endocardium is most commonly affected although a myocarditis can occur as part of a pancarditis
valves on the left side of the heart are mainly affected, with mitral valvulitis the most common lesion
vegetations in acute rheumatic fever are, in general, small and acutely attached to the surface of the endocardium. This contrasts with the large and friable vegetations that are characteristic of infective endocarditis
pathological changes:
acute stage: oedema and cellular infiltration of the leaflets and chordae tendinae which lead to incomplete closure of the valve
chronic stage: subsequent fibrosis results in deformity and shortening of the leaflets and shortening of the chordae tendinae. This process results in valve stenosis +/- valve incompetence
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