The significance of rheumatic fever in the etiology of coronary artery disease and thrombosis

Abstract

Coronary thrombosis is relatively rare in patients with rheumatic valvular disease. At necropsy the coronary arteries of young patients with rheumatic heart disease showed strikingly little arteriosclerotic change. The age period of our series corresponds to that of ordinary cases of coronary sclerosis. In this material the degenerative changes of the coronary arteries corresponded roughly to the ages of the patients. A rheumatic subject without aortic insufficiency or active carditis who develops anginal pain may have an independent coronary arteriosclerosis. On the other hand, a patient with arteriosclerotic heart disease who shows enlargement of the right heart or the left auricle out of proportion to congestive failure may have an associated rheumatic lesion of the mitral valve. We believe that the most significant reason for the infrequent association of rheumatic and arteriosclerotic heart disease is that rheumatic fever runs its course before the degenerative period of heart disease. Those who survive middle life, especially if they develop hypertension or diabetes mellitus, may develop arteriosclerotic heart disease. Rheumatic fever per se does not, however, appear to predispose to coronary arteriosclerosis.