Rheumatic Fever & Heart Disease - Part 1/7 🫀
Dr. Najeeb Lectures
0:08 Now today we are going to discuss about
0:10 Now today we are going to discuss about
0:10 Now today we are going to discuss about the rheumatic fever and rheumatic heart
0:12 the rheumatic fever and rheumatic heart
0:12 the rheumatic fever and rheumatic heart disease. First we'll develop the concept
0:14 disease. First we'll develop the concept
0:14 disease. First we'll develop the concept of rheumatic fever and then we'll see
0:17 of rheumatic fever and then we'll see
0:17 of rheumatic fever and then we'll see what is the relationship between the
0:18 what is the relationship between the
0:18 what is the relationship between the rheumatic fever and the rheumatic heart
0:20 rheumatic fever and the rheumatic heart
0:20 rheumatic fever and the rheumatic heart disease. Actually we have to develop
0:23 disease. Actually we have to develop
0:23 disease. Actually we have to develop three concepts. Number one, what is the
0:26 three concepts. Number one, what is the
0:26 three concepts. Number one, what is the relationship of strep special type of
0:28 relationship of strep special type of
0:28 relationship of strep special type of streptocoy? Their relationship with
0:30 streptocoy? Their relationship with
0:30 streptocoy? Their relationship with rheumatic fever and what is the
0:33 rheumatic fever and what is the
0:33 rheumatic fever and what is the relationship of rheumatic fever with the
0:35 relationship of rheumatic fever with the
0:35 relationship of rheumatic fever with the rheumatic heart disease. This is our
0:37 rheumatic heart disease. This is our
0:37 rheumatic heart disease. This is our task.
0:39 task.
0:39 task. Today our work is that we have to
0:42 Today our work is that we have to
0:42 Today our work is that we have to develop what is the conceptual
0:43 develop what is the conceptual
0:43 develop what is the conceptual relationship between steptocal infection
0:45 relationship between steptocal infection
0:46 relationship between steptocal infection with the romatic fever and what is the
0:47 with the romatic fever and what is the
0:47 with the romatic fever and what is the relationship of romatic fever with the
0:49 relationship of romatic fever with the
0:49 relationship of romatic fever with the romatic heart disease. Let's take a
0:52 romatic heart disease. Let's take a
0:52 romatic heart disease. Let's take a simple example.
0:54 simple example.
0:54 simple example. that there's a child here
0:58 that there's a child here
0:58 that there's a child here and what really happens that in this
1:01 and what really happens that in this
1:01 and what really happens that in this person,
1:05 right?
1:07 right?
1:08 right? There is sore throat.
1:15 Let's suppose there's a special type of
1:17 Let's suppose there's a special type of
1:17 Let's suppose there's a special type of bacteria which enters in the
1:21 bacteria which enters in the
1:22 bacteria which enters in the ferings. It attacks the fangial mucosa
1:24 ferings. It attacks the fangial mucosa
1:24 ferings. It attacks the fangial mucosa or it may attack the tonsils.
1:27 or it may attack the tonsils.
1:27 or it may attack the tonsils. Right? This special type of bacteria
1:30 Right? This special type of bacteria
1:30 Right? This special type of bacteria which can inside the rheumatic fever
1:33 which can inside the rheumatic fever
1:33 which can inside the rheumatic fever this is streptococcus and not every
1:35 this is streptococcus and not every
1:35 this is streptococcus and not every streptocus a very special type of
1:38 streptocus a very special type of
1:38 streptocus a very special type of streptococcus. Let me tell you what is
1:40 streptococcus. Let me tell you what is
1:40 streptococcus. Let me tell you what is this bacteria. It is streptococcus.
1:43 this bacteria. It is streptococcus.
1:43 this bacteria. It is streptococcus. So strepto
1:45 So strepto
1:45 So strepto coy streptococcus beta hemolyticus which
1:50 coy streptococcus beta hemolyticus which
1:50 coy streptococcus beta hemolyticus which group beta hemmoyticus
1:55 right which produces a strong hemolysis
1:57 right which produces a strong hemolysis
1:57 right which produces a strong hemolysis because these streptocoya produce strong
2:01 because these streptocoya produce strong
2:01 because these streptocoya produce strong hemolecence which produce the hemolysis
2:03 hemolecence which produce the hemolysis
2:03 hemolecence which produce the hemolysis of RBCS and blood agar. So this
2:06 of RBCS and blood agar. So this
2:06 of RBCS and blood agar. So this streptoco beta himmolyticus belonging to
2:09 streptoco beta himmolyticus belonging to
2:09 streptoco beta himmolyticus belonging to the lens field lens field
2:13 the lens field lens field
2:13 the lens field lens field group A
2:16 group A
2:16 group A right there was a lady called Rebecca
2:19 right there was a lady called Rebecca
2:19 right there was a lady called Rebecca Lansfield which subclassified the beta
2:22 Lansfield which subclassified the beta
2:22 Lansfield which subclassified the beta hemolyticus streptocoy according to the
2:26 hemolyticus streptocoy according to the
2:26 hemolyticus streptocoy according to the special type of cell wall carbohydrates
2:29 special type of cell wall carbohydrates
2:29 special type of cell wall carbohydrates right so according to the cell wall
2:32 right so according to the cell wall
2:32 right so according to the cell wall carbohydrates of the streptocoy rebecca
2:35 carbohydrates of the streptocoy rebecca
2:35 carbohydrates of the streptocoy rebecca lens lfield classified the bacteria into
2:39 lens lfield classified the bacteria into
2:39 lens lfield classified the bacteria into lance field group A and B C D so and so
2:44 lance field group A and B C D so and so
2:44 lance field group A and B C D so and so forth this particular bacteria which I'm
2:46 forth this particular bacteria which I'm
2:46 forth this particular bacteria which I'm talking right now this has to be
2:48 talking right now this has to be
2:48 talking right now this has to be streptococcus it has to be beta
2:50 streptococcus it has to be beta
2:50 streptococcus it has to be beta emolyticus it must belong to blood group
2:52 emolyticus it must belong to blood group
2:52 emolyticus it must belong to blood group uh it must belong to lancefield group
2:56 uh it must belong to lancefield group
2:56 uh it must belong to lancefield group a with and it has to be rumor
2:59 a with and it has to be rumor
2:59 a with and it has to be rumor rheumatenic strain rheatenic
3:03 strain there's some strain there some
3:07 strain there's some strain there some
3:07 strain there's some strain there some special strains of group A which can
3:09 special strains of group A which can
3:09 special strains of group A which can specially produce rheumatic fever. Now
3:14 specially produce rheumatic fever. Now
3:14 specially produce rheumatic fever. Now let's suppose that this person develops
3:19 let's suppose that this person develops
3:19 let's suppose that this person develops this particular streptocoal infection in
3:22 this particular streptocoal infection in
3:22 this particular streptocoal infection in the sore throat form fringitis or
3:25 the sore throat form fringitis or
3:25 the sore throat form fringitis or tonsillitis. Then what really happens as
3:28 tonsillitis. Then what really happens as
3:28 tonsillitis. Then what really happens as you know that these bacteria will be
3:31 you know that these bacteria will be
3:31 you know that these bacteria will be attacked by the macrofasages
3:33 attacked by the macrofasages
3:33 attacked by the macrofasages right and macrofasages will take up the
3:36 right and macrofasages will take up the
3:36 right and macrofasages will take up the antigens of bacteria and present to the
3:38 antigens of bacteria and present to the
3:38 antigens of bacteria and present to the immune system. Let's suppose here is
3:41 immune system. Let's suppose here is
3:41 immune system. Let's suppose here is your immune headquarter. This is your
3:46 your immune headquarter. This is your
3:46 your immune headquarter. This is your immune headquarter.
3:48 immune headquarter.
3:48 immune headquarter. This patient's immune headquarter means
3:50 This patient's immune headquarter means
3:50 This patient's immune headquarter means its immune system. Now naturally what
3:53 its immune system. Now naturally what
3:53 its immune system. Now naturally what really happens when bacteria will attack
3:55 really happens when bacteria will attack
3:55 really happens when bacteria will attack the mucosa? Bacteria will start
3:57 the mucosa? Bacteria will start
3:57 the mucosa? Bacteria will start producing damaging there and that that
3:59 producing damaging there and that that
3:59 producing damaging there and that that will result in inflammation of the
4:02 will result in inflammation of the
4:02 will result in inflammation of the ferinx and when inflammation of the
4:04 ferinx and when inflammation of the
4:04 ferinx and when inflammation of the ferinx is there naturally neutrfils and
4:06 ferinx is there naturally neutrfils and
4:06 ferinx is there naturally neutrfils and macrofages are coming there right
4:09 macrofages are coming there right
4:09 macrofages are coming there right macrofase will take up the bacteria and
4:11 macrofase will take up the bacteria and
4:11 macrofase will take up the bacteria and present the antigens of macrofasages to
4:13 present the antigens of macrofasages to
4:13 present the antigens of macrofasages to the immune system. Is that right? And
4:15 the immune system. Is that right? And
4:16 the immune system. Is that right? And what will be the result that when
4:18 what will be the result that when
4:18 what will be the result that when antigens are presented to the immune
4:21 antigens are presented to the immune
4:21 antigens are presented to the immune system, immune system will respond by
4:24 system, immune system will respond by
4:24 system, immune system will respond by producing
4:28 antibodies. Producing antibodies and
4:30 antibodies. Producing antibodies and
4:30 antibodies. Producing antibodies and sensitized lymphosytes, right? We say
4:33 sensitized lymphosytes, right? We say
4:33 sensitized lymphosytes, right? We say there will be immune response. Now,
4:35 there will be immune response. Now,
4:35 there will be immune response. Now, ideally speaking, what should happen?
4:38 ideally speaking, what should happen?
4:38 ideally speaking, what should happen? Ideally speaking
4:40 Ideally speaking
4:40 Ideally speaking in response to the streptocoal infection
4:44 in response to the streptocoal infection
4:44 in response to the streptocoal infection antistptocal immune response should be
4:47 antistptocal immune response should be
4:48 antistptocal immune response should be generated and this response this immune
4:51 generated and this response this immune
4:51 generated and this response this immune response should attack back to the
4:53 response should attack back to the
4:53 response should attack back to the bacteria.
4:55 bacteria.
4:55 bacteria. These antibodies should attack the
4:57 These antibodies should attack the
4:57 These antibodies should attack the bacteria and of course you know some of
4:59 bacteria and of course you know some of
4:59 bacteria and of course you know some of these antibodies will activate the
5:01 these antibodies will activate the
5:01 these antibodies will activate the compliments and destroy the bacteria.
5:03 compliments and destroy the bacteria.
5:03 compliments and destroy the bacteria. Some of these antibodies anti-steptocoal
5:05 Some of these antibodies anti-steptocoal
5:05 Some of these antibodies anti-steptocoal antibodies of course they will act as
5:08 antibodies of course they will act as
5:08 antibodies of course they will act as opsonin and help in rapid elimination of
5:10 opsonin and help in rapid elimination of
5:10 opsonin and help in rapid elimination of bacteria by the focitic cells.
5:14 bacteria by the focitic cells.
5:14 bacteria by the focitic cells. This is this is what ideally should
5:16 This is this is what ideally should
5:16 This is this is what ideally should happen that when a person suffer with
5:19 happen that when a person suffer with
5:19 happen that when a person suffer with streptocoal infection in the throat
5:21 streptocoal infection in the throat
5:21 streptocoal infection in the throat right immune system should be activated
5:23 right immune system should be activated
5:23 right immune system should be activated immune response should be generated and
5:27 immune response should be generated and
5:27 immune response should be generated and this immune response should eventually
5:29 this immune response should eventually
5:29 this immune response should eventually eliminate the bacteria. Is that clear?
5:32 eliminate the bacteria. Is that clear?
5:32 eliminate the bacteria. Is that clear? But you know as it happens in practical
5:35 But you know as it happens in practical
5:35 But you know as it happens in practical life everything is not ideal. Same is
5:37 life everything is not ideal. Same is
5:37 life everything is not ideal. Same is here that this type of situation that
5:41 here that this type of situation that
5:41 here that this type of situation that bacteria enters immune system activated
5:44 bacteria enters immune system activated
5:44 bacteria enters immune system activated and response is back. This type of
5:46 and response is back. This type of
5:46 and response is back. This type of situation is true in 97% of cases. This
5:50 situation is true in 97% of cases. This
5:50 situation is true in 97% of cases. This is true in 97% of cases. In about 3% of
5:55 is true in 97% of cases. In about 3% of
5:55 is true in 97% of cases. In about 3% of the patient there's a sad story. within
5:58 the patient there's a sad story. within
5:58 the patient there's a sad story. within 2 to 3% of the patient something sad
6:01 2 to 3% of the patient something sad
6:01 2 to 3% of the patient something sad happens. What happens?
6:04 happens. What happens?
6:04 happens. What happens? Listen carefully. Now
6:07 Listen carefully. Now
6:07 Listen carefully. Now if there are 100 people with this type
6:09 if there are 100 people with this type
6:09 if there are 100 people with this type of infection
6:11 of infection
6:11 of infection 97 to 98% are lucky. Why? Because when
6:14 97 to 98% are lucky. Why? Because when
6:14 97 to 98% are lucky. Why? Because when immune system gives a response this
6:16 immune system gives a response this
6:16 immune system gives a response this response is so specific that it fires
6:18 response is so specific that it fires
6:18 response is so specific that it fires back on the bacteria and destroy them.
6:21 back on the bacteria and destroy them.
6:21 back on the bacteria and destroy them. But unfortunately in about 2 to 3% of
6:24 But unfortunately in about 2 to 3% of
6:24 But unfortunately in about 2 to 3% of the population the immune system not
6:26 the population the immune system not
6:26 the population the immune system not only fire back on the bacteria
6:29 only fire back on the bacteria
6:29 only fire back on the bacteria unfortunately it attacks our own tissue
6:31 unfortunately it attacks our own tissue
6:31 unfortunately it attacks our own tissue as well. Immune system attacks our own
6:35 as well. Immune system attacks our own
6:35 as well. Immune system attacks our own tissue as well. For example this may
6:37 tissue as well. For example this may
6:37 tissue as well. For example this may attack the cardiac tissue.
6:41 attack the cardiac tissue.
6:41 attack the cardiac tissue. It may attack
6:43 It may attack
6:43 It may attack joints
6:45 joints
6:45 joints especially senuial joints.
6:48 especially senuial joints.
6:48 especially senuial joints. It may attack skin.
6:52 It may attack skin.
6:52 It may attack skin. It may attack subcutaneous tissue and it
6:56 It may attack subcutaneous tissue and it
6:56 It may attack subcutaneous tissue and it may attack central nervous
6:59 may attack central nervous
6:59 may attack central nervous system.
7:01 system.
7:01 system. Right? So unfortunately in two to 3% of
7:04 Right? So unfortunately in two to 3% of
7:04 Right? So unfortunately in two to 3% of uh people who suffer with such type of
7:07 uh people who suffer with such type of
7:07 uh people who suffer with such type of fringitis right this immune activation
7:11 fringitis right this immune activation
7:11 fringitis right this immune activation may produce leans in the skin leans in
7:13 may produce leans in the skin leans in
7:13 may produce leans in the skin leans in subcutaneous tissue leans in the central
7:16 subcutaneous tissue leans in the central
7:16 subcutaneous tissue leans in the central nervous system leans in the heart and
7:19 nervous system leans in the heart and
7:19 nervous system leans in the heart and leans in the senial joints.
7:22 leans in the senial joints.
7:22 leans in the senial joints. So what really happens in two to 3% of
7:24 So what really happens in two to 3% of
7:24 So what really happens in two to 3% of these patient they develop
7:27 these patient they develop
7:27 these patient they develop carditis they develop polyarthritis
7:31 carditis they develop polyarthritis
7:31 carditis they develop polyarthritis they develop special type of leans in
7:33 they develop special type of leans in
7:33 they develop special type of leans in the skin they develop sub those leans
7:36 the skin they develop sub those leans
7:36 the skin they develop sub those leans are called arythema marginatum and some
7:39 are called arythema marginatum and some
7:39 are called arythema marginatum and some of these patient also develop
7:41 of these patient also develop
7:41 of these patient also develop subcutaneous nodules and very
7:43 subcutaneous nodules and very
7:43 subcutaneous nodules and very unfortunate people also develop central
7:45 unfortunate people also develop central
7:45 unfortunate people also develop central nervous system problem especially uh
7:47 nervous system problem especially uh
7:48 nervous system problem especially uh motor disturbances and korea. So what
7:52 motor disturbances and korea. So what
7:52 motor disturbances and korea. So what what is happening there right? We can
7:55 what is happening there right? We can
7:56 what is happening there right? We can say bacteria has activated the immune
7:59 say bacteria has activated the immune
7:59 say bacteria has activated the immune system in majority of the people immune
8:01 system in majority of the people immune
8:01 system in majority of the people immune system will react in a very appropriate
8:03 system will react in a very appropriate
8:03 system will react in a very appropriate way and eliminate the bacteria only. But
8:05 way and eliminate the bacteria only. But
8:05 way and eliminate the bacteria only. But in some vulnerable patient who are
8:07 in some vulnerable patient who are
8:07 in some vulnerable patient who are genetically vulnerable 2 to 3% of the
8:09 genetically vulnerable 2 to 3% of the
8:09 genetically vulnerable 2 to 3% of the population this immune system which is
8:11 population this immune system which is
8:11 population this immune system which is triggered by the immune response which
8:13 triggered by the immune response which
8:14 triggered by the immune response which is triggered by that streptocoal
8:16 is triggered by that streptocoal
8:16 is triggered by that streptocoal fringitis that immune response
8:17 fringitis that immune response
8:18 fringitis that immune response inappropriately
8:19 inappropriately
8:19 inappropriately crossreact with our own tissues. Why it
8:22 crossreact with our own tissues. Why it
8:22 crossreact with our own tissues. Why it happens so because some of the bacterial
8:25 happens so because some of the bacterial
8:25 happens so because some of the bacterial antigens are very similar with our own
8:27 antigens are very similar with our own
8:27 antigens are very similar with our own antigens. Some of the bacterial antigens
8:30 antigens. Some of the bacterial antigens
8:30 antigens. Some of the bacterial antigens are very very similar with our own
8:33 are very very similar with our own
8:33 are very very similar with our own antigens. For example, in the bacterial
8:36 antigens. For example, in the bacterial
8:36 antigens. For example, in the bacterial suppose here is the bacteria
8:39 suppose here is the bacteria
8:39 suppose here is the bacteria right and this is the membrane of the
8:42 right and this is the membrane of the
8:42 right and this is the membrane of the bacteria cell membrane of the bacteria
8:44 bacteria cell membrane of the bacteria
8:44 bacteria cell membrane of the bacteria and here is cell wall of the bacteria
8:49 and here is cell wall of the bacteria
8:49 and here is cell wall of the bacteria gram positive bacteria. Now listen they
8:53 gram positive bacteria. Now listen they
8:53 gram positive bacteria. Now listen they say some of the antigens which are
8:55 say some of the antigens which are
8:55 say some of the antigens which are present in the capsule carbohydrate
8:56 present in the capsule carbohydrate
8:56 present in the capsule carbohydrate antigens they're very very structurally
8:59 antigens they're very very structurally
8:59 antigens they're very very structurally similar with cardiac valves. So when
9:02 similar with cardiac valves. So when
9:02 similar with cardiac valves. So when immune system react against these immune
9:05 immune system react against these immune
9:06 immune system react against these immune system is reacting against these cell
9:09 system is reacting against these cell
9:09 system is reacting against these cell wall components it may crossreact with
9:11 wall components it may crossreact with
9:11 wall components it may crossreact with the cardiac glyoproteins and some other
9:15 the cardiac glyoproteins and some other
9:15 the cardiac glyoproteins and some other people claim that some of the proteins
9:17 people claim that some of the proteins
9:17 people claim that some of the proteins which are present in the cell membrane
9:20 which are present in the cell membrane
9:20 which are present in the cell membrane of the bacteria especially protein M.
9:23 of the bacteria especially protein M.
9:23 of the bacteria especially protein M. The protein M in the bacterial cell
9:25 The protein M in the bacterial cell
9:25 The protein M in the bacterial cell membrane is very very similar with some
9:28 membrane is very very similar with some
9:28 membrane is very very similar with some of the proteins in our own tissue like
9:30 of the proteins in our own tissue like
9:30 of the proteins in our own tissue like mioardial cells saroma of the mio
9:32 mioardial cells saroma of the mio
9:32 mioardial cells saroma of the mio myioardial cell. So they say that
9:36 myioardial cell. So they say that
9:36 myioardial cell. So they say that there is a great deal of antigenic
9:40 there is a great deal of antigenic
9:40 there is a great deal of antigenic micray.