Rheumatic fever is an autoimmune disease caused by streptococcal infection that can lead to rheumatic heart disease. It typically affects children ages 5-15 and symptoms include carditis, arthritis, chorea, and others. Left untreated, approximately 60% of patients develop chronic rheumatic heart disease, which can cause heart valve defects. Diagnosis involves meeting modified Jones criteria through symptoms, labs, and echocardiogram findings. Treatment focuses on antibiotics to prevent recurrence, anti-inflammatories for carditis, and management of heart defects through medications, surgery, or valve replacements.
Perspective of Cardiac Troponin and Membrane Potential in People Living with ...asclepiuspdfs
Background: Hypertension is an event in which the force of the blood against the artery walls is too high leading to severe health complications and increases the risk of heart disease, stroke, and sometimes death. Aim: This study was carried out to determine the levels of cardiac troponin 1 and membrane potential in hypertensive subjects in Owerri, Imo state. Materials and Methods: A total of 120 subjects within the age 30–70 years were recruited for this study. The study consists of 60 subjects who were diagnosed of hypertension and 60 were apparently healthy individuals who served as controls subjects of the same age bracket. The levels of cardiac troponin 1 and membrane potential were analyzed using enzyme-linked immunosorbent assay technique. Data were assessed using SPSS version 20, the mean value with P ˂ 0.05 was considered statistically significant. Results: The result revealed that the levels of cardiac troponin 1 in hypertension were significantly increased when compared with control subjects while the levels of membrane potential were significantly decreased when compared to control at P < 0.05. Conclusion: The increased serum level of cardiac troponin 1 and decreased membrane potential in hypertensive subjects may contribute some risk factors in patients with hypertension.
Kristopher R. Maday is an assistant professor and academic coordinator of the surgical physician assistant program at the University of Alabama at Birmingham. The document discusses asthma, including its pathophysiology, risk factors, diagnosis, management, and treatment. It provides detailed information on evaluating and diagnosing the severity of asthma exacerbations. The goals of asthma therapy and examples of common medications used to treat and prevent asthma are also summarized.
- A 21-year-old Filipino female student presented with a one-year history of left neck swellings. Physical examination revealed two firm, mobile masses on the left side of her neck and a smaller mass on the right side.
- Investigations including blood tests, chest x-ray, ultrasound and biopsy of the lymph nodes were performed. The biopsy showed necrotizing granulomatous lymphadenitis suspicious for tuberculosis, though AFB staining was negative.
- The patient was admitted and an excisional biopsy of the left lymph nodes was performed. She was started on anti-tuberculosis treatment and discharged with follow up appointments in the infectious disease clinic.
Systemic corticosteroids in the treatment of acute exacerbations of copdChoying Chen
- The patient presented with an acute exacerbation of COPD with respiratory acidosis and was treated with BiPAP, bronchodilators, antibiotics, and systemic corticosteroids.
- Despite treatment, he developed hyperglycemia and hypertension which were managed by adjusting antihyperglycemic and antihypertensive medications.
- He showed improvement in respiratory status and was discharged with a tapering course of prednisolone and other medications while continuing home BiPAP use.
Acute rheumatic fever is a systemic disease that primarily affects children following a group A streptococcal infection. It involves inflammation of the heart, joints, skin, and brain. It is diagnosed using the modified Jones criteria which looks for major manifestations like carditis or chorea along with minor manifestations and evidence of a prior streptococcal infection. Treatment involves antibiotics to treat the initial infection, anti-inflammatory drugs like aspirin to reduce inflammation, and long-term prevention of recurrent attacks using antibiotics like benzathine penicillin.
RF is an autoimmune response triggered by Group A streptococcal (GAS) pharyngitis. The molecular mimicry between antigens on GAS and host tissues can lead to cross-reactive antibodies that attack the heart, joints, brain, and skin, causing inflammation. Repeated episodes can lead to rheumatic heart disease (RHD). The risk is determined by interactions between the GAS virulence factors, host genetic susceptibility, and socioeconomic environment. Countries with comprehensive prevention programs have seen declines in RF, while it remains highly prevalent in developing nations with inadequate access to healthcare.
Perspective of Cardiac Troponin and Membrane Potential in People Living with ...asclepiuspdfs
Background: Hypertension is an event in which the force of the blood against the artery walls is too high leading to severe health complications and increases the risk of heart disease, stroke, and sometimes death. Aim: This study was carried out to determine the levels of cardiac troponin 1 and membrane potential in hypertensive subjects in Owerri, Imo state. Materials and Methods: A total of 120 subjects within the age 30–70 years were recruited for this study. The study consists of 60 subjects who were diagnosed of hypertension and 60 were apparently healthy individuals who served as controls subjects of the same age bracket. The levels of cardiac troponin 1 and membrane potential were analyzed using enzyme-linked immunosorbent assay technique. Data were assessed using SPSS version 20, the mean value with P ˂ 0.05 was considered statistically significant. Results: The result revealed that the levels of cardiac troponin 1 in hypertension were significantly increased when compared with control subjects while the levels of membrane potential were significantly decreased when compared to control at P < 0.05. Conclusion: The increased serum level of cardiac troponin 1 and decreased membrane potential in hypertensive subjects may contribute some risk factors in patients with hypertension.
Kristopher R. Maday is an assistant professor and academic coordinator of the surgical physician assistant program at the University of Alabama at Birmingham. The document discusses asthma, including its pathophysiology, risk factors, diagnosis, management, and treatment. It provides detailed information on evaluating and diagnosing the severity of asthma exacerbations. The goals of asthma therapy and examples of common medications used to treat and prevent asthma are also summarized.
- A 21-year-old Filipino female student presented with a one-year history of left neck swellings. Physical examination revealed two firm, mobile masses on the left side of her neck and a smaller mass on the right side.
- Investigations including blood tests, chest x-ray, ultrasound and biopsy of the lymph nodes were performed. The biopsy showed necrotizing granulomatous lymphadenitis suspicious for tuberculosis, though AFB staining was negative.
- The patient was admitted and an excisional biopsy of the left lymph nodes was performed. She was started on anti-tuberculosis treatment and discharged with follow up appointments in the infectious disease clinic.
Systemic corticosteroids in the treatment of acute exacerbations of copdChoying Chen
- The patient presented with an acute exacerbation of COPD with respiratory acidosis and was treated with BiPAP, bronchodilators, antibiotics, and systemic corticosteroids.
- Despite treatment, he developed hyperglycemia and hypertension which were managed by adjusting antihyperglycemic and antihypertensive medications.
- He showed improvement in respiratory status and was discharged with a tapering course of prednisolone and other medications while continuing home BiPAP use.
Acute rheumatic fever is a systemic disease that primarily affects children following a group A streptococcal infection. It involves inflammation of the heart, joints, skin, and brain. It is diagnosed using the modified Jones criteria which looks for major manifestations like carditis or chorea along with minor manifestations and evidence of a prior streptococcal infection. Treatment involves antibiotics to treat the initial infection, anti-inflammatory drugs like aspirin to reduce inflammation, and long-term prevention of recurrent attacks using antibiotics like benzathine penicillin.
RF is an autoimmune response triggered by Group A streptococcal (GAS) pharyngitis. The molecular mimicry between antigens on GAS and host tissues can lead to cross-reactive antibodies that attack the heart, joints, brain, and skin, causing inflammation. Repeated episodes can lead to rheumatic heart disease (RHD). The risk is determined by interactions between the GAS virulence factors, host genetic susceptibility, and socioeconomic environment. Countries with comprehensive prevention programs have seen declines in RF, while it remains highly prevalent in developing nations with inadequate access to healthcare.
Rheumatic heart disease is a major global health problem caused by untreated streptococcal infections like strep throat. It often leads to narrowing or stiffening of the heart valves. In India, the prevalence is about 6 per 1000 children aged 5-15, and it is the most common heart disease, accounting for 20-30% of cardiovascular hospital admissions. Nurses play an important role in prevention through health education, screening schoolchildren, and ensuring proper treatment of streptococcal infections to prevent recurrent rheumatic fever and further heart damage.
This document provides information on acute rheumatic fever (ARF), including its definition, incidence, pathophysiology, diagnosis, management, and secondary prevention. ARF is an autoimmune response to Group A streptococcal infection that causes inflammation of the heart, joints, brain and skin. It predominantly affects school-aged children and those in low socioeconomic conditions. Accurate diagnosis is important to avoid over- or under-treatment. Management involves treating streptococcal infections, suppressing inflammation, and long-term antibiotic prophylaxis to prevent recurrence.
Realistic and possible abilities in prevention of COPD exacerbationDejan Zujovic
1) Hospitalization for an acute exacerbation of COPD is associated with significantly higher mortality than hospitalization for an acute myocardial infarction. Mortality at 12 months following COPD exacerbation hospitalization is between 20-40%.
2) Proper treatment of acute exacerbations, including antibiotics, bronchodilators, corticosteroids, and oxygen therapy can help prevent future exacerbations and readmissions. However, quality of care for COPD exacerbations remains suboptimal in many cases.
3) Smoking cessation, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, and adherence to maintenance therapies can help prevent COPD exacerbations but uptake and adherence remain low compared to potential benefits. Improving self
Rheumatic heart disease is caused by rheumatic fever, which is a sequela of strep throat infections. It is a major cause of mitral valve insufficiency and stenosis globally, with 15 million cases worldwide and over 200,000 deaths in 2008. In India, it commonly affects children aged 5-15, with a prevalence of 5-7 cases per 1,000 children. The severity of valve damage depends on factors like the number of previous rheumatic fever attacks, time between onset and treatment, and sex. Prevention involves treating strep throat infections aggressively with benzathine penicillin injections over multiple years.
The document discusses disease presentation in elderly patients. Key points include:
- Illness presentation may be classical, non-presenting (silent), vague, or atypical in elderly patients.
- Common reasons for underreporting of illness include viewing symptoms as normal aging, insidious onset, embarrassment, depression, and denial.
- Non-specific presentations ("geriatric giants") include immobility, instability, incontinence, confusion, self-neglect, apathy, dyspnea, fatigue, and unintentional weight loss.
- Atypical presentations of infections, acute abdomen, GERD, and peptic ulcer disease are common in elderly and may lack typical symptoms. Thorough evaluation
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin.
Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly.
Early diagnosis of these infections and treatment with antibiotics is key to preventing rheumatic fever.
This document discusses several key aspects of managing sepsis, including:
1) Definitions of sepsis, severe sepsis, and septic shock. Sepsis is a leading cause of death in ICU patients.
2) Early interventions such as antibiotics, early goal-directed therapy to optimize oxygen delivery, and tight glucose control can improve outcomes but must be carefully implemented to avoid harm.
3) The evidence for corticosteroids and vasopressin in septic shock is mixed, and their use remains controversial. Large randomized trials have had conflicting results.
Rheumatic fever is an inflammatory disease that occurs as a delayed reaction to a Group A streptococcal throat infection. It most commonly affects children between 5-18 years old. The main manifestations include arthritis, carditis, chorea, and less commonly subcutaneous nodules and erythema marginatum. It is diagnosed using the revised Jones criteria which requires evidence of a preceding streptococcal infection and either two major manifestations or one major and two minor manifestations. Treatment involves primary prevention through antibiotic treatment of streptococcal infections, anti-inflammatory treatment such as aspirin for arthritis and steroids for carditis, supportive management of complications, and long-term secondary prevention through antibiotic prophylaxis.
This document provides an overview of scleroderma and its pulmonary complications from the perspective of an expert in the field. It summarizes that interstitial lung disease is a common complication of scleroderma and may present in various ways. It also reviews treatment approaches for scleroderma-associated interstitial lung disease that have been supported by clinical trials, including cyclophosphamide, mycophenolate, and rituximab.
This document provides an overview of rheumatic fever, including its causes, risk factors, manifestations, diagnosis, treatment, and nursing management. Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection, usually within 2-6 weeks. It commonly affects the heart, joints, skin, and brain in children ages 5-15. The main risk is permanent heart damage known as rheumatic heart disease. Treatment involves antibiotics to eliminate strep bacteria, anti-inflammatory drugs, and long-term preventative antibiotics to reduce the risk of recurrence. Nursing care focuses on treatment compliance, recovery support, education, and prevention.
Acute rheumatic fever is an autoimmune disease that occurs after a streptococcal throat infection. It causes inflammation in connective tissues and blood vessels in joints and the heart. Symptoms include arthritis, heart issues like valve damage, and involuntary movements. Treatment involves antibiotics to eliminate streptococcus, medications for pain and inflammation, bed rest, and potentially heart valve replacement for severe cases. Long term prevention requires continued antibiotics to avoid recurrent bouts of the disease.
Rheumatic fever is an inflammatory disease that can occur after a streptococcal throat infection. It involves the heart, joints, skin and connective tissue. The presentation includes fever, arthritis and heart complications like pancarditis. Diagnosis is based on clinical criteria after excluding other conditions. Prevention relies on prompt antibiotic treatment of streptococcal infections. For those with a history of rheumatic fever, long-term antibiotic prophylaxis is needed to prevent recurrences that can further damage the heart.
Surviving Sepsis Campaign
International Guidelines for Management of Severe Sepsis and Septic Shock: 2012
Critical Care Medicine 2013 Feb;41(2):580-637
Kawasaki disease is an acute vasculitis that predominantly affects coronary arteries in children. It is characterized by fever, rash, conjunctival injection, cervical lymphadenopathy, and changes to the mouth and lips. The cause is unknown but may involve a novel RNA virus. Treatment involves intravenous immunoglobulin and aspirin to reduce inflammation and prevent coronary artery abnormalities. Refractory cases may require additional immunomodulating therapies.
Acute rheumatic fever is an inflammatory disease that can affect the heart, joints, brain, and skin. It occurs as a complication of untreated strep throat infection. Major symptoms include heart inflammation, arthritis, abnormal movements, skin nodules, and rashes. It is diagnosed based on symptoms and evidence of prior strep infection. Treatment involves antibiotics to treat strep, aspirin or steroids to reduce inflammation, and lifelong antibiotics to prevent recurrence. Nursing care focuses on reducing fever, monitoring the heart for damage, maintaining activity, and educating patients about prevention and management of the disease.
COPD: Management of Acute Exacerbationmustaqadnan1
This document discusses the management of COPD exacerbations. It begins by defining a COPD exacerbation and classifying exacerbations by severity. It then outlines the goals of exacerbation treatment and recommends short-acting bronchodilators as the initial treatment. It advocates for systemic corticosteroids to improve outcomes and antibiotics when indicated. The document also recommends non-invasive ventilation for acute respiratory failure. Finally, it stresses implementing prevention strategies after an exacerbation.
Case studies on the treatment of chronic hepatitis c virusAry Nogueira Filho
This document summarizes a study on using traditional Chinese medicine (TCM) to treat chronic hepatitis C virus (HCV). It provides background on HCV and TCM perspectives on liver disorders. An integrated treatment approach is proposed using Chinese herbs, acupuncture, dietary therapy, and lifestyle changes combined with conventional antiviral drugs. Two case studies are presented, one using only antiviral drugs and the other using an integrated TCM and drug approach, showing improved outcomes with the integrated treatment.
1) Rheumatic fever is an autoimmune disease that can occur as a delayed complication of untreated Group A streptococcal pharyngitis, with a latent period of 1-3 weeks.
2) It commonly affects children between 5-15 years of age and can involve the heart, joints, skin, and brain. The heart is involved in approximately 50-60% of cases (carditis).
3) Treatment involves bed rest, antibiotics to eradicate streptococci, anti-inflammatory drugs like aspirin for arthritis and carditis, corticosteroids for moderate to severe carditis, and long-term antibiotic prophylaxis to prevent recurrences.
Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection and can damage the heart valves. It is most common in school-aged children and adolescents. The symptoms involve the joints, skin, brain and heart. Diagnosis is based on guidelines that evaluate symptoms and lab tests. Treatment focuses on eradicating streptococci, reducing inflammation, managing complications, and long-term prophylaxis to prevent recurrence. Untreated rheumatic fever can lead to rheumatic heart disease, permanent damage to the heart valves.
Rheumatic Heart Disease (RHD) is caused by acute rheumatic fever and affects 39 million people worldwide, claiming 291,000 lives each year. It is a major public health problem in Nepal, with prevalence among school children between 0.9-1.35 per thousand. The Nepal RF/RHD Prevention and Control Program aims to reduce morbidity and mortality through early detection, registration of patients, secondary prophylaxis of penicillin injections, and raising awareness. Key elements include establishing treatment centers, developing an epidemiological registry, training health workers, and delivering ongoing care.
Rheumatic heart disease is a major global health problem caused by untreated streptococcal infections like strep throat. It often leads to narrowing or stiffening of the heart valves. In India, the prevalence is about 6 per 1000 children aged 5-15, and it is the most common heart disease, accounting for 20-30% of cardiovascular hospital admissions. Nurses play an important role in prevention through health education, screening schoolchildren, and ensuring proper treatment of streptococcal infections to prevent recurrent rheumatic fever and further heart damage.
This document provides information on acute rheumatic fever (ARF), including its definition, incidence, pathophysiology, diagnosis, management, and secondary prevention. ARF is an autoimmune response to Group A streptococcal infection that causes inflammation of the heart, joints, brain and skin. It predominantly affects school-aged children and those in low socioeconomic conditions. Accurate diagnosis is important to avoid over- or under-treatment. Management involves treating streptococcal infections, suppressing inflammation, and long-term antibiotic prophylaxis to prevent recurrence.
Realistic and possible abilities in prevention of COPD exacerbationDejan Zujovic
1) Hospitalization for an acute exacerbation of COPD is associated with significantly higher mortality than hospitalization for an acute myocardial infarction. Mortality at 12 months following COPD exacerbation hospitalization is between 20-40%.
2) Proper treatment of acute exacerbations, including antibiotics, bronchodilators, corticosteroids, and oxygen therapy can help prevent future exacerbations and readmissions. However, quality of care for COPD exacerbations remains suboptimal in many cases.
3) Smoking cessation, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, and adherence to maintenance therapies can help prevent COPD exacerbations but uptake and adherence remain low compared to potential benefits. Improving self
Rheumatic heart disease is caused by rheumatic fever, which is a sequela of strep throat infections. It is a major cause of mitral valve insufficiency and stenosis globally, with 15 million cases worldwide and over 200,000 deaths in 2008. In India, it commonly affects children aged 5-15, with a prevalence of 5-7 cases per 1,000 children. The severity of valve damage depends on factors like the number of previous rheumatic fever attacks, time between onset and treatment, and sex. Prevention involves treating strep throat infections aggressively with benzathine penicillin injections over multiple years.
The document discusses disease presentation in elderly patients. Key points include:
- Illness presentation may be classical, non-presenting (silent), vague, or atypical in elderly patients.
- Common reasons for underreporting of illness include viewing symptoms as normal aging, insidious onset, embarrassment, depression, and denial.
- Non-specific presentations ("geriatric giants") include immobility, instability, incontinence, confusion, self-neglect, apathy, dyspnea, fatigue, and unintentional weight loss.
- Atypical presentations of infections, acute abdomen, GERD, and peptic ulcer disease are common in elderly and may lack typical symptoms. Thorough evaluation
Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin.
Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly.
Early diagnosis of these infections and treatment with antibiotics is key to preventing rheumatic fever.
This document discusses several key aspects of managing sepsis, including:
1) Definitions of sepsis, severe sepsis, and septic shock. Sepsis is a leading cause of death in ICU patients.
2) Early interventions such as antibiotics, early goal-directed therapy to optimize oxygen delivery, and tight glucose control can improve outcomes but must be carefully implemented to avoid harm.
3) The evidence for corticosteroids and vasopressin in septic shock is mixed, and their use remains controversial. Large randomized trials have had conflicting results.
Rheumatic fever is an inflammatory disease that occurs as a delayed reaction to a Group A streptococcal throat infection. It most commonly affects children between 5-18 years old. The main manifestations include arthritis, carditis, chorea, and less commonly subcutaneous nodules and erythema marginatum. It is diagnosed using the revised Jones criteria which requires evidence of a preceding streptococcal infection and either two major manifestations or one major and two minor manifestations. Treatment involves primary prevention through antibiotic treatment of streptococcal infections, anti-inflammatory treatment such as aspirin for arthritis and steroids for carditis, supportive management of complications, and long-term secondary prevention through antibiotic prophylaxis.
This document provides an overview of scleroderma and its pulmonary complications from the perspective of an expert in the field. It summarizes that interstitial lung disease is a common complication of scleroderma and may present in various ways. It also reviews treatment approaches for scleroderma-associated interstitial lung disease that have been supported by clinical trials, including cyclophosphamide, mycophenolate, and rituximab.
This document provides an overview of rheumatic fever, including its causes, risk factors, manifestations, diagnosis, treatment, and nursing management. Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection, usually within 2-6 weeks. It commonly affects the heart, joints, skin, and brain in children ages 5-15. The main risk is permanent heart damage known as rheumatic heart disease. Treatment involves antibiotics to eliminate strep bacteria, anti-inflammatory drugs, and long-term preventative antibiotics to reduce the risk of recurrence. Nursing care focuses on treatment compliance, recovery support, education, and prevention.
Acute rheumatic fever is an autoimmune disease that occurs after a streptococcal throat infection. It causes inflammation in connective tissues and blood vessels in joints and the heart. Symptoms include arthritis, heart issues like valve damage, and involuntary movements. Treatment involves antibiotics to eliminate streptococcus, medications for pain and inflammation, bed rest, and potentially heart valve replacement for severe cases. Long term prevention requires continued antibiotics to avoid recurrent bouts of the disease.
Rheumatic fever is an inflammatory disease that can occur after a streptococcal throat infection. It involves the heart, joints, skin and connective tissue. The presentation includes fever, arthritis and heart complications like pancarditis. Diagnosis is based on clinical criteria after excluding other conditions. Prevention relies on prompt antibiotic treatment of streptococcal infections. For those with a history of rheumatic fever, long-term antibiotic prophylaxis is needed to prevent recurrences that can further damage the heart.
Surviving Sepsis Campaign
International Guidelines for Management of Severe Sepsis and Septic Shock: 2012
Critical Care Medicine 2013 Feb;41(2):580-637
Kawasaki disease is an acute vasculitis that predominantly affects coronary arteries in children. It is characterized by fever, rash, conjunctival injection, cervical lymphadenopathy, and changes to the mouth and lips. The cause is unknown but may involve a novel RNA virus. Treatment involves intravenous immunoglobulin and aspirin to reduce inflammation and prevent coronary artery abnormalities. Refractory cases may require additional immunomodulating therapies.
Acute rheumatic fever is an inflammatory disease that can affect the heart, joints, brain, and skin. It occurs as a complication of untreated strep throat infection. Major symptoms include heart inflammation, arthritis, abnormal movements, skin nodules, and rashes. It is diagnosed based on symptoms and evidence of prior strep infection. Treatment involves antibiotics to treat strep, aspirin or steroids to reduce inflammation, and lifelong antibiotics to prevent recurrence. Nursing care focuses on reducing fever, monitoring the heart for damage, maintaining activity, and educating patients about prevention and management of the disease.
COPD: Management of Acute Exacerbationmustaqadnan1
This document discusses the management of COPD exacerbations. It begins by defining a COPD exacerbation and classifying exacerbations by severity. It then outlines the goals of exacerbation treatment and recommends short-acting bronchodilators as the initial treatment. It advocates for systemic corticosteroids to improve outcomes and antibiotics when indicated. The document also recommends non-invasive ventilation for acute respiratory failure. Finally, it stresses implementing prevention strategies after an exacerbation.
Case studies on the treatment of chronic hepatitis c virusAry Nogueira Filho
This document summarizes a study on using traditional Chinese medicine (TCM) to treat chronic hepatitis C virus (HCV). It provides background on HCV and TCM perspectives on liver disorders. An integrated treatment approach is proposed using Chinese herbs, acupuncture, dietary therapy, and lifestyle changes combined with conventional antiviral drugs. Two case studies are presented, one using only antiviral drugs and the other using an integrated TCM and drug approach, showing improved outcomes with the integrated treatment.
1) Rheumatic fever is an autoimmune disease that can occur as a delayed complication of untreated Group A streptococcal pharyngitis, with a latent period of 1-3 weeks.
2) It commonly affects children between 5-15 years of age and can involve the heart, joints, skin, and brain. The heart is involved in approximately 50-60% of cases (carditis).
3) Treatment involves bed rest, antibiotics to eradicate streptococci, anti-inflammatory drugs like aspirin for arthritis and carditis, corticosteroids for moderate to severe carditis, and long-term antibiotic prophylaxis to prevent recurrences.
Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection and can damage the heart valves. It is most common in school-aged children and adolescents. The symptoms involve the joints, skin, brain and heart. Diagnosis is based on guidelines that evaluate symptoms and lab tests. Treatment focuses on eradicating streptococci, reducing inflammation, managing complications, and long-term prophylaxis to prevent recurrence. Untreated rheumatic fever can lead to rheumatic heart disease, permanent damage to the heart valves.
Rheumatic Heart Disease (RHD) is caused by acute rheumatic fever and affects 39 million people worldwide, claiming 291,000 lives each year. It is a major public health problem in Nepal, with prevalence among school children between 0.9-1.35 per thousand. The Nepal RF/RHD Prevention and Control Program aims to reduce morbidity and mortality through early detection, registration of patients, secondary prophylaxis of penicillin injections, and raising awareness. Key elements include establishing treatment centers, developing an epidemiological registry, training health workers, and delivering ongoing care.
Rheumatic fever is an autoimmune disease that can occur as a result of a streptococcal throat infection. It affects multiple body systems but commonly involves the heart, joints, and brain. Symptoms may include heart inflammation (carditis), painful and migratory swollen joints (arthritis), jerky involuntary movements (chorea), and others. The disease is caused by an abnormal immune response that causes antibodies produced against streptococcal bacteria to also attack human tissues. Treatment involves bed rest, antibiotics to treat the initial infection, and anti-inflammatory drugs. Recurrences of the disease can be prevented with long-term antibiotic prophylaxis but cardiac damage may persist long-term in the form of rheumatic heart disease.
Acute rheumatic fever is an autoimmune disease that can occur after a streptococcal throat infection. It commonly affects children ages 5-15 and involves the heart, joints, skin, and brain. Joint pain and heart valve damage are among the main clinical manifestations. Diagnosis is based on the Jones criteria of symptoms and a prior streptococcal infection. Treatment involves antibiotics to eliminate the bacteria, anti-inflammatory drugs like aspirin to reduce symptoms, and long-term antibiotic prophylaxis to prevent recurrence of the disease from future streptococcal infections. Those with carditis have a risk of developing rheumatic heart disease.
Rheumatic Fever (Basics & Updates)
BY
Dr. Al Hussein Ragab Zaky
Luxor International Hospital,EGYPT
Tel: 00201113033672-00201012727282
Facebook : Al Hussein Ragab
Cardiovascular diseases treatment guidelines Govt of IndiaDr Jitu Lal Meena
This document provides guidelines for the diagnosis and management of non-ST elevation acute coronary syndrome (NSTE ACS) in India. It summarizes current evidence and recommendations. The diagnosis of NSTE ACS involves evaluating patients presenting with symptoms suggestive of acute myocardial ischemia. Facilities for diagnosis and treatment of ACS across India are categorized. The goals of treatment are to prevent myocardial necrosis, reinfarction, and reduce mortality and morbidity. Treatment involves antiplatelet and anticoagulant medications, cardiac catheterization and revascularization when indicated.
This document provides information about acute rheumatic fever, including its etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis. It is caused by a delayed immune response to a Group A streptococcal infection. It most commonly affects children ages 5-15 and can cause inflammation of the heart, joints, subcutaneous tissue, and brain. Diagnosis is based on the modified Jones criteria and treatment involves antibiotics, anti-inflammatories, and long-term antibiotic prophylaxis to prevent recurrences. While arthritis and chorea typically resolve, carditis can cause permanent heart valve damage.
Rheumatic heart disease is a chronic condition that results from damage to the heart valves caused by rheumatic fever. Rheumatic fever is an inflammatory reaction that typically affects the heart, joints, brain and skin and is triggered by a prior streptococcal throat infection. It can cause scarring and deformity of the heart valves over time due to recurrent attacks. Treatment involves controlling streptococcal infections with antibiotics like penicillin to prevent recurrence of rheumatic fever and further heart damage. Patients are also at risk for developing valvular heart disease long-term.
Rheumatic fever and rheumatic heart disease are caused by an autoimmune reaction to untreated group A streptococcal infection. They commonly affect children aged 5-14 and can cause long-term heart damage through repeated episodes damaging the heart valves over time. Treatment involves antibiotics for the initial infection along with salicylates to reduce joint inflammation and fever. Lifestyle changes like a nutritious diet, stress management, and exercise can help with prevention and management of symptoms. Naturopathic treatments such as hydrotherapy, meditation, and yoga can also provide relief from joint pain and cardiac symptoms.
Standard guidelines for management of cardiovascular diseases in IndiaDr Neelesh Bhandari
This brief document will provide a broad outline for selected congenital heart diseases. It needs to
be recognized that there are unlimited possibilities because of the enormous variety of congenital
heart diseases. Therefore only a few common situations will be discussed here. Guidelines have
been recently developed and published through consensus among all leading pediatric cardiologists
in India and these references are listed below. They cover most common situations and provide a
ready reference.
This document discusses acute rheumatic fever, which is triggered by an immune response to streptococcal infection and causes inflammation in connective tissues including the heart, joints, and skin. Key points include:
- It commonly affects children ages 5-15 and is characterized by fever, joint pain, and sometimes heart complications.
- The heart issues are due to cross-reactivity between streptococcal and heart proteins, leading to conditions like rheumatic carditis.
- Diagnosis is based on symptoms and evidence of prior streptococcal infection. Treatment focuses on antibiotics, aspirin or steroids to reduce inflammation, and long-term antibiotic prophylaxis to prevent future attacks.
This document provides information on acute coronary syndrome (ACS). ACS refers to a spectrum of clinical presentations ranging from ST-segment elevation myocardial infarction (STEMI) to non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. It is usually caused by acute coronary atherothrombosis. Risk factors include smoking, high cholesterol, diabetes, and family history. The document discusses gender differences in ACS presentation and outlines treatments including anti-ischemic drugs, antiplatelet therapy, anticoagulants, and revascularization procedures. It also covers STEMI and NSTEMI diagnosis and management.
Rheumatic fever is an inflammatory disease that occurs following a streptococcal throat infection. It commonly affects the heart, joints, brain and skin. It is most prevalent in developing countries and accounts for a significant percentage of cardiovascular disease hospital admissions. The disease is caused by an autoimmune response triggered by streptococcal infection. Symptoms vary but may include arthritis, carditis, chorea and skin nodules. Treatment involves antibiotics for streptococcal infection and anti-inflammatory drugs. Recurrence can be prevented through long-term antibiotic prophylaxis. Rheumatic heart disease is a serious complication if carditis damages the heart valves.
Pericardial diseases can present as pericarditis, pericardial effusion, tamponade, constrictive pericarditis, or effusive-constrictive pericarditis. The document discusses the anatomy and functions of the pericardium, pericarditis including its classification, presentations, investigations, and management. It also covers pericardial effusion and tamponade discussing their pathophysiology, clinical features, diagnostic workup including echocardiography, and management focusing on pericardiocentesis for tamponade cases. Recurrent pericarditis and its treatment strategies are also summarized.
1) The document discusses pericardial diseases, beginning with the anatomy and functions of the pericardium.
2) It then covers pericarditis, including classifications, presentations, and management. Empirical anti-inflammatory therapy including NSAIDs and colchicine is recommended for acute idiopathic pericarditis.
3) Recurrent pericarditis is identified as the most common complication, occurring in 15-30% of cases, and requiring prolonged anti-inflammatory treatment.
Rheumatic heart disease is caused by a prior streptococcal throat infection and leads to damage of the heart valves over time. It is a major public health problem globally and in India, where there are approximately 1 million cases. The Jai Vigyan Mission Mode project in India conducted epidemiological studies of streptococcal infections and established registries for rheumatic fever and rheumatic heart disease. Rheumatic heart disease is diagnosed using revised Jones criteria and treated with long-term antibiotic prophylaxis to prevent recurrent streptococcal infections and further valve damage. Prevention through proper treatment of streptococcal infections is critical to reducing the burden of rheumatic heart disease worldwide.
The patient is a 25-year-old male who presented with 3 months of giddiness, 1 week of headaches, and 1 day of fever. He experienced blackouts while working as a driver. Examination found brisk reflexes. Imaging and tests ruled out other causes. He was diagnosed with neurocysticercosis based on MRI findings. Treatment involved anti-seizure medications, albendazole, and steroids to reduce inflammation from dying cysts.
The document discusses electrocardiography and rheumatic fever. It provides details on:
1) The components and intervals of an electrocardiogram (ECG) waveform
2) The Jones criteria for diagnosing rheumatic fever, which involves certain major and minor clinical manifestations
3) Treatment for rheumatic fever involves antibiotics, anti-inflammatory drugs, and in cases of cardiac involvement, corticosteroids. Secondary prevention relies on long-term antibiotics.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. Lecture- 12
Rheumatic Fever and Rheumatic Heart
Diseases in Children
Prof. Dr. Sunil Natha Mhaske
Dean
Dr. Vithalrao Vikhe Patil Foundation’s Medical College and Hospital,
Ahmednagar (M.S.) India-414111
Mo- 7588024773
Mail-sunilmhaske1970@gmail.com
3. Rheumatic fever was described for the first time in 1898 in
London by William Cheadle.
In 1904, Aschoff described typical histopathological lesions in
rheumatic heart disease.
The first RF diagnostic criteria were developed in 1944 by
Jones, then they were modified by AHA in 1992.
RF is an autoimmune disease associated with group A β-
hemolytic streptococcal infection.
It usually appears in children between the ages of 5 and 15.
4. The patients develop carditis (50–78%), arthritis (35–88%), chorea
(2–19%), erythema marginatum (< 6%) and subcutaneous nodules
(< 1–13%)
Acquired heart defects can be a consequence of RF.
approximately 60% of RF patients in endemic countries develop
chronic rheumatic heart disease, which is a complication of RF
The risk of chronic rheumatic heart disease is 1.6–2 times higher in
female patients.
The course of the disease is characterized by relapses, where after
the first episode more may follow, thus increasing the risk of heart
defects. The risk is the higher the younger the patient is.
Rheumatic fever symptoms occur 2–3 weeks after streptococcal
pharyngitis, never after streptococcal dermatitis.
5. Thomas Duckett Jones (d. 1954) :
• He was the director of research in
rheumatic fever and rheumatic heart
disease at the House of the Good
Samaritan in Boston for 20 years.
• He worked clinically at Massachusetts
General Hospital and was on faculty
at Harvard Medical School.
• Dr. Jones was appointed to the
inaugural National Advisory Heart
Council and also served as vice-
president of the American Heart
Association, chairman of the AHA's
Council on Rheumatic Fever, and
president-elect of the National Health
Council.
6. • Polyarthritis (a temporary migrating inflammation of the large
joints, usually starting in the legs and migrating upwards) is
considered as a major criterion in low-risk populations, whereas
monoarthritis, polyarthritis and polyarthralgia are all included as
major criteria in high-risk populations.
• Carditis: can involve the pericardium, myocardium, endocardium
in the form of valvulitis.
• Sydenham's chorea (St. Vitus' dance): A characteristic series of
involuntary rapid movements of the face and arms. This can occur
very late in the disease for at least three months from onset of
infection. Milk maid grip, spooning and pronation of extended
hands, wormian movements of tongue etc.
7. • 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.
This rash typically spares the face and is made worse with heat.
8. Diagnostic criteria– modified 1992 Jones criteria
Major criteria Minor criteria
Carditis
Arthritis
Chorea
Erythema marginatum
Subcutaneous nodules
Hyperpyrexia
Arthralgia, without other signs
of inflammation
Laboratory indicators of acute
phase:
ESR, CRP
Prolonged PR interval in ECG
And evidence of antecedent streptococcal infection
– Throat swab culture or rapid antigen test
– Elevated/increasing anti-streptococcal antibody titer in serum
9. • Major criteria -main clinical presentation of the disease.
• Minor criteria - clinical presentation and laboratory tests.
• The diagnosis of a first RF episode -2 major criteria or 1 major and
2 minor criteria, along with evidence of antecedent group A β-
hemolytic streptococcal infection.
• Rheumatic fever can also be diagnosed if the Jones criteria are not
met, in the case of isolated chorea or carditis with an insidious
onset, long-term course and inconspicuous progression of lesions,
after other causes have been excluded.
• In the revised 2015 Jones criteria , a low, medium and high-risk
population was identified. A low risk population is one in which
cases of acute RF occur in ≤ 2/100 000 school-age children or
rheumatic heart disease is diagnosed in ≤ 1/1000 patients at any
age during one year .
10. Diagnostic criteria– modified 2015 Jones criteria
Major criteria
Low risk population High risk population
Carditis (clinical or subclinical)
Arthritis – only polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
Carditis (clinical or subclinical)
Arthritis – monoarthritis or polyarthritis
Polyarthralgia
Chorea
Erythema marginatum
Subcutaneous nodules
Minor criteria
Low risk population High risk population
Polyarthralgia
Hyperpyrexia (≥ 38.5ºC)
ESR ≥ 60 mm/h and/or CRP ≥ 3.0 mg/dl
Prolonged PR interval (after taking into
account the differences related to age; if
there is no carditis as a major criterion)
Monoarthralgia
Hyperpyrexia (≥ 38.0ºC)
ESR ≥ 30 mm/h and/or CRP ≥ 3.0 mg/dl
Prolonged PR interval (after taking into
account the differences related to age; if
there is no carditis as a major criterion)
11. Echocardiographiy is main diagnostic tool developed by AHA in 2012 -
I. Echocardiographic (Doppler) criteria:
Pathological mitral regurgitation – 4 criteria (all must be met):
1.Visible at least in 2 projections.
2.Regurgitation jet length ≥ 2 cm at least in 1 projection.
3.Regurgitation peak velocity > 3 m/s.
4.Regurgitation pansystolic.
Pathological aortic regurgitation – 4 criteria (all must be met):
1.Visible at least in 2 projections.
2.Regurgitation jet length ≥ 1 cm at least in 1 projection.
3.Regurgitation peak velocity > 3 m/s.
4.Regurgitation pandiastolic.
12. II. Echocardiographic (morphological) criteria:
In acute mitral valve involvement:
1.Dilatation of mitral annulus.
2.Elongation of chordae tendineae.
3.Rupture of chorda tendinea with acute mitral regurgitation.
4.Prolapse of anterior (less often posterior) leaflet.
5.Nodular lesions on leaflets.
13. In chronic mitral valve involvement (invisible in acute
involvement):
1.Thickening of leaflets.
2.Thickening of chordae tendinea, with their fusion.
3.Limited mobility of leaflets.
4.Calcifications.
Lesions in acute and chronic aortic valve involvement:
1.Symmetrical or focal thickening of leaflets.
2.Disturbed leaflet coaptation (leaflet closing during systole).
3.Limited mobility of leaflets.
4.Prolapse of leaflets.
16. Anti-streptococcal treatment-I. Primary prevention- treatment of streptococcal
pharyngitis-
Phenoxymethylpenicillin orally , weight > 40 kg – 2–3 MIU/day in 2 divided doses
every 12 hours for 10 days, children with a body weight < 40 kg – 100,000 to
200,000 IU/kg/day in 2 divided doses every 12 hours for 10 days.
Benzylpenicillin, intramuscularly at a single dose, weight > 40 kg – 1.2 MIU,
children with a body weight < 40 kg – 600,000 IU.
Cefadroxil: weight > 40 kg – 1 g, children with a body weight < 40 kg – 30 mg/kg,
in a single dose for 10 days.
Cefalexin: children 25–50 mg/kg/day in 2 doses for 10 days.
Erythromycin: weight > 40 kg – 0.2–0.4 γ every 6–8 hours, weight < 40 kg – 30–50
mg/kg/day in 3–4 doses, for 10 days.
Clarithromycin: weight > 40 kg – 250–500 mg every 12 hours, weight < 40 kg – 15
mg/kg/day in 2 doses, for 10 days.
Azithromycin: weight > 40 kg – 500 mg on the first day, then 250 mg for three
consecutive days, weight < 40 kg – a single daily dose of 12 mg/kg/day for 5 days
17. II. Secondary prevention - prevention of subsequent rheumatic fever
relapses –
Secondary prevention should be administered from 5 to 10 years
from the last RF relapse, or up to 21 years of age (whichever is
longer)
In RF cases with carditis leading to chronic valvular heart disease,
the prevention should be administered for 10 years or until 40
years of age (whichever is longer)
Secondary prevention makes use of benzathine benzylpenicillin,
intramuscularly: weight > 20 kg – 1.2 MIU, weight < 20 kg –
600,000 IU every 4 weeks
Phenoxymethylpenicillin is administered orally at a dose of 2 ×
250 mg (i.e. 2 × 400,000 IU).
18. Anti-inflammatory treatments-
Heart involvement, glucocorticosteroids (GCs) are used prednisone
at a dose of 1–2 mg/kg/day for 2–3 weeks, then the dose should be
reduced gradually.
The total duration of GCs treatment is 6 weeks.
During the period of prednisone dose reduction, acetylsalicylic
acid should be initiated – at 60 mg/kg/day.
Carditis with out- Cardiomegaly & or CCF-Aspirin 100mg/Kg/24hr
qid 4 day, 75 mg/24hrs/ qid 4 week
19. • Supportive therapy- when required Digoxin, Diuretics, Oxygen,
Fluid & salt restriction.
• Chronic heart lesions- Prophylaxis against bacterial endocarditis
during surgical procedures.
• Sydenham’s chorea –
- Phenobarbitol 15-30 mg tds or qid oral is the drug of choice
- Haloperidol 0.01- 0.03mg/kg/24hrs bd oral
- Chlorpromazine 0.5mg/kg every 4-6 hrs oral
22. Commonest acquired heart disease.
Rheumatic heart disease is the most serious complication
of rheumatic fever.
Acute rheumatic fever and rheumatic heart disease are thought to
result from an autoimmune response, but the exact pathogenesis
remains unclear.
Rheumatic heart disease is the result of permanent heart valve
damage secondary to acute rheumatic fever and the resultant
rheumatic carditis involving pericarditis, myocarditis, or valvulitis.
With chronic rheumatic heart disease, patients develop mitral valve
stenosis with varying degrees of regurgitation, atrial dilatation,
arrhythmias, and ventricular dysfunction.
Although the mitral valve is involved in most cases of rheumatic
heart disease, the aortic and tricuspid valves can be involved as
well.
MV AV TV PV
23. Rheumatic Mitral stenosis
• One of the grave consequences of rheumatic heart disease.
• Mitral valve involvement is seen mainly as mitral regurgitation and
less commonly mitral stenosis.
• A narrowing of the heart's mitral valve.
• This abnormal valve doesn't open properly, blocking blood flow
into the left ventricle
• The main cause of mitral valve stenosis is an infection called
rheumatic fever.
• Rarely congenital
• 40% of all patients with rheumatic heart disease
• Two-thirds of all patients with MS are female.
24. Right Heart Failure:
Hepatic Congestion
JVD
Tricuspid Regurgitation
RA Enlargement
Pulmonary HTN
Pulmonary Congestion
LA Enlargement
Atrial Fib
LA Thrombi
LA Pressure
RV Pressure Overload
RVH
RV Failure LV Filling
Normal valve area: 4-6 cm2
Mild mitral stenosis:
MVA 1.5-2.5 cm2
Minimal symptoms
Mod mitral stenosis
MVA 1.0-1.5 cm2 usually does not produce symptoms at rest
Severe mitral stenosis
MVA < 1.0 cm2
25. Signs and Symptoms -
Fatigue
Shortness of breath with exertion or when lying flat
Shortness of breath and coughing during the night
Swollen ankles and feet
Palpitations
Heavy coughing which may produce blood-stained mucus
• Palpation:
- Small volume pulse
- Tapping apex-palpable S1
+/- palpable opening snap (OS)
- RV lift
- Palpable S2
• Auscultation:
- Loud S1
- Diastolic rumble: length proportional to severity
26. • First heart sound (S1) is accentuated and snapping
• Opening snap (OS) after aortic valve closure
• Low pitch diastolic rumble at the apex
• Pre-systolic accentuation (esp. if in sinus rhythm)
• ECG: LAE, RVH, RAD
• Cardiac murmur,
• Echocardiogram,
• Chest X-ray,
• Transesophageal echocardiogram
• Cardiac catheterization
27. Complications –
• Atrial dysrhythmias
• Systemic embolization (10-25%)
• Congestive heart failure
• Pulmonary infarcts
• Hemoptysis
• Endocarditis
• Pulmonary infections
Treatment -
• Medical
Diuretics for LHF/RHF
Digitalis/Beta blockers/CCB: Rate control in A Fib
Anticoagulation
Endocarditis prophylaxis
• Balloon valvuloplasty
• Mitral valve repair or replacement surgery.
28. Rheumatic Mitral Regurgitation
• Mitral valve doesn't close tightly.
• Allowing blood to flow backward in
heart.
• Often mild and progresses slowly.
• Chronic LV volume overload
compensatory LVE initially
maintaining cardiac output
• Decompensation (increased LV wall
tension) CHF
• LVE annulus dilation increased
MR
• Backflow LAE, A. fib, Pulmonary
HTN
29. • Similar to MS
• Dyspnea
• Orthopnea
• PND
• Fatigue
• Pulmonary HTN
• right sided failure
• Hemoptysis
• Systemic embolization in A Fib
• Pulse: brisk, low volume
• Apex:
• hyperdynamic
• laterally displaced
• palpable S3 +/- thrill
• late parasternal lift
• S 1 soft or normal
• S 2 wide split (early A2)
• Murmur-Fixed MR:
• pan systolic
• loudest apex to axilla
• no post extra-systolic
accentuation
• Murmur-Dynamic
MR(MVP)
• mid systolic
• S 3 / flow rumble if severe
30. Complications-
Heart failure.
Atrial fibrillation.
Pulmonary hypertension.
ECG:
LA enlargement
LVH
RVH (15%)
Combined hypertrophy (5%)
CXR:
LV
LA
pulmonary vascularity
CHF
Only effective
treatment is valve
repair/replacement
31. Mitral Valve Prolapse
•Common in girls and thin children
•May be inherited as autosomal dominant
•Associated with Marfan’s syndrome, Pectus excavatum
•May not be recognized till adolescent
•Symptoms are chest pain or palpitation
•On auscultation, systolic ejection click may be present
•Arrhythmias may occur
•Echocardiography is diagnostic
32. Aortic valve stenosis
Aortic stenosis is narrowing of the aortic valve, impeding delivery
of blood from the heart to the body.
Aortic stenosis can be caused by congenital bicuspid aortic valve,
scarred aortic valve of rheumatic fever, and wearing of aortic valve
in the elderly.
prevents the valve from opening fully, which reduces or blocks
blood flow from your heart into the main artery to aorta and to the
rest of body.
Normal aortic valve area 2.5-3.5 cm2
Mild stenosis 1.5-2.5 cm2
Moderate stenosis 1.0-1.5 cm2
Severe stenosis < 1.0 cm2
33. Signs and symptoms -
Abnormal heart sound
heart murmur
Chest pain
angina
dizzy or fainting
Shortness of breath.
Fatigue
palpitations
Not gaining weight
Complications-
Heart failure
Stroke
Blood clots
Bleeding
arrhythmias
endocarditis
Death
34. Diagnosis-
• low volume pulse (pulsus parvus et tardus)
• delay between the first heart sound and the corresponding pulse in the carotid artery ( apical-
carotid delay).
• delay between the appearance of each pulse in the brachial artery and the radial artery
• The first heart sound may be followed by ejection click best heard at the lower left sternal
border and the apex.
• systolic, crescendo-decrescendo murmur is heard loudest at the upper right sternal border, at
the 2nd right intercostal space and radiates to the carotid arteries bilaterally.
• second heart sound tends to become decreased and softer as the aortic stenosis becomes more
severe.
• fourth heart sound due to the stiff ventricle.
• sustained, heaving apex beat
precordial thrill
narrowed pulse pressure
• Electrocardiogram- left ventricular hypertrophy
• Chest X-ray- enlarged left ventricle and atrium.
35. Treatment-
• Aortic valve repair
• Aortic valve replacement
• Transcatheter aortic valve replacement
• Balloon valvuloplasty
History-
Aortic stenosis was first described by French physician Lazare Rivière
in 1663
36. Aortic Regurgitation
• Leaking of the aortic valve of the heart that causes blood to flow
in the reverse direction during ventricular diastole, from
the aorta into the left ventricle.
Signs and symptoms-
Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea
Palpitations
Angina pectoris
Cyanosis (in acute cases)
37. Physical examination-
• S3 heart sound
• S3 gallop
• early diastolic and decrescendo- third left intercostal space and
radiate along the left sternal border.
• increased stroke volume of the left ventricle due to volume
overload, an ejection systolic 'flow' murmur may also be present
when auscultating the same aortic area.
• Austin Flint murmur- soft mid-diastolic rumble heard at the apical
area; it appears when a regurgitant jet of blood from severe aortic
insufficiency partially closes the anterior mitral leaflet.
• Widened pulse pressure : Systolic – diastolic = pulse pressure
• Aortic diastolic murmur (Severe)
• Apex: Enlarged, Displaced, Hyper-dynamic, Palpable S3 (Severe)
38. Landolfi's sign
Becker's sign
Mayne's sign
Rosenbach's sign
Gerhardt's sign
Lincoln sign
Sherman sign
• Quincke’s sign: capillary pulsation
• Corrigan’s sign: water hammer pulse
(holding the middle of forearm or leg
and elevating it discloses a sharply
rising and abruptly falling pulse)
• De Musset’s sign: systolic head
bobbing
• Mueller’s sign: systolic pulsation of
uvula
• Durosier’s sign: femoral retrograde
bruits
• Traube’s sign: pistol shot femorals
• Hill’s sign:BP Lower extremity >BP
Upper extremity by
• > 20 mm Hg - mild AR
• > 40 mm Hg – mod AR
• > 60 mm Hg – severe AR
Peripheral physical signs
39. Diagnosis-
• transthoracic echocardiography
• Chest X-ray - left ventricular hypertrophy and dilated aorta.
• ECG typically indicates left ventricular hypertrophy.
• Cardiac chamber catheterization
40. Treatment-
• Vasodilators-ACE inhibitors or angiotensin II receptor
antagonists, nifedipine, and
• low sodium diet, diuretics, digoxin, calcium blockers and
avoiding very strenuous activity.
• Surgery- aortic valve replacement
Prognosis-
AI is fatal in 10 to 20%,who do not undergo surgery.
41. Pulmonary Valve Stenosis
The pulmonary valve is located between right ventricle and the pulmonary arteries.
The pulmonary valve is made up of three thin pieces of tissue called cusps that are
arranged in a circle.
With each heartbeat, the valve opens in the direction of blood flow — into the pulmonary
artery and continuing to the lungs — then closes to prevent blood from flowing backward
into the heart's right ventricle.
valve acts as a doorway that lets blood into and out of the heart.
in pulmonary valve stenosis-One or more of the cusps may be defective or too thick, or
the cusps may not separate from each other properly. If this happens, the valve doesn't
open correctly, restricting blood flow.
42. Signs And Symptoms-
Heart murmur
Fatigue
Shortness of breath, especially during exertion
Chest pain
Loss of consciousness
prominent and enlarged jugular vein
bluish tint to the skin
palpitations
failure to thrive
sudden death
44. Treatment-
• Mild stenosis may improve with time
• Prostaglandins to improve blood flow
• Blood thinners to reduce clotting
• A surgical procedure - balloon valvuloplasty.
• Replace the pulmonary valve
45. Pulmonary Regurgitation
• The pulmonary valve is located at the junction of the distal end
of the right ventricular outflow tract and the pulmonary artery.
• It is comprised of three semilunar leaflets which are of equal
dimensions.
• These leaflets are joined by three commissures, which are the
attachments between the pulmonic wall and the leaflets.
• The pulmonic valve is not attached to papillary muscles, as
seen with atrioventricular valves. The pulmonic valves help in
delivering deoxygenated blood from the right ventricle to the
lung vasculature during systole when they open completely.
• They close completely during diastole to prevent regurgitant
flow.
46. A leaky pulmonary valve.
This valve helps control the flow of blood passing from the right
ventricle to the lungs.
A leaky pulmonary valve allows blood to flow back into the right
ventricle before it gets to the lungs for oxygen.
Symptoms -
• Heart murmur.
• Right ventricle enlarged.
• Heart failure
• Chest pain
• Fatigue
• lightheadedness or fainting.
47. Auscultation-
The first heart sound (S) is normal.
P2 is not audible .
A systolic ejection click .
An S3 and S4 audible.
In the absence of pulmonary hypertension, the PR murmur is a
diamond-shaped, diastolic low pitched murmur which commences
as soon as the pulmonary artery and the right ventricular pressures
diverge .
The Graham Steell murmur: It is heard when systolic pulmonary
artery pressure exceeds approximately 55 mm Hg, resulting in
dilatation of the pulmonary annulus causing high-velocity
regurgitant jet.
48. EKG-
- in the absence of pulmonary artery hypertension (PAH) are rSR configuration in
the right precordial leads, which reflects RV diastolic overload.
- If it is secondary to PAH, then a P-pulmonale (tall p waves- indicating right atrial
enlargement), increased r to s ratio in the right precordial leads along with right
axis deviation can be seen.
chest X-ray- both pulmonary artery and right ventricular enlargement are visible.
Echocardiography
Mild PR - Normal right ventricular dimensions with thin (less than 10mm in
length) regurgitant jet width by color doppler
Moderate PR - Normal or dilated right ventricle with intermediate regurgitant jet
width (less than 50% of pulmonic valve annulus)
Severe PR- Dilated right ventricle (except in acute PR) with large regurgitant jet
width (greater than 50% of pulmonic valve annulus)
Angiography
49. Treatment -
• Symptomatic patients who are not surgical candidates- heart
failure therapy, especially diuretics, ACE inhibitors, and digoxin.
• Valve replacement
• transcatheter pulmonary valve replacement
• A bioprosthetic valve
• Percutaneous pulmonary valve implantation .
50. Tricuspid Valve Stenosis
The tricuspid valve is located between the right atrium and right
ventricle
Its role is to make sure blood flows in a forward direction from the
right atrium to the ventricle.
abnormal function of the tricuspid valve.
valve leaflets are stiff and do not open widely enough, causing a
restriction in the forward flow of blood.
Symptoms -
Atrial fibrillation
Fatigue
fluttering discomfort in the neck
Heart failure
51. Diagnosis-
• Mild diastolic murmur at left sternal border with rumbling
character and tricuspid opening snap with wide-splitting S2. It may
increase in intensity with inspiration (carvallo's sign).
• Echocardiograph
Treatment-
• Tricuspid valve stenosis itself usually doesn't require treatment.
• If stenosis is mild, monitoring the condition closely suffices
• Severe stenosis, or damage to other valves in the heart, may
require surgical repair or replacement.
• surgery -tricuspid valve replacement or percutaneous balloon
valvuloplasty.
52. Tricuspid regurgitation
• Tricuspid valve regurgitation is a condition in which the valve
between the right ventricle and right atrium doesn't close
properly.
• The malfunctioning valve allows blood to flow back into right
atrium
• Active pulsing in the neck veins
• Decreased urine output
• Fatigue
• General swelling
• ECG
• Echocardiogram
• Doppler echocardiography
• Right-sided cardiac catheterization
• CT scan or MRI of the chest (heart)
53. Treatment
• Treatment may not be needed if there are few or no symptoms.
• Heart failure- diuretics
• Repair or replace the tricuspid valve.