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File:IPLab9ARF6.jpg|This high-power photomicrograph of myocardium shows the cellular detail of another Aschoff body. In this case there appears to be a multinucleated Aschoff giant cell (arrow).
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== Virtual Microscopy ==
<peir-vm>IPLab9ARF</peir-vm>
== Study Questions ==
* <spoiler text="What is the etiology of rheumatic myocarditis?">Rheumatic fever is an acute, often recurrent, inflammatory disease that principally affects children following a pharyngeal (but not skin) infection with group A beta-hemolytic streptococci. Evidence strongly suggests that rheumatic fever is the result of an immune response to streptococcal antigens inciting either a cross-reaction to tissue antigens or a streptococcal-induced autoimmune reaction to normal tissue antigens.</spoiler>
* <spoiler text="Would it be possible to culture the causative agent from these lesions on the heart valves?">No. Rheumatic fever is an immune-mediated disease. No organisms can be cultured from the heart valves or from the Aschoff bodies.</spoiler>
* <spoiler text="Is this case an example of acute rheumatic fever?">Yes and no!
This patient has acute ramifications of rheumatic fever (acute valve lesions and Aschoff bodies) but there are also a number of old lesions in the heart suggesting that this patient has had numerous bouts of rheumatic fever over the course of many years.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/236582-overview eMedicine Medical Library: Rheumatic Fever]
* [http://emedicine.medscape.com/article/808945-overview eMedicine Medical Library: Rheumatic Fever in Emergency Medicine]
* [http://emedicine.medscape.com/article/333103-overview eMedicine Medical Library: Acute Rheumatic Fever]
* [http://www.merckmanuals.com/professional/pediatrics/rheumatic_fever/rheumatic_fever.html Merck Manual: Rheumatic Fever]
=== Journal Articles ===
* American Heart Association Committee on Rheumatic Fever. [http://dx.doi.org/10.1161/CIR.0000000000000205 Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography]. ''Circulation'' 2015 April 23; 131:1806-1818.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/2153-streptococcus PEIR Digital Library: Streptococcus Images]
* [http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html#8 Webpath: Myocarditis]
{{IPLab 9}}
[[Category: IPLab:Lab 9]]
