rheumatic heart disease.docx

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Rheumatic Heart Disease

Rheumatic Heart Disease caused by recurrent episodes of rheumatic fever; characterized by

changes in the myocardium or scarring of the heart valves that reduce the power of the heart to

pump blood

Rheumatic fever principally involves the heart, joints, CNS (Central Nervous System),

skin, subcutaneous tissues.

The term Rheumatic heart disease refers to the cardiac involvement develops to 50% of

patients and may affect the endocardium, myocardium or pericardium. It may later affect

the heart valves, causing chronic valvular disease.

The extent of damage to the heart depends on where the disorder strikes.

Causative Factors

• GABS (Group A Beta- Hemolytic Streptococci)

• Rheumatic fever



Signs and Symptoms

• Poly arthritis- sharp, sudden pain starts over sternum and radiates to neck, shoulders,

back and arms.

• Erythema marginatum- a non- pruritic, muscular, transient rash.

• Subcutaneous nodules- a firm, movable, nontender and about 3 mm-2 cm in diameter.

• Transient chorea- involuntary grimace and an inability to use skeletal muscles in a

coordinated manner.

• Heart murmur

• CHF

Laboratory and Diagnostic Test

There is no diagnostic studies are specific for rheumatic heart disease, but the following can support the

diagnosis:

• WBC count and ESR is elevated

• C- reactive protein is positive.

• Cardiac enzmes levels may increase in severe carditis.(Creatine Kinase and Troponin)

• Anti streptolysin- O titser is elevated 95% of patients with in 2 months onset.

• Throat cultures continue to presence of GABS; however they usually occur in small

numbers. Isolating them is difficult.

• ECG reveals no diagnostic changes, but 20% of patient show a prolonged PR interval.

• Echocardiography helps evaluate valvular damage, chamber size, ventricular function

and the presence of a pericardial effusion.

• Cardiac catheter evaluates valvular damage and left ventricular function in severe cardiac

dysfunction.

Treatment

Severe mitral or aortic valve dysfunction that causes persistent heart failure requires corrective surgery

such as:

• Commissurotomy

• Valvuloplasty

• Valve replacement



Valve Replacement

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