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
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. Mitral and aortic valve -25% . Mitral valve alone-65 to 70% of the cases.
. Carditis is likely to worsen with each recurrence and damage is cumulative. 99% of cases of mitral stenosis is due to RHD.
. Rheumatic fever is an acute immunologically mediated multi system Inflammatory disease. can be acute or chronic.Rheumatic Fever
A sequelae of rheumatic fever. Diagnosed by Jones Criteria: Either two of the major manifestations or one major and two minor manifestations. It occurs 10 days to 6 weeks after an episode of group A (Beta-hemolytic) streptococcal (pharyngitis) and often involves the heart.
Carditis 2.Erythema Marginatum 5.Fever 2.C-Reactive Protein c.a neurologic
disorder with involuntary purposeless rapid movements.S.
4.Previous History of RF 4.E.Increased a.R b.JONES CRITERIA
1.Prlonged PR intravel
1.Arthralgia 3.Poly arthritis 3.Leucocytosis 5.Subcutaneous Nodules
. Autoimmune mech. joints and other tissues. has been proposed Antibodies directed against the M proteins of certain strains of streptococci cross-react with tissue glycoprotein in the heart.Pathogenesis
Hypersensitivity reaction. Progressive fibrosis of both healing of the acute inflammatory lesion.
Formation of chronic sequelae And the turbulence induced by ongoing valvular deformities.
Mitral and aortic valve -25% .
INVOLVEMENT OF VALVES
99% of cases of mitral stenosis is due to RHD. Weak heart sounds Tachycardia
Arrhythmias Functional mitral valve insufficiency Heart failure. Mitral value alone-65 to 70% of the cases.CLINICAL FEATURES
Pericardial friction rubs.
Polyarthritis Subcutaneous nodules Erythema maginatum Chorea minor
came to AA Hospital with chief complain: Shortness of the breath since 2 weeks ago
.Description of the case
Patient W. 12 yrs. ♂.
and the patient more comfortable when sleeping use some pillow. Shortness decrease when resting.Present Illness History
Shortness of the breath since 2 weeks ago particularly during activity such as climbing stairs. Patient also complained of frequent chest pounding
. and looked pale. fever (-). abdominal pain (-). Patient feel the body feel weak. Patient also complained of pain in the joints and the pain is felt to move.
higher at night. chills (-). pain in the ear (-) Defecation and urination no complaints
. 1 month ago patient’s fever for 3days continuously. bleeding gums or nose (-). painful swallowing (+). fever up and down.
Patient also complained of cough with phlegm and runny nose. seizures (-).
Past Illness History
Patients often experiencesore throat
Generalized condition Conciousness : composmentis Vital Sign BP : 100/70 mmHg HR : 106x/i RR : 26x/i T : 37.4˚C
Linea sternalis dekstra SIK IV Kiri .Head and neck : normal head size. enlarged lymph nodes Thorax : Lung : normaly Heart: Ins peksi :ictus cordis seen Palpasi : ictus cordis palpable at SIC V. 1 finger lateral LMCS SIK V Auskultasi: systolic murmur (+)
. 2 finger lateral LMCS Perk usi : Kanan . conjunctiva anemis (+/+).
Abdomen Genitourinary Lymph node Extremity
: Normal : Normal : Normal : clubbing fingger (-). edema (-)
serological : ASTO and CRP Rontgen thorak PA Echocardiografi EKG
Routine blood test.
900/uL Serological ASTO : reaktif 800 IU/ml ( < 200 IU/ml ) CRP : reaktif 192 mg/l ( < 6 mg/l )
.Laboratory test results
Routine blood test : Hb: 8.7% Led:105 mm/jam Trombosit:483.000/uL Leukosit : 12.1 g/dL Ht : 23.
Rontgen Thorax 20-2-2013 Rontgen thorak : impression cardiomegali
Impression : MR moderate ec RHD
RHD with kardiomegali + karditis + anemia
5 = 1590 kkal
Berikan O2 2 L/menit (k/p) IVFD D5 ½ 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.