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Rheumatic Heart Disease
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Rheumatic Heart Disease ICD-10:
Rheumatic Heart Disease
Rheumatic heart
disease (RHD) is a
chronic,
inflammatory
disease of the heart
that develops in
susceptible
individuals following
a group A
streptococcal (GAS)
infection, such as
strep throat or
scarlet fever. The
inflammation
primarily targets the
heart valves,
leading to fibrosis
and scarring, and
ultimately, valve
dysfunction.
Valves of the Heart:
Introduction
Valves Of The Heart
โ€ข Mitral Valve:
Located between
the left atrium and
left ventricle.
Responsible for
preventing blood
from flowing back
into the left atrium
during ventricular
contraction.
โ€ข Aortic Valve:
Located between
the left ventricle
and the aorta.
Responsible for
preventing blood
from flowing back
into the left
ventricle during
diastole.
Tricuspid Valve:
Located between
the right atrium
and right ventricle.
Responsible for
preventing blood
from flowing back
into the right
atrium during
ventricular
contraction.
Pulmonary Valve:
Located between
the right ventricle
and the pulmonary
artery. Responsible
for preventing
blood from flowing
back into the right
ventricle during
diastole.
Prevalence
Prevalence
โ€ข It affects an
estimated 40
million people
worldwide,
causing
approximately
300,000 deaths
annually.
โ€ข The majority of
cases occur in
children and
young adults, with
a higher
prevalence in
females.
Prevalence
Risk factors
โ€ข Previous GAS
infections:
Recurrent GAS
infections,
especially without
adequate antibiotic
treatment,
increase the risk of
developing RHD.
โ€ข Socioeconomic
disparities:
Poverty,
overcrowding, and
inadequate access
to hygiene and
healthcare
contribute to the
spread of GAS and
RHD.
Risk factors
โ€ข Genetic
predisposition:
Some individuals
have a genetic
predisposition to
developing RHD,
making them more
susceptible to the
disease even after a
single GAS
infection.
โ€ข Malnutrition:
Malnutrition can
weaken the immune
system and
increase
susceptibility to
infections like GAS.
Risk factors
Risk factors
Pathophysiology
โ€ข Autoimmune
Response: RHD
arises from an
autoimmune response
to Group A
streptococcal (GAS)
infection, specifically
targeting the heart
valves.
โ€ข Molecular Mimicry: M
proteins on GAS
share structural
similarities with
antigens in heart valve
tissues, triggering an
immune response that
mistakenly attacks
both.
โ€ข Inflammation and
Fibrosis: Immune cells
infiltrate the valves,
causing inflammation
and damage. Fibrosis
and scarring follow,
leading to valve
dysfunction.
Pathophysiology
Aortic Regurgitation
โ€ข Cause: Damage to
the aortic valve
leaflets or supporting
structures prevents
proper closure during
diastole, leading to
blood flow back into
the left ventricle.
โ€ข Symptoms: Fatigue,
shortness of breath,
chest pain,
palpitations, and heart
failure in severe
cases.
โ€ข Diagnosis:
Echocardiography
remains the gold
standard, revealing
valve regurgitation
and chamber
enlargement.
Mitral Stenosis
โ€ข Cause: Thickening
and fusion of the
mitral valve leaflets
restrict blood flow
from the left atrium to
the left ventricle.
โ€ข Symptoms: Fatigue,
shortness of breath,
especially on exertion,
chest pain, and
hemoptysis (coughing
up blood) in severe
cases.
โ€ข Diagnosis:
Echocardiography
reveals narrowed
valve opening,
pressure gradients,
and chamber
enlargement.
Aortic Stenosis
โ€ข Cause: Calcification
and narrowing of the
aortic valve opening
restricts blood flow
from the left ventricle
to the aorta.
โ€ข Symptoms: Fatigue,
shortness of breath,
chest pain, syncope
(fainting), and angina
(chest pain due to
heart muscle
ischemia).
โ€ข Diagnosis:
Echocardiography
reveals a narrowed
valve opening,
increased pressure
gradients across the
valve, and potential
left ventricular
hypertrophy.
Normal Aortic Valve
โ€ข The normal aortic
valve consists of
three cusps
(leaflets) that
open and close
smoothly,
ensuring
unidirectional
blood flow during
systole
(ventricular
contraction) and
diastole
(ventricular
relaxation).
Stenotic Aortic Valve
โ€ข In RHD, the aortic
valve leaflets
become
thickened,
calcified, and
may fuse,
restricting blood
flow and causing
the heart to work
harder to pump
blood.
Symptoms
โ€ข Variable
depending on the
affected valve(s)
and severity of
disease.
โ€ข General: Fatigue,
shortness of
breath, chest
pain, palpitations,
fever, weight loss.
โ€ข Mitral Valve:
Shortness of
breath,
particularly on
exertion, fatigue,
cough,
hemoptysis
(coughing up
blood).
โ€ข Aortic Valve:
Fatigue,
shortness of
breath, chest
pain, syncope
(fainting), angina
(chest pain due to
heart muscle
ischemia).
โ€ข Tricuspid Valve:
Fatigue,
shortness of
breath, abdominal
discomfort,
swelling in the
legs and ankles
(edema).
โ€ข Pulmonary Valve:
Fatigue,
shortness of
breath, chest
pain, right-sided
heart failure
symptoms.
Symptoms
โ€ข Chest pain
โ€ข Swollen joints
โ€ข Fever
โ€ข Weariness
โ€ข Heart palpitation
โ€ข Skin nodules
Diagnosis
โ€ข Medical history:
Assessing prior
GAS infections and
symptoms.
โ€ข Physical
examination:
Listening for heart
murmurs and other
signs of valve
dysfunction.
โ€ข Echocardiography:
The gold standard
for diagnosis,
visualizing the heart
valves and
assessing their
function.
Diagnosis
โ€ข Blood tests: Ant
streptolysin O
(ASO) titer and
other markers of
inflammation can
suggest recent
GAS infection.
โ€ข Electrocardiogram
(ECG): May show
abnormalities in
heart rhythm or
conduction.
โ€ข Chest X-ray: Can
reveal enlarged
heart chambers in
advanced cases.
Treatment
โ€ข Antibiotic
prophylaxis: Long-
term penicillin to
prevent recurrent
GAS infections
and further valve
damage.
โ€ข Anti-inflammatory
medications: To
reduce
inflammation and
alleviate
symptoms.
โ€ข Valvuloplasty:
Minimally invasive
procedures to
repair or widen
narrowed valves.
Treatment
โ€ข Valve
replacement
surgery:
Replacing
damaged valves
with prosthetic
ones.
โ€ข Heart failure
management:
Medications,
diuretics, and
other
interventions for
patients with
advanced heart
failure.
Complications
โ€ข Heart failure: The
heart's inability to
pump blood
effectively.
โ€ข Arrhythmias:
Abnormal heart
rhythms.
โ€ข Stroke: Embolic
events due to blood
clots forming in the
heart.
โ€ข Endocarditis:
Infection of the inner
lining of the heart.
โ€ข Sudden cardiac
death: In severe
cases with
significant valve
dysfunction.
Complications
Prevention
Early diagnosis and
prompt treatment
are crucial for
preventing valve
damage and
reducing the risk of
complications
associated with
RHD.
Prevention
โ€ข Healthy lifestyle
โ€ข Benzathine
benzylpenicillin
injections
โ€ข Improved
healthcare services
โ€ข Preventing
rheumatic fever
Prevention

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Rheumatic Heart Disease ( RHD )

  • 3. Rheumatic Heart Disease Rheumatic heart disease (RHD) is a chronic, inflammatory disease of the heart that develops in susceptible individuals following a group A streptococcal (GAS) infection, such as strep throat or scarlet fever. The inflammation primarily targets the heart valves, leading to fibrosis and scarring, and ultimately, valve dysfunction. Valves of the Heart:
  • 5. Valves Of The Heart โ€ข Mitral Valve: Located between the left atrium and left ventricle. Responsible for preventing blood from flowing back into the left atrium during ventricular contraction. โ€ข Aortic Valve: Located between the left ventricle and the aorta. Responsible for preventing blood from flowing back into the left ventricle during diastole. Tricuspid Valve: Located between the right atrium and right ventricle. Responsible for preventing blood from flowing back into the right atrium during ventricular contraction. Pulmonary Valve: Located between the right ventricle and the pulmonary artery. Responsible for preventing blood from flowing back into the right ventricle during diastole.
  • 7. Prevalence โ€ข It affects an estimated 40 million people worldwide, causing approximately 300,000 deaths annually. โ€ข The majority of cases occur in children and young adults, with a higher prevalence in females.
  • 9. Risk factors โ€ข Previous GAS infections: Recurrent GAS infections, especially without adequate antibiotic treatment, increase the risk of developing RHD. โ€ข Socioeconomic disparities: Poverty, overcrowding, and inadequate access to hygiene and healthcare contribute to the spread of GAS and RHD.
  • 10. Risk factors โ€ข Genetic predisposition: Some individuals have a genetic predisposition to developing RHD, making them more susceptible to the disease even after a single GAS infection. โ€ข Malnutrition: Malnutrition can weaken the immune system and increase susceptibility to infections like GAS.
  • 13. Pathophysiology โ€ข Autoimmune Response: RHD arises from an autoimmune response to Group A streptococcal (GAS) infection, specifically targeting the heart valves. โ€ข Molecular Mimicry: M proteins on GAS share structural similarities with antigens in heart valve tissues, triggering an immune response that mistakenly attacks both. โ€ข Inflammation and Fibrosis: Immune cells infiltrate the valves, causing inflammation and damage. Fibrosis and scarring follow, leading to valve dysfunction.
  • 15. Aortic Regurgitation โ€ข Cause: Damage to the aortic valve leaflets or supporting structures prevents proper closure during diastole, leading to blood flow back into the left ventricle. โ€ข Symptoms: Fatigue, shortness of breath, chest pain, palpitations, and heart failure in severe cases. โ€ข Diagnosis: Echocardiography remains the gold standard, revealing valve regurgitation and chamber enlargement.
  • 16. Mitral Stenosis โ€ข Cause: Thickening and fusion of the mitral valve leaflets restrict blood flow from the left atrium to the left ventricle. โ€ข Symptoms: Fatigue, shortness of breath, especially on exertion, chest pain, and hemoptysis (coughing up blood) in severe cases. โ€ข Diagnosis: Echocardiography reveals narrowed valve opening, pressure gradients, and chamber enlargement.
  • 17. Aortic Stenosis โ€ข Cause: Calcification and narrowing of the aortic valve opening restricts blood flow from the left ventricle to the aorta. โ€ข Symptoms: Fatigue, shortness of breath, chest pain, syncope (fainting), and angina (chest pain due to heart muscle ischemia). โ€ข Diagnosis: Echocardiography reveals a narrowed valve opening, increased pressure gradients across the valve, and potential left ventricular hypertrophy.
  • 18. Normal Aortic Valve โ€ข The normal aortic valve consists of three cusps (leaflets) that open and close smoothly, ensuring unidirectional blood flow during systole (ventricular contraction) and diastole (ventricular relaxation).
  • 19. Stenotic Aortic Valve โ€ข In RHD, the aortic valve leaflets become thickened, calcified, and may fuse, restricting blood flow and causing the heart to work harder to pump blood.
  • 20. Symptoms โ€ข Variable depending on the affected valve(s) and severity of disease. โ€ข General: Fatigue, shortness of breath, chest pain, palpitations, fever, weight loss. โ€ข Mitral Valve: Shortness of breath, particularly on exertion, fatigue, cough, hemoptysis (coughing up blood). โ€ข Aortic Valve: Fatigue, shortness of breath, chest pain, syncope (fainting), angina (chest pain due to heart muscle ischemia). โ€ข Tricuspid Valve: Fatigue, shortness of breath, abdominal discomfort, swelling in the legs and ankles (edema). โ€ข Pulmonary Valve: Fatigue, shortness of breath, chest pain, right-sided heart failure symptoms.
  • 21. Symptoms โ€ข Chest pain โ€ข Swollen joints โ€ข Fever โ€ข Weariness โ€ข Heart palpitation โ€ข Skin nodules
  • 22. Diagnosis โ€ข Medical history: Assessing prior GAS infections and symptoms. โ€ข Physical examination: Listening for heart murmurs and other signs of valve dysfunction. โ€ข Echocardiography: The gold standard for diagnosis, visualizing the heart valves and assessing their function.
  • 23. Diagnosis โ€ข Blood tests: Ant streptolysin O (ASO) titer and other markers of inflammation can suggest recent GAS infection. โ€ข Electrocardiogram (ECG): May show abnormalities in heart rhythm or conduction. โ€ข Chest X-ray: Can reveal enlarged heart chambers in advanced cases.
  • 24. Treatment โ€ข Antibiotic prophylaxis: Long- term penicillin to prevent recurrent GAS infections and further valve damage. โ€ข Anti-inflammatory medications: To reduce inflammation and alleviate symptoms. โ€ข Valvuloplasty: Minimally invasive procedures to repair or widen narrowed valves.
  • 25. Treatment โ€ข Valve replacement surgery: Replacing damaged valves with prosthetic ones. โ€ข Heart failure management: Medications, diuretics, and other interventions for patients with advanced heart failure.
  • 26. Complications โ€ข Heart failure: The heart's inability to pump blood effectively. โ€ข Arrhythmias: Abnormal heart rhythms. โ€ข Stroke: Embolic events due to blood clots forming in the heart. โ€ข Endocarditis: Infection of the inner lining of the heart. โ€ข Sudden cardiac death: In severe cases with significant valve dysfunction.
  • 28. Prevention Early diagnosis and prompt treatment are crucial for preventing valve damage and reducing the risk of complications associated with RHD.
  • 29. Prevention โ€ข Healthy lifestyle โ€ข Benzathine benzylpenicillin injections โ€ข Improved healthcare services โ€ข Preventing rheumatic fever