RHEUMATIC HEART DISEASE

Diana Khusnety 0608120166 Lecturer Dr. Riza Irianai Nst, SpA

Rheumatic Heart Disease DEFINITION

Rheumatic heart disease is a chronic condition charectorised by scaring and fibrosis of valves and layers of the heart secondary to rheumatic fever

INCIDENCE
Acute rheumatic fever appear most often in children between the age 5 and 15 years Increased vulnerability to reactivation of the disease with subsequent pharyngeal infections. Carditis is likely to worsen with each recurrence and damage is cumulative. 99% of cases of mitral stenosis is due to RHD. Mitral valve alone-65 to 70% of the cases. Mitral and aortic valve -25% .

Rheumatic Fever
A sequelae of rheumatic fever, can be acute or chronic. Rheumatic fever is an acute immunologically mediated multi system Inflammatory disease. It occurs 10 days to 6 weeks after an episode of group A (Beta-hemolytic) streptococcal (pharyngitis) and often involves the heart. Diagnosed by Jones Criteria: Either two of the major manifestations or one major and two minor manifestations.

JONES CRITERIA
MAJOR CRITERIA

MINOR CRITEIA
1.Fever 2.Arthralgia 3.Previous History of RF 4.Increased a.E.S.R b.C-Reactive Protein c.Leucocytosis 5.Prlonged PR intravel

1.Carditis 2.Poly arthritis 3.Chorea:- a neurologic

disorder with involuntary purposeless rapid movements.

4.Erythema Marginatum 5.Subcutaneous Nodules

Pathogenesis
Hypersensitivity reaction. Autoimmune mech. has been proposed Antibodies directed against the M proteins of certain strains of streptococci cross-react with tissue glycoprotein in the heart, joints and other tissues. Progressive fibrosis of both healing of the acute inflammatory lesion.

Formation of chronic sequelae And the turbulence induced by ongoing valvular deformities.

CLINICAL FEATURES
Pericardial friction rubs, Weak heart sounds Tachycardia

COMPLICATIONS
Arrhythmias Functional mitral valve insufficiency Heart failure.

INVOLVEMENT OF VALVES

99% of cases of mitral stenosis is due to RHD. Mitral value alone-65 to 70% of the cases. Mitral and aortic valve -25% .

Extracardiac Lesions
Polyarthritis Subcutaneous nodules Erythema maginatum Chorea minor

Description of the case

Patient W, , 12 yrs, came to AA Hospital with chief complain: Shortness of the breath since 2 weeks ago

Present Illness History

Shortness of the breath since 2 weeks ago particularly during activity such as climbing stairs. Shortness decrease when resting, and the patient more comfortable when sleeping use some pillow. Patient also complained of frequent chest pounding

 Patient also complained of pain in the joints and the pain is felt to move. Patient feel the body feel weak, fever (-), abdominal pain (-), decreased appetite, and looked pale.

 1 month ago patients fever for 3days continuously, fever up and down, higher at night, chills (-), bleeding gums or nose (-), seizures (-).
Patient also complained of cough with phlegm and runny nose, painful swallowing (+), pain in the ear (-) Defecation and urination no complaints

Past Illness History

Patients often experiencesore throat

Physical Examination
Generalized condition Conciousness : composmentis Vital Sign BP : 100/70 mmHg HR : 106x/i RR : 26x/i T : 37,4C

Head and neck : normal head size, conjunctiva anemis (+/+), enlarged lymph nodes Thorax : Lung : normaly Heart: Ins peksi :ictus cordis seen Palpasi : ictus cordis palpable at SIC V, 2 finger lateral LMCS Perk usi : Kanan ; Linea sternalis dekstra SIK IV Kiri ; 1 finger lateral LMCS SIK V Auskultasi: systolic murmur (+)

Abdomen Genitourinary Lymph node Extremity

: Normal : Normal : Normal : clubbing fingger (-), edema (-)

Investigation
Routine blood test, serological : ASTO and CRP Rontgen thorak PA Echocardiografi EKG

Laboratory test results

Routine blood test : Hb: 8,1 g/dL Ht : 23,7% Led:105 mm/jam Trombosit:483.000/uL Leukosit : 12.900/uL Serological ASTO : reaktif 800 IU/ml ( < 200 IU/ml ) CRP : reaktif 192 mg/l ( < 6 mg/l )

 Rontgen Thorax 20-2-2013 Rontgen thorak : impression cardiomegali

Echocardiografi:
Impression : MR moderate ec RHD

Working diagnosis

RHD with kardiomegali + karditis + anemia

Therapy
Berikan O2 2 L/menit (k/p) IVFD D5 NS 10 tpm Penisilin prokain 600.000 UI ( 10 hari ) IM Lasix 30 mg/24 jam Captopril 2 x 6,25 mg Diet makan lunak RDA x BBI = 60 x 26,5 = 1590 kkal