Rheumatic fever and rheumatic heart disease are systemic inflammatory diseases primarily affecting the connective tissue and usually preceded by group A streptococcal infection. They can lead to acute rheumatic endocarditis characterized by small vegetations along the mitral valve margin. Advanced cases result in chronic rheumatic heart valve disease like mitral stenosis and aortic regurgitation. Long-term management involves eradicating streptococcal infection, suppressing inflammation, and secondary prevention with antibiotics.

1. RHEUMATIC HEART
DISEASE
What are the Consequences?
Nahar Taufiq
Bagian Kardiologi Kedokteran Vaskuler FK UGM
KSM Jantung RSUP DR Sardjito
Jogjakarta

2.  Acute Rhematic Fever (RF) and
Rhematic heart disease (RHD)
 Consequences of Haemodynamic
 When to Intervention?
 Consequences of Anticoagulant Therapy
An Overview

3.  Rhematic Fever (RF) and or Rhematic
heart disease (RHD) is a a major health
hazard in most developing countries as well
as sporadically in developed economies
Rheumatic Heart Disease

4.  RF and RHD are systemic inflamatory
disease with protean manifestation
primarily affecting the connective tissue
and usually preceded by a group A beta
hemolytic streptococcal (GABHS)
infection characterized by acute
exacerbation and recurrencces
Rheumatic Heart Disease

5. Infection by GABHS
2 – 5 days intubation
URI infection
high fever, sore throat, headache, body weakness,
and increase in WBC count
Acute Rheumatic Fever
Acute Rheumatic Heart Disease
3% of them develop RF after
Several weeks
Major : Carditis, Polyarthritis,Chorea,
erythema marginatum, Subcutaneus nodule
Minor : Clinis : arthralgia , fever
Lab : Erythrocyt cedimen rate, C – reactive protein
prolonged PR interval,positive throat culture,etc
2 Major or 1 major 2 minor
Evidence for recent GAS infection

6. Acute Rheumatic heart disease
Divided into rheumatic endocarditis,
rheumatic myocarditis
and rheumatic pericarditis,
often for rheumatic pancarditis.

7. Management ARF-ARHD
1. Eradicate the GAS
 Benzathine Penicilin G ,
 < 27 kg : 600.000 U –IM (once)
 > 27 kg : 1,200,000 U – IM (once)
 Erythromycin estolate, 20-40mg/kg/2-4 times daily ( 10
days)
 Erythromycin Ethylsuccinate 40mg/kg/2-4 times (max 1
g/d) (10 days)

8. Management ARF-ARHD
2. Suppress the Inflamatory response
 Aspirin 90-120 mg/kg/day for 10 weeks and tapered in the
next 2 weeks
 > 20 kg: Prednison 60 mg/day three weeks and tapered in
the next nine weeks
 < 20 kg : prednison 40 md/day

9. Secondary Prevention of RF
• Benzathine Penicilin G 1,200,000/ 3-4 weeks – IM
• Penicilin V 25 mg twice daily – oral
• Erythromycin 250 mg twice daily -oral

10. Acute Rheumatic Fever
Acute Rheumatic Heart Disease
Acute rheumatic endocarditis: small (diameter 1- to 2-mm)
vegetations along the mitral valve margin, insufficient to
cause valvular deformation.

11. Chronic Rheumatic Heart Disease

15. Mitral Regurgitation

16. Mitral Regurgitation

17. Mitral Regurgitation

18. Mitral Regurgitation

19. Mitral Regurgitation
Porcine model, 6M

21. Mitral Stenosis

22. Mitral Stenosis

23. Mitral Stenosis

24. Mitral Stenosis

25. Mitral Stenosis

27. Due to the vibration of the anterior leaflet of the mitral
valve as it is buffetted simultaneously by the blood jets
from the left atrium and the aorta.
Aortic Regurgitation
Aortic Regurg – Austin Flint Murmur

28. Aortic Regurgitation

29. Aortic Regurgitation

30. Aortic Regurgitation

31. Aortic Regurgitation

33. Aortic Stenotic

34. Aortic Stenotic

42. TERIMA
KASIH

43. Dr. T Duckett Jones
- Major Manifestation
- Carditis, Arthritis, subcutaneous nodules,
erythema marginatum and chorea
- Minor manifestation
- Fever, arthralgia
- Essensial Criteria
Acute Rheumatic Fever
Acute Rheumatic Heart Disease

44. Acute rheumatic endocarditis: small (diameter 1- to 2-mm) vegetations along the mitral valve
margin, insufficient to cause valvular deformation.

45. Small vegetations (verruca) are visible along the line
of closure of the mitral valve leaflet (arrows).

46. Advanced: vegetations organization, recurrent organization cause chronic heart valve disease (
valvular stenosis and / or valvular insufficiency )

48. Mitral stenosis with diffuse fibrous thickening and distortion of
the valve leaflets, commissural fusion (arrows), and thickening
and shortening of the chordae tendineae.

49.  Rhematic Fever (RF) and or Rhematic
heart disease (RHD) is a systemic
inflamatory disease with protean
manifestation primarily affecting the
connective tissue and usually preceded
by a group A beta hemolytic streptococcal
(GABHS) infection characterized by acute
exacerbation and recurrencces
Rheumatic Heart Disease

58. Template
 Jogja Cardiology Update
 Jogja Cardiology Update
 Jogja Cardiology Update
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59. Jogja Cardiology
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 Jogja Cardiology Update
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Jogja Cardiology Update
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60. Jogja Cardiology Update
 Jogja Cardiology
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Update
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Update
 Jogja Cardiology
Update