Rheumatic heart disease and valve diseases


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Rheumatic heart disease and valve diseases

  2. 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). 11/22/2013 Free template from www.brainybetty.com 2
  3. 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. 11/22/2013 Free template from www.brainybetty.com 3
  4. 4. ETIOLOGY • Infection with the Group A Streptococcus (GAS) bacterium. 11/22/2013 Free template from www.brainybetty.com 4
  5. 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. 11/22/2013 Free template from www.brainybetty.com 5
  6. 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) 11/22/2013 Free template from www.brainybetty.com 6
  7. 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 11/22/2013 Free template from www.brainybetty.com 7
  8. 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. 11/22/2013 Free template from www.brainybetty.com 8
  9. 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 11/22/2013 Free template from www.brainybetty.com 9
  10. 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 11/22/2013 Free template from www.brainybetty.com 10
  11. 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). 11/22/2013 Free template from www.brainybetty.com 11
  12. 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. 11/22/2013 Free template from www.brainybetty.com 12
  13. 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. 11/22/2013 Free template from www.brainybetty.com 13
  14. 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. 11/22/2013 14 Free template from www.brainybetty.com
  15. 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. 11/22/2013 Free template from www.brainybetty.com 15
  16. 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. 11/22/2013 Free template from www.brainybetty.com 16
  17. 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. 11/22/2013 Free template from www.brainybetty.com 17
  18. 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. • 11/22/2013 18 Free template from www.brainybetty.com
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  20. 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. 11/22/2013 Free template from www.brainybetty.com 20
  21. 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. 11/22/2013 Free template from www.brainybetty.com 21
  22. 22. SYMPTOMS • • • • • Shortness of breath Weakness or dizziness Discomfort Palpitations Swelling of your ankles, feet or abdomen • Rapid weight gain 11/22/2013 Free template from www.brainybetty.com 22
  23. 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) 11/22/2013 Free template from www.brainybetty.com 23
  24. 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 11/22/2013 Free template from www.brainybetty.com 24
  25. 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. 11/22/2013 Free template from www.brainybetty.com 25
  26. 26. PROTECTING HEART VALVES FROM FURTHER DAMAGE • Antibiotics before procedures • (especially dental procedures) 11/22/2013 Free template from www.brainybetty.com 26
  27. 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 11/22/2013 Free template from www.brainybetty.com 27
  28. 28. BALLOON VALVULOPLASTY 11/22/2013 Free template from www.brainybetty.com 28
  29. 29. BALLOON VALVOTOMY 11/22/2013 Free template from www.brainybetty.com 29
  30. 30. REPLACING HEART VALVES BIOLOGICAL AND MECHANICAL VALVES 11/22/2013 Free template from www.brainybetty.com 30
  31. 31. TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) 11/22/2013 Free template from www.brainybetty.com 31
  32. 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.
  33. 33. Thank uuuuuuu………………. 11/22/2013 Free template from www.brainybetty.com 33