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Seminar On Rheumatic Heart Disease: by Zerihun Getachew
Seminar On Rheumatic Heart Disease: by Zerihun Getachew
Seminar on
Rheumatic heart
Disease
23/03/2013 by zerihun getachew 1
Content:-
Introduction
Epidemiology
Etiology and risk factor
Pathophysiology
Pattern of cardiac valve disease
Clinical presentation and Diagnosis
Management/ treatment
If Strep A and ARF go untreated, repeated infections are more likely to occur.
The valvular lesions begin as small verrucae composed of fibrin and blood cells along
The mitral valve is affected most often, followed in frequency by the aortic valve; right-
Long-term consequences of RHD may include stroke, heart failure, and premature
mortality.
23/03/2013 by zerihun getachew 4
EPIDEMIOLOGY
ARF is mainly a disease of children age 5–15 years but, rare in persons age >40
and < 4 years.
Initial episodes become less common in older adolescents , young adults.
By contrast, recurrent episodes of ARF remain relatively common in adolescents
and young adults.
This pattern contrasts with the prevalence of RHD, which peaks between
25 and 40 years.
There is no clear gender association for ARF, but RHD more commonly affects
females, sometimes up to twice as frequently as males.
Over crowding
Age
Sometimes these antibodies, in addition to killing the strep, can damage the heart
valve.
Acute rheumatic fever can occur following an untreated strep throat infection and
can cause irreversible damage to the major cardiac valves, known as rheumatic
heart disease.
23/03/2013 by zerihun getachew 9
Pathophysiology
Exposure
pharyngitis
to GABS
RF
Heart
RHD
23/03/2013 by zerihun getachew 10
PATTERNS OF VALVULAR DISEASE
1. MITRAL INSUFFICIENCY
Mitral insufficiency is the result of structural changes that usually include some
loss of valvular substance or shortening and thickening of the chordae tendineae.
During acute rheumatic fever with severe cardiac involvement, heart failure is
caused by a combination of mitral insufficiency coupled with inflammatory disease
of the pericardium, myocardium, endocardium, and epicardium.
Because of the high volume load and inflammatory process, the left ventricle
becomes enlarged.
The left atrium dilates as blood regurgitates into this chamber.
Increased left atrial pressure results in pulmonary congestion and symptoms of
left-sided heart failure
In patients with severe chronic mitral insufficiency, pulmonary arterial pressure
becomes elevated, the right ventricle and atrium become enlarged, and right-sided
The effects of chronic mitral insufficiency may become manifest after many years and
More severe degrees of obstruction are associated with exercise intolerance and
dyspnea.
Combined mitral and aortic insufficiency is more common than aortic involvement
alone
aortic insufficiency, the heart is enlarged, with a left ventricular apical heave.
23/03/2013 by zerihun getachew 17
Cont..
The murmur is heard over the upper and midleft sternal border with radiation to
An apical presystolic murmur (Austin Flint murmur) resembling that of mitral
Concomitant signs of mitral or aortic valve disease, with or without atrial fibrillation,
are frequent
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PULMONARY VALVE DISEASE
Pulmonary insufficiency usually occurs on a functional basis secondary to
The murmur (Graham Steell murmur) is similar to that of aortic insufficiency, but
GAS infection.
Major minor
Carditis Arthralgia
Subcutaneous nodules
23/03/2013 by zerihun getachew 24
Cont..
Diagnosis of acute rheumatic fever is established with: 2 major criteria or 1 major
and 2 minor criteria and supporting evidence for antecedent streptococcal
pharyngitis (mandatory).
Strict adherence to Jones criteria is not needed under the following situations:
Sydenham’s chorea
Indolent carditis
Rheumatic fever recurrence
culture results, the patient should receive 10 days of orally administered penicillin
The usual dose of prednisone is 2mg/kg/day in 4 divided doses for 2-3 wk,
followed by half the dose for 2-3 wk. and then tapering of the dose by 5mg/24 hr
every 2-3 days.
If heart failure develops treatment, include ACEI, BB, and Diuretics.
Patients with carditis and more than minimal cardiomegaly and/or congestive
heart failure should receive corticosteroids.
Bed rest is usually advised to reduce cardiac effort until evidence of inflammation
has subside.