral valve disease 4 )
* cardiomegaly
o global cardiomegaly from a dilated cardiomyopathy
o left atrial enlargement (particularly appendage) from mitral valve disease
* valvular calcification
* diffuse alveolar haemorrhage can result from severe mitral stenosis.


* valvular or pericardial calcification
* dilated ventricles and atria


* dilated cardiac chambers
* pericardial inflammation
* pericardial effusion
* myocardial inflammation

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Article Source : Dr Yuranga Weerakkody, Radiopaedia


  1. Glockner JF, Johnston DL, Mcgee KP. Evaluation of cardiac valvular disease with MR imaging: qualitative and quantitative techniques. Radiographics. 23 (1): e9. doi:10.1148/rg.e9 - Pubmed citation
  2. Chen JJ, Manning MA, Frazier AA et-al. CT angiography of the cardiac valves: normal, diseased, and postoperative appearances. Radiographics. 29 (5): 1393-412. doi:10.1148/rg.295095002 - Pubmed citation
  3. T Feldman et.al, Rheumatic heart disease, Curr Opin Cardiol. 1996 Mar;11(2):126-30.
  4. Woolley K, Stark P. Pulmonary parenchymal manifestations of mitral valve disease. Radiographics. 19 (4): 965-72. Radiographics (full text) - Pubmed citation
  5. Higgins CB, Byrd BF, Mcnamara MT et-al. Magnetic resonance imaging of the heart: a review of the experience in 172 subjects. Radiology. 1985;155 (3): 671-9. Radiology (abstract) - Pubmed citation
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