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April 13, 2021
Rheumatic Heart Disease Karl Albert Ludwig Aschoff

Karl Albert Ludwig Aschoff (1866-1942)

Zur Myocarditisfrage. Verh. Dtsch. Path. Ges., 1904, 8, 46-53

Karl Albert Ludwig Aschoff
Portrait of Karl Albert Ludwig Aschoff
Portrait of Karl Albert Ludwig Aschoff

Ludwig Aschoff was a German pathologist with outstanding contributions to the histologic study of the normal heart and to cardiac pathology.

In the introduction of his work, "Zur Myocarditisfrage" (Concerning the question of Myocarditis), Aschoff referred to Krehl and Romberg, from the university of leipzig, who had shown significant histologic alterations in the myocardium with interstitial inflammation in some protracted cases of scarlet fever, diphteria and typhoid fever complicated with heart failure. Subsequently, The leipzig group postulated that heart failure in patients with valvular regurgitation  was due to interstitial myocarditis.

To further investigate this theory, Aschoff asked his pupil, Sunao Tawara, to perform detailed histologic examinations of 150 hearts, some affected with rheumatic heart disease and valvular insufficiency. Aschoff and Tawara's investigational study did not confirm the theory of myocarditis as the primary cause of heart failure in patients with valvular disease, but their research led to the identification of "peculiar nodules, which appear to be specific for rheumatic myocarditis."

In his histologic description, Aschoff noted :

"...They [nodules] regularly occur in the neighborhood of small or medium-sized vessels, and most frequently were present in the vicinity of the adventitia. Or there existed simultaneously  a disease of all the vascular layers, such as is described in arteritis nodosa. The aforementioned nodules are unusually small, mostly submiliary, and originate by the conglomeration of large elements, with one or more abnormally large indented or polymorphic nuclei.  The arrangement of the cells frequently occurs in the form of a fan or a rosette.  The periphery is formed by the large nuclei, the center by the paler or colorless appearing necrotic mass of confluent cell protoplasm."

He also mentioned the presence of polymorphonuclear leucocytes and lymphocytic infiltration. He then continued to describe the multinucleated giant cells :

"In these richly cellular projections are found isolated cells with large nuclei, with all the transitions to a simple large leukocytoid element, which are even found in a normal manner in the neighborhood of the smallest vessels and appear very distinct in all inflammations...From these large cells, which are the inflamed swollen adventitial cells of the vessels, the giant cell-like large nucleated element arises, these appear singly or are collected in nodules, and give the rheumatic cellular infiltration  its peculiar configuration. "

The illustrations shown below are from Coombs' outstanding book, "Rheumatic heart disease."

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Aschoff and Tawara were the first to identify these specific myocardial lesions in rheumatic heart disease: "As we have the large cell nodule formation only in rheumatic endocarditis, and never in the typhoid heart, diphteria heart, et cetera, we believe it permissible to conclude that it is especially characteristic of rheumatic myocarditis."  These nodules are now called  "Aschoff bodies."

Aschoff and Tawara also had major contributions with reference to the conduction system of the heart and discovered the atrioventricular node after extensive histological studies.  These results were published in Tawara's monograph entitled, "Das reizleitungssystem des saugetierherzens", in 1906. The atrioventricular node is also called Aschoff-Tawara node.


Aschoff L.  Zur myocarditisfrage (Concerning the question of myocarditis), in Cardiac Classics (Eds. Willius FA, Keys TE), St. Louis, Mosby, 1941

Coombs CF. Rheumatic heart disease. New York, William Wood, 1924


Jean Baptiste Bouillaud Frederick John Poynton