Your SlideShare is downloading. ×
Rheumatic Heart Disease
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Rheumatic Heart Disease

11,958
views

Published on

Published in: Health & Medicine

1 Comment
7 Likes
Statistics
Notes
No Downloads
Views
Total Views
11,958
On Slideshare
0
From Embeds
0
Number of Embeds
15
Actions
Shares
0
Downloads
681
Comments
1
Likes
7
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Dr.Rajkumar Patil Asstt. Prof., Community Medicine AVMCH, Pondicherry
  • 2.  
  • 3. RF is the most common cause of heart disease in 5-30 yr age group
  • 4.  
  • 5.
    • RHD in India
    • Prevalence: 5/1000 population of 5-15 age group
    • 1 million RHD cases in India
    • Hospital admissions due to RHD is 20-30% of CVD
  • 6.
    • Acute rheumatic fever (ARF) is a systemic disease of childhood
    • It is a delayed non-suppurative sequelae to URTI with GABH streptococci
    • It is a diffuse inflammatory disease of connective tissue,primarily involving heart,blood vessels,joints, subcut.tissue and CNS
  • 7. Epidemiological Factors
  • 8. Agent
  • 9.
    • Age:
    • 5-15 yrs(most susceptible)
    • Sex:
    • both
    • Environmental factors
    • over crowding, poor sanitation, poverty
    • Incidence more during
    • winter & early spring
    Host Factors
  • 10.  
  • 11.
    • Flitting & fleeting migratory polyarthritis, involving major joints
    • Commonly involved joints-knee,ankle,elbow & wrist
    • Occur in 80%,involved joints are exquisitely tender
    • In children below 5 yrs:It is mild but carditis is more prominent
    • Arthritis do not progress to chronic disease
    1.Arthritis
  • 12.
    • Manifest as pancarditis (endocarditis, myocarditis and pericarditis),occur in 50% of cases
    • Carditis is the only manifestation of rheumatic fever that leaves a sequelae & permanent damage to the organ
    • Valvulitis occur in acute phase
    • Chronic phase- fibrosis,calcification & stenosis of heart valves (fishmouth valves)
    2.Carditis
  • 13. Rheumatic heart disease . Abnormal mitral valve. Thick, fused chordae
  • 14.
    • Occur in 5-10% of cases
    • Mainly in girls of 1-15 yrs age
    • Clinically manifest as-clumsiness, deterioration of handwriting, emotional lability or grimacing of face
    • Clinical signs- pronator sign, jack in the box sign , milking sign of hand s
    3.Sydenham Chorea
  • 15.
    • Occur in <5%.
    • Unique,transient,serpiginous lesions of 1-2 inches in size
    • Pale center with red irregular margin
    • More on trunks & limbs & non-itchy
    • Worsens with application of heat
    • Often associated with chronic carditis
    4.Erythema Marginatum
  • 16.
    • Occur in 10%
    • Painless,pea-sized,palpable nodules
    • Mainly over extensor surfaces of joints,spine,scapulae & scalp
    • Associated with strong seropositivity
    • Always associated with severe carditis
    5.Subcutaneous nodules
  • 17.
    • Fever(mild)
    • Polyarthralgia
    • Pallor
    • Anorexia
    • Loss of weight
    Other features (Minor features)
  • 18.  
  • 19.  
  • 20.
    • Chorea alone, if other causes have been excluded
    • Insidious or late-onset carditis with no other explanation
  • 21.
    • Juvenile rheumatiod arthritis
    • Septic arthritis
    • Sickle-cell arthropathy
    • Kawasaki disease
    • Myocarditis
    • Scarlet fever
    • Leukemia
  • 22. Prevention and control
    • To prevent the first attack of RF,by detection and
    • treatment of streptococcal throat inf.
    • Many inf are inapparent or undiagnosed
    • High risk approach:
    • Surveillance for streptococcal pharyngitis
    • among school children
    Primary prevention
  • 23. Sore throat should be swabbed and cultured If strepto.— Give Penicillin (If culture is not possible a sore throat can be treated with Benzathine Benzyl Penicillin) Dose: One IM inj.,1.2 miilion units(adults),0.6 million units(children) Or Oral Penicillin G/Penicillin V for 10 days Erythromycin (In case of allergy to Penicillin) Primary prevention contd…
  • 24. Secondary Prevention
  • 25.
    • Other measures in Secondary Prevention
    • Surveys to know the prevalence of RHD
    • among school children
    • Every 5 years in 6-14 years age group
  • 26.
    • Rheumatic fever can recur whenever the individual experience new GABH streptococcal infection,if not on prophylactic medicines
    • Good prognosis for older age group & if no carditis during the initial attack
    • Bad prognosis for younger children & those with carditis with valvar lesions