Age/sex: 45-year-old female
Size: 14.5 x 12.8 x 9.3 cm
The specimen has been opened to show a dilated left atrium (L). A dilated right atrium (R) can be seen behind. A red rod is present in the mitral valve orifice, which has a “fish mouth” appearance characteristic of mitral stenosis (seen better upside-down). Although difficult to appreciate in this photograph, the aortic valve leaflets are partially fused and thickened indicating stenosis of this valve as well.
Mitral stenosis and post-rheumatic fever
By far the most common cause of mitral stenosis is rheumatic fever (RF), a multisystem disease that can complicate pharyngeal infection by the bacterium Streptococcus pyogenes. About 2 -3 % of people with untreated “Strep throat” develop fever, joint pain (typically affecting several joints at different times), and a feeling of unease (malaise) 2 to 4 weeks after the beginning of pharyngitis. Some also develop skin rash, signs of heart disease, and unusual involuntary movements of the arms and legs (Sydenham’s chorea).
Children and adolescents are most often affected. Because of effective antibiotic treatment of “Strep throat”, the incidence of RF (and thus its principal cardiac complication, mitral stenosis) have decreased dramatically in “developed” countries in the 20th century. Worldwide however, it is estimated that about 30 – 35 million individuals are still affected by RF every year and that as many as 50 million people have some degree of rheumatic mitral stenosis.
Thomas Sydenham (1624 – 1689) was an English physician whose Observationes Medicae was the standard English language textbook of medicine for almost two centuries. In this and other publications, he gave some of the first and most detailed descriptions of diseases such as gout, smallpox, scarlet fever, and chorea. He was also known as a practical and honest “healer” – the “English Hippocrates”. Below is a statement attributed to him that illustrates this quality.
The arrival of a good clown exercises a more beneficial influence upon the health of a town than of twenty asses laden with drugs.
Below: An illustration depicting the dance de Saint Guy, or St. Vitus’s dance, a historical name for Sydenham’s chorea resulting from rheumatic fever. (St. Vitus is the patron saint of dancers.)
Source: Remitamine. (2020). Boys afflicted with rheumatic chorea. Wikimedia Commons.
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