Rheumatic heart disease (RHD) (Diagnosis (Physical examination While a…
Rheumatic heart disease (RHD)
Undiagnosed Rheumatic fever
developed from the body’s immune response to a bacteria infection with group A streptococcus (also known as Streptococcus bacteria).
Infections includes strep throat and sore throat
Early treatment of recurrent rheumatic fever can prevent progression of rheumatic heart disease
A single severe episode or multiple recurrent episodes of rheumatic fever disease causes rheumatic heart disease
Group A Streptococcus
the infection can be caught when an infected person talks, coughs, sneezes small droplets contain infectious agents in the air.
The droplets in the air may be breathed in by those nearby.
The droplets may also contaminate hands or objects such as drinking cup or eating utensils.
Infection can also spread by eating contaminated food.
Infection can spread by direct contact with infected wounds or skin sores.
The risk of RHD is more with repeated infections of rheumatic fever in children of 5-15 years of age.
Occurrence of RHD is rare before 3 years and after 30 years of age
More common in females - although it is unclear whether the difference in RHD prevalence is due to a greater susceptibility to developing autoimmune response or whether social factors such as involvement in child-raising.
RHD often becomes apparent during pregnancy due to association with higher cardiac burden
Unhygienic living conditions
Greater household crowding due to low low socialeconomic status
Limited access to medical resources
Group A-hemolytic Streptococci
- Humoral and cellular-mediated immune response occurring 1-3 weeks after the onset of streptococci pharyngitis
- Human cardiac antigens
Myosin: laminin and extracellular matris alpha helix coiled protein
Signs & Symptoms
Breathlessness on exertion
Paroxysmal nocturnal dyspnoea
Swollen, tender, red and extremely painful joints - particularly the knees and ankles
Uncontrolled movements of arms, legs, or facial muscles
Fever associated with infection of damaged heart valves
100 years ago rheumatic heart disease was believed to be a disease of "temperature climate."
Rheumatic heart disease follows from untreated rheumatic fever.
in the past 10 years, group A streptococcal infections are frequent in the Orient and lead to a high incidence of rheumatic fever and rheumatic heart disease.
The pattern of childhood rheumatic fever varied: Carditis was the most common manifested, occurring in 57% to 94% of the patients
While a heart murmur may suggest rheumatic heart disease, many patients with do not have a murmur
including evidence of past rheumatic fever or strep infection
to check for enlargement of the heart of fluid on the lungs
to checkin the chambers of the heart have enlarged or if there is an abnormal heart rhythm (arrhythmia)
this is the most useful test assess if rheumatic heart disease is present- Echocardiogram is used to check the heart valves for any damage or infection and assess if there is heart failure.
Certain blood tests may be used to look for infection and inflammation.
An imaging test to take a detailed picture of the heart to get a more precise description of the heart valves and heart muscles.
Hospital admission to threat heart failure
Antibiotics for infection
Blood-thinning medicine to prevent stroke or thin blood for replacement valves
Balloons inserted through a vein to open up stuck valves
Heart valve surgery - to repair or replace damaged heart valves
Medical treatment also includes reducing the risks of complications
Regular check-ups with a cardiologist
to monitor the heart
Up-to-date flu vaccinations
influenza and pneumococcal
Regular (prevention) antibiotic
to prevent Group A Streptococcus throat infections and recurring acute rheumatic fever
Antibiotic treatment for sore throat or skin skin sores
Ensure all cuts and skin sores are kept clean
Regular dental check ups
Fluoridated water supply
as oral bacteria entering the bloodstream can increase the risks of inflammation of the inner lining of the heart
may be given to some people before some dental or surgical procedures to prevent bacterial infection of the managed areas of the heart
Good parental care
pregnancy can make rheumatic heart disease worse.
Penicillin G benzathine/pencillin G procaine
Used when administration of penicillin is not feasible or dependable
The drug of choice for treatment of group A Streptococcal pharyngitis.
long term treatment every 3-4 weeks
used to prevent further episodes of acute rheumatic fever, therefore prevents further damage to the heart valves
Used to treat patients allergic to penicillin.
Inhibits bacterial growth, possibly by blocking disassociation of peptidyl tRNA from ribosomes causing RNA-dpendendent protein synthesis to arrest.
Aspirin (Anacin, Ascriptin, Bayer Aspirin
used to prevent formation of platelet-aggregating thromboxane A2
Start immediately after the diagnosis of rheumatic fever
Prednisone (Deltasone, Orasone)
May decrease inflammation by reversing increased capillary permeability.
Angiotensin-converting enzyne (ACE) inhibitors
indicated for chronic aortic and/or mitral regurgitation.
-Prevents conversion of angiotensin l to angiotensin ll.
Prevents conversion of angriotension l to angiotensin ll, a potent vasoconstrictor, resulting in lower aldosterone secretion.