Rheumatic Heart Disease


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Rheumatic Heart Disease

  1. 1. Dr.Rajkumar Patil Asstt. Prof., Community Medicine AVMCH, Pondicherry
  2. 3. RF is the most common cause of heart disease in 5-30 yr age group
  3. 5. <ul><li>RHD in India </li></ul><ul><li>Prevalence: 5/1000 population of 5-15 age group </li></ul><ul><li>1 million RHD cases in India </li></ul><ul><li>Hospital admissions due to RHD is 20-30% of CVD </li></ul>
  4. 6. <ul><li>Acute rheumatic fever (ARF) is a systemic disease of childhood </li></ul><ul><li>It is a delayed non-suppurative sequelae to URTI with GABH streptococci </li></ul><ul><li>It is a diffuse inflammatory disease of connective tissue,primarily involving heart,blood vessels,joints, subcut.tissue and CNS </li></ul>
  5. 7. Epidemiological Factors
  6. 8. Agent
  7. 9. <ul><li>Age: </li></ul><ul><li>5-15 yrs(most susceptible) </li></ul><ul><li>Sex: </li></ul><ul><li>both </li></ul><ul><li>Environmental factors </li></ul><ul><li>over crowding, poor sanitation, poverty </li></ul><ul><li>Incidence more during </li></ul><ul><li>winter & early spring </li></ul>Host Factors
  8. 11. <ul><li>Flitting & fleeting migratory polyarthritis, involving major joints </li></ul><ul><li>Commonly involved joints-knee,ankle,elbow & wrist </li></ul><ul><li>Occur in 80%,involved joints are exquisitely tender </li></ul><ul><li>In children below 5 yrs:It is mild but carditis is more prominent </li></ul><ul><li>Arthritis do not progress to chronic disease </li></ul>1.Arthritis
  9. 12. <ul><li>Manifest as pancarditis (endocarditis, myocarditis and pericarditis),occur in 50% of cases </li></ul><ul><li>Carditis is the only manifestation of rheumatic fever that leaves a sequelae & permanent damage to the organ </li></ul><ul><li>Valvulitis occur in acute phase </li></ul><ul><li>Chronic phase- fibrosis,calcification & stenosis of heart valves (fishmouth valves) </li></ul>2.Carditis
  10. 13. Rheumatic heart disease . Abnormal mitral valve. Thick, fused chordae
  11. 14. <ul><li>Occur in 5-10% of cases </li></ul><ul><li>Mainly in girls of 1-15 yrs age </li></ul><ul><li>Clinically manifest as-clumsiness, deterioration of handwriting, emotional lability or grimacing of face </li></ul><ul><li>Clinical signs- pronator sign, jack in the box sign , milking sign of hand s </li></ul>3.Sydenham Chorea
  12. 15. <ul><li>Occur in <5%. </li></ul><ul><li>Unique,transient,serpiginous lesions of 1-2 inches in size </li></ul><ul><li>Pale center with red irregular margin </li></ul><ul><li>More on trunks & limbs & non-itchy </li></ul><ul><li>Worsens with application of heat </li></ul><ul><li>Often associated with chronic carditis </li></ul>4.Erythema Marginatum
  13. 16. <ul><li>Occur in 10% </li></ul><ul><li>Painless,pea-sized,palpable nodules </li></ul><ul><li>Mainly over extensor surfaces of joints,spine,scapulae & scalp </li></ul><ul><li>Associated with strong seropositivity </li></ul><ul><li>Always associated with severe carditis </li></ul>5.Subcutaneous nodules
  14. 17. <ul><li>Fever(mild) </li></ul><ul><li>Polyarthralgia </li></ul><ul><li>Pallor </li></ul><ul><li>Anorexia </li></ul><ul><li>Loss of weight </li></ul>Other features (Minor features)
  15. 20. <ul><li>Chorea alone, if other causes have been excluded </li></ul><ul><li>Insidious or late-onset carditis with no other explanation </li></ul>
  16. 21. <ul><li>Juvenile rheumatiod arthritis </li></ul><ul><li>Septic arthritis </li></ul><ul><li>Sickle-cell arthropathy </li></ul><ul><li>Kawasaki disease </li></ul><ul><li>Myocarditis </li></ul><ul><li>Scarlet fever </li></ul><ul><li>Leukemia </li></ul>
  17. 22. Prevention and control <ul><li>To prevent the first attack of RF,by detection and </li></ul><ul><li>treatment of streptococcal throat inf. </li></ul><ul><li>Many inf are inapparent or undiagnosed </li></ul><ul><li>High risk approach: </li></ul><ul><li>Surveillance for streptococcal pharyngitis </li></ul><ul><li>among school children </li></ul>Primary prevention
  18. 23. Sore throat should be swabbed and cultured If strepto.— Give Penicillin (If culture is not possible a sore throat can be treated with Benzathine Benzyl Penicillin) Dose: One IM inj.,1.2 miilion units(adults),0.6 million units(children) Or Oral Penicillin G/Penicillin V for 10 days Erythromycin (In case of allergy to Penicillin) Primary prevention contd…
  19. 24. Secondary Prevention
  20. 25. <ul><li>Other measures in Secondary Prevention </li></ul><ul><li>Surveys to know the prevalence of RHD </li></ul><ul><li>among school children </li></ul><ul><li>Every 5 years in 6-14 years age group </li></ul>
  21. 26. <ul><li>Rheumatic fever can recur whenever the individual experience new GABH streptococcal infection,if not on prophylactic medicines </li></ul><ul><li>Good prognosis for older age group & if no carditis during the initial attack </li></ul><ul><li>Bad prognosis for younger children & those with carditis with valvar lesions </li></ul>