Rheumatic heart disease
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1. A 28-year-old woman presented with palpitations, dizziness, and shortness of breath during household work. Examination and tests revealed mitral stenosis, reduced ejection fraction, and a history of recurrent sore throat since childhood, leading to a diagnosis of rheumatic heart disease. 2. Rheumatic heart disease is a chronic condition caused by rheumatic fever following strep throat infections. It involves scarring and deformity of the heart valves. 3. Rheumatic endocarditis during acute rheumatic fever can progress to chronic rheumatic heart disease over decades through progressive scarring and thickening of the heart valves.
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Rheumatic heart disease
- 1. RHEUMATIC HEART DISEASE Presented by: Dhrishya Sasidharan Nair GN, CCU
- 2. OBJECTIVES
- 3. CASE SCENARIO • Mrs. X , 28 years visited the cardiologist with complaints of palpitation, dizziness & shortness of breath while doing household work. • On assessment: vitals: HR 92/mt, BP 106/72 mmHg, spo2 96%, Murmur heard on auscultation , history of recurrent sore throat since childhood, no other medical history. ECG shows first degree heart block. • ECHO revealed LVF with mitral stenosis, EF 35% • Lab tests were run & was Diagnosed as RHD.
- 4. INTRODUCTION • Rheumatic heart disease ( RHD) is the most common acquired heart disease in children especially in developing countries • RHD is a chronic heart condition caused by rheumatic fever that can be prevented and controlled
- 7. HOW?? STREP THROAT RHEUMATIC FEVER RHEUMATIC HEART DISEASE
- 8. WHAT IS RHEUMATIC FEVER?? • Rheumatic fever is an immunologically mediated inflammatory disorder which occurs as a sequel to group A streptococcal pharyngeal infection • Multisystem disease affecting connective tissue particularly of the heart, joints, brain, cutaneous & subcutaneous tissue.
- 11. • Rheumatic Fever is not a Communicable Disease but results from a Communicable Disease. • Acute rheumatic fever & rheumatic heart diseases are 100% preventable!!
- 12. CAUSES • Everyday oral activities • Infection • Weakened immune system • Certain dental procedures
- 13. PATHOGEN • Group A beta hemolytic Streptococci • Cox sackie virus type B4
- 14. Immune cross reaction Or Molecular Mimicry HOW DOES IT AFFECT ??
- 16. PATHOPHYSIOLOGY Body produces antibody against streptococci These antibodies cross react with human tissues because of the antigenic similarity between streptococcal antigens & human connective tissue ( Molecular Mimicry) This will cause immunologically mediated inflammation & damage to tissues with antigenic similarity ( joints, heart, skin, brain & subcutaneous tissue) Rheumatic fever
- 18. How is it manifested? J O N E S Oints Heart Odules Rythema chorea
- 21. 1.MIGRATORY POLYARTHRITIS ( J ) • Most common feature, seen in more than 90% of cases with RF. • Painful, migratory • Usually more than 5 large joints are affected- (knees, ankles, wrist, elbow, shoulders)
- 22. 2.
- 23. 3. N- SUBCUTANEOUS NODULES • Small painless mobile hard lumps beneath the skin • Most common along extensor surfaces of joints • Appears 4 weeks after onset of RF • Delayed sign, often disappears without residual damage. • Often associated with carditis.
- 24. 4. E- ERYTHEMA MARGINATUM • Occurs in less than 7% of cases with RF • It forms wavy lines or rings with sharp edges • More on trunks & limbs, never on face • Non Itchy • Worsens with heat application
- 26. MINOR MANIFESTATIONS 1) Clinical findings • Previous rheumatic fever/ RHD • Arthralgia • Fever associated with weakness, malaise, weight loss and anorexia. 2) Laboratory findings • Elevated ESR, CRP & leukocytosis • ECG & echocardiogram to confirm rhythm problems and structural changes • Chest X ray shows enlarged heart
- 27. DIAGNOSIS
- 28. CRITERIA TO DIAGNOSE RHEUMATIC FEVER
- 29. • Rapid Antigen detection test • Throat culture • Antistreptococcal antibodies LABORATORY DIAGNOSIS
- 31. ECHO
- 32. CHEST X RAY
- 38. REMEMBER!! ”RHEUMATIC FEVER LICKS THE JOINTS & EATS THE HEART ”
- 40. • It is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves. • It is the permanent heart valve damage resulting from one or more attacks of RF. • It is estimated that 40-60% of patients with RF will go on developing RHD • Sadly RHD can go undetected, with the results that patients presents with debilitating heart failure. Rheumatic heart disease
- 41. TYPES ?? • ACUTE RHEUMATIC HEART DISEASE Rheumatic pericarditis Rheumatic myocarditis Rheumatic endocarditis • CHRONIC RHEUMATIC HEART DISEASE
- 45. PERICARDITIS • Sharp, cutting pain, relieved on leaning forward • Pericardial friction rub- Due to inflammed pericardium rub Is it chronic or irreversible? • No long term complications as when rheumatic fever subsides the fibrin strands are cut down by plasmin & all fibrin threads are reabsorbed. • Heals completely.
- 48. MYOCARDITIS CONTD… • Myocarditis during acute rheumatic fever is lethal as myocardium becomes loose , flabby & doesn’t contract well • Mortality during acute phase of rheumatic fever is mostly due to MYOCARDITIS • But once rheumatic fever subsides, Myocarditis doesn’t leave long term damage. Congestive heart failure
- 49. RHEUMATIC ENDOCARDITIS • Acute stage of rheumatic valvulitis shows thickening & loss of translucency of valve cusps with the development of verrucacea ( vegetations, warty ) along the line of closure.
- 50. Fibrin & platelet aggregates Rheumatic/ Sterile vegetationRheumatic vegetations are not caused by microbes & hence will not break or cause emboli..
- 51. Fibrin & platelet aggregates Fibrin & platelet aggregatesadhesions & fibrosis
- 52. ENDOCARDITIS
- 53. MITRAL VALVE- NORMAL & DISEASED
- 54. CLOSING OF VALVES- COMPARISON
- 57. WHICH TYPE OF CARDITIS PROGRESSES TO CHRONIC RHD? • Rheumatic pericarditis • Rheumatic endocarditis • • Rheumatic myocarditis
- 58. CHRONIC RHD Endocarditis heals by progressive fibrosis Scarring of valves Development of chronic valvular deformities Clinically manifest decades after the acute process
- 59. • Leaflet thickening • Commisural fusion • Shortening , thickening & fusion of chordae tendinae • Orifice narrowed CHRONIC RHD FEATURES
- 64. TREATMENT
- 67. COMMISUROTOMY
- 69. VALVE REPAIR
- 71. TAVI ( TRANS CATHETER AORTIC VALVE REPLACEMENT)
- 83. QUIZ- NAME IT Aschoff body seen in myocarditis
- 84. WHICH AMONG THE FOLLOWING IS KNOWN AS FISH-MOUTH STENOSIS? • 1 2 Mitral stenosis Aortic stenosis
- 85. QUIZ CONTD… • Highest mortality rate among children during acute rheumatic fever is mostly due to • Does a patient regularly receiving Inj.Benzyl Penicillin since 3 years need a test dose before next administration? Myocarditis YES
- 86. GIVE THE OTHER NAME FOR FIBRINOUS PERICARDITIS ? BREAD & BUTTER PERICARDITIS