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