2. INTRODUCTION
• Rheumatic heart disease describes a group of short-term (acute) and
long-term (chronic) heart disorders that can occur as a result of
rheumatic fever. One common result of rheumatic fever is heart
valve damage. Every part of the heart, including the outer sac (the
pericardium), the inner lining (the endocardium) and the valves may be
damaged by inflammation caused by acute rheumatic fever. it usually
occurs in children between the ages of 5 and 15 years.
• Valvular heart disease is any .Disease process involving one or more
of the valves of the heart (the aortic and mitral valves on the left and
the pulmonary and tricuspid valves on the right).
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3. RHEUMATIC FEVER
• Rheumatic fever is an inflammatory
disease that occurs following a
Streptococcus pyogenes infection, such
as streptococcal pharyngitis that may
affect many connective tissues of the
body, especially those of the heart, joints,
brain or skin. It usually starts out as a
strep throat (streptococcal) infection.
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4. ETIOLOGY
• Infection with the Group A
Streptococcus (GAS) bacterium.
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5. RISK FACTORS
• Factors that may increase the risk of rheumatic fever include:
• Family history (genes)
• Type of strep bacteria Certain strains of strep bacteria are
more likely to contribute to rheumatic fever than are other
strains.
• Environmental factors A greater risk of rheumatic fever is
associated with overcrowding, poor sanitation, and other
conditions that may easily result in the rapid transmission or
multiple exposures to strep bacteria.
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6. SIGNS AND SYMPTOMS
• Rheumatic fever signs and symptoms — which result from
inflammation in the heart, joints, skin or central nervous
system and may include:
• Fever
• Painful and tender joints most often the ankles, knees,
elbows or wrists; less often the shoulders, hips, hands and
feet
• Pain in one joint that migrates to another joint
• Red, hot or swollen joints
• Small, painless nodules beneath the skin
• Chest pain
• Sensation of rapid, fluttering or pounding heartbeats
(palpitations)
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7. • Fatigue
• Shortness of breath
• Flat or slightly raised, painless rash with a
ragged edge (erythema marginatum)
• Jerky, uncontrollable body movements
(Sydenham chorea or St. Vitus' dance) most
often in the hands, feet and face
• Outbursts of unusual behavior, such as crying or
inappropriate laughing, that accompanies
Sydenham chorea
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8. JONES CRITERIA
• Modified Jones criteria were first published in 1944 by T. Duckett Jones
• MAJOR CRITERIA
• Polyarthritis :A temporary migrating inflammation of the large joints, usually starting
in the legs and migrating upwards.
• Carditis: Inflammation of the heart muscle (myocarditis) which can manifest as
congestive heart failure with shortness of breath, pericarditis with a rub, or a new
heart murmur.
• Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or
tendons. They commonly appear on the back of the wrist, the outside elbow, and the
front of the knees.
• Erythema marginatum: A long-lasting reddish rash that begins on the trunk or arms
as macules, which spread outward and clear in the middle to form rings, which
continue to spread and coalesce with other rings, ultimately taking on a snake-like
appearance.
• Sydenham's chorea (St. Vitus' dance): A characteristic series of rapid movements
without purpose of the face and arms. This can occur very late in the disease for at
least three months from onset of infection.
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9. MINOR CRITERIA
• Fever of 38.2–38.9 °C (101–102 °F)
• Arthralgia: Joint pain without swelling (Cannot be included if
polyarthritis is present as a major symptom)
• Raised erythrocyte sedimentation rate or C reactive protein
• Leukocytosis
• ECG showing features of heart block, such as a prolonged PR
interval (Cannot be included if carditis is present as a major
symptom)
• Previous episode of rheumatic fever or inactive heart disease
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10. COMPLICATIONS
• Rheumatic fever results in rheumatic heart disease and
involves;
• Valve stenosis. This condition is a narrowing of the valve, which results in
decreased blood flow.
• Valve regurgitation. This condition is a leak in the valve, which allows
blood to flow in the wrong direction.
• Damage to heart muscle. The inflammation associated with rheumatic
fever can weaken the heart muscle, resulting in poor pumping function.
• Damage to the mitral valve, other heart valves or other heart tissues can
cause problems with the heart later in life. Resulting conditions may include:
• Atrial fibrillation, an irregular and chaotic beating of the upper chambers of
the heart (atria)
• Heart failure, an inability of the heart to pump enough blood to the body
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11. RHEUMATIC HEART DISEASE
The term "rheumatic heart disease" refers to the
chronic heart valve damage that can occur after a
person has had an episode of acute rheumatic fever.
This valve damage can eventually lead to heart
failure.
Acute rheumatic fever often produces inflammation of
the heart (carditis). This carditis affects virtually all
parts of the heart - the pericardial, or exterior, surface
of the heart (pericarditis); the heart muscle itself
(myocarditis); and the endocardial, or interior, surface
of the heart (endocarditis).
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12. CARDIAC PROBLEMS WITH
RHEUMATIC HEART DISEASE
• MITRAL VALVE DISEASE is the most common cardiac problem seen in
rheumatic heart disease. In rheumatic heart disease, the mitral valve
becomes laden with heavy deposits of calcium, which disrupt the normal
function of the valve. Because of these heavy calcium deposits, the valve
often fails to open completely (a condition called mitral stenosis). The same
calcium deposits can also prevent the valve from closing completely, leading
to mitral regurgitation (a "leaky" valve).
• AORTIC VALVE DISEASE is also common in rheumatic heart disease
rheumatic aortic valves can develop either stenosis or regurgitation, or both.
• HEART FAILURE:Rheumatic heart disease can tremendously increase the
workload on the heart muscle, and as a result heart failure frequently
develops, often after a period of many years.
• ATRIAL FIBRILLATION is very commonly seen in rheumatic heart disease,
especially if the mitral valve is involved.
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13. RISK FACTORS OF RHD
•
Risk factors include;
• poverty
• overcrowding and
• reduced access to medical care.
• Stopping episodes of recurrent ARF can prevent
rheumatic heart disease. Once acute rheumatic fever
is diagnosed, stopping further episodes of ARF can
halt progression of the disease. Treatment can
manage symptoms and reduce the risk of
complications.
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14. SYMPTOMS OF RHD
•
•
•
•
•
Chest pain
Heart palpitations
Breathlessness on exertion
Breathing problems when lying down (orthopnoea)
Waking from sleep with the need to sit or stand up
(paroxysmal nocturnal dyspnoea)
• Swelling (oedema)
• Fainting (syncope)
• Stroke
• Fever associated with infection of damaged heart
valves.
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15. DIAGNOSIS
• Diagnosis may include:
• Physical examination – while a heart murmur may suggest
RHD, many patients with RHD do not have a murmur
• Medical history – including evidence of past ARF or strep
infection
• Chest x-ray – to check for enlargement of the heart or fluid on
the lungs
• Electrocardiogram (ECG) – to check if the chambers of the
heart have enlarged or if there is an abnormal heart rhythm
(arrhythmia)
• Echocardiogram – to check the heart valves for any damage
or infection and assessing if there is heart failure. This is the
most useful test for finding out if RHD is present.
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16. TREATMENT
•
•
•
•
•
Treatment depends on the severity of rheumatic
heart disease, but may include:
Hospital admission to treat heart failure
Antibiotics for infection (especially of the heart
valves)
Blood-thinning medicine to prevent stroke or thin
blood for replacement valves
Balloons inserted through a vein to open up stuck
valves (VALVULOPLASTY)
Heart valve surgery to repair or replace damaged
heart valves.
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17. VALVE DISEASES
• Heart valve disease occurs if one or more of
your heart valves don't work well. The heart has
four valves: the tricuspid, pulmonary, mitral, and
aortic valves.
• These valves have tissue flaps that open and
close with each heartbeat. The flaps make sure
blood flows in the right direction through your
heart's four chambers and to the rest of your
body.
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18. TYPES OF VALVE
DISEASE
• There are several types of valve disease:
• Valvular stenosis This occurs when a valve opening is smaller
than normal due to stiff or fused leaflets. The narrowed opening
may make the heart work very hard to pump blood through it.
This can lead to heart failure and other symptoms.
• Valvular insufficiency Also called regurgitation, incompetence
or "leaky valve", this occurs when a valve does not close tightly.
If the valves do not seal, some blood will leak backwards
across the valve. As the leak worsens, the heart has to work
harder to make up for the leaky valve, and less blood may flow
to the rest of the body.
• Atresia occurs if a heart valve lacks an opening for blood to
pass through.
•
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20. CAUSES
•
•
•
•
•
•
Congenital valve disease. Most often affects the aortic or pulmonic valve. Valves
may be the wrong size, have malformed leaflets, or have leaflets that are not
attached to the annulus correctly.
Bicuspid aortic valve disease is a congenital valve disease that affects the aortic
valve
Acquired valve disease. These may involve changes in the structure or your valve
due to a variety of diseases or infections, including rheumatic fever or endocarditis.
Endocarditis occurs when germs, especially bacteria, enter the bloodstream and
attack the heart valves, causing growths and holes in the valves and scarring. This
can lead to leaky valves. prolapse without thickening or regurgitation/leaking) are at
increased risk for developing this life-threatening infection.
changes in the valves of the heart. The chordae tendinea or papillary muscles can
stretch or tear; the annulus of the valve can dilate (become wide); or the valve
leaflets can become fibrotic (stiff) and calcified.
Mitral valve prolapse (MVP) is a very common condition, affecting 1 to 2 percent of
the population. MVP causes the leaflets of the mitral valve to flop back into the left
atrium during the heart's contraction. MVP also causes the tissues of the valve to
become abnormal and stretchy, causing the valve to leak.
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21. • Other causes of valve disease include:
coronary artery disease
heart attack,
cardiomyopathy (heart muscle disease)
syphilis (a sexually transmitted disease)
hypertension
aortic aneurysms and
connective tissue diseases.
Less common causes of valve disease include
tumors, some types of drugs and radiation.
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22. SYMPTOMS
•
•
•
•
•
Shortness of breath
Weakness or dizziness
Discomfort
Palpitations
Swelling of your ankles, feet or
abdomen
• Rapid weight gain
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23. DIAGNOSIS
History taking AND Physical examination
Diagnostic tests may include:
Echocardiography
Transesophageal echocardiography
Cardiac catheterization (also called an
angiogram)
Radionuclide scans
Magnetic resonance imaging (MRI)
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24. TREATMENT
• Goals of treating heart valve disease
• Preventing,
treating,
or
relieving
the
symptoms of other related heart conditions.
• Protecting heart valves from further damage.
• Repairing or replacing faulty valves
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25. PREVENTING, TREATING, OR RELIEVING
THE SYMPTOMS OF OTHER RELATED
HEART CONDITIONS
• COMMON TYPES OF MEDICATIONS
• Diuretics ("water pills")
• Antiarrhythmic medications:Control the heart's rhythm
• Vasodilators
• ACE inhibitors
• Beta blockers
• Anticoagulants ("blood thinners")
• Prolong the clotting time of your blood, if you are at risk for
developing blood clots on your heart valve.
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26. PROTECTING HEART VALVES
FROM FURTHER DAMAGE
• Antibiotics before procedures
• (especially dental procedures)
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27. REPAIRING HEART VALVES
• Heart surgeons can repair heart valves by:
Separating fused valve flaps
Removing or reshaping tissue so the valve can
close tighter
Adding tissue to patch holes or tears or to
increase the support at the base of the valve
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32. CONCLUSION
• Rheumatic heart disease (RHD) is a consequence of acute rheumatic
fever (ARF). While ARF usually occurs between 5 and 15 years of age,
it can also occasionally occur in adulthood. RHD is particularly
associated with damage to the valves of the heart. ARF is caused by
infection with the Group A Streptococcus bacterium.
• People with valvular heart disease are living longer, with less
morbidity, than ever before. Advances in surgical techniques and a
better understanding of timing for surgical intervention account for
increased rates of survival. Aside from antibiotic prophylaxis, very little
medical therapy is available for patients with valvular heart disease;
surgery is the treatment for most symptomatic lesions or for lesions
causing left ventricular dysfunction even in the absence of symptoms.