Rheumatic heart disease.pptx

8/9/2019 Rheumatic heart disease.pptx

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RHEUMATICHEART

DISEASEPresented by

Dr. Thein Tun

2nd Dr.D.Sc (Oral Medicine)

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RHEUMATIC HEART DISEASE

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• Rheumatic fever is a poststreptococcal immune

mediated inflammatory disease affect heart and

e!tracardiac sites e.". #oints$ s%in$ brain.

• The incidence and mortality of rheumatic fever

has declined over the past &' years (due to

improved socioeconomic condition and rapid

dia"nosis and treatment of strep. pharyn"itis).


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Pathogenesis

n acute attac% of streptococcal pharyn"itis by

"roup betahemolytic streptococci.

ithin 2* +ee%s after this attac% antistreptococcal

antibodies are formed and attac% the heart and the

e!tracardiac sites.

The mechanism of this immune reaction is not yet

understood$ ho+ever$ the most accepted hypothesis

is antigenic similarity hypothesis.

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The disease passes into t+o phases,

A. Acute phase acute rheumatic pancarditis (inflammation of

endocardium$ myocardium and pericardium)

-. Myocarditis.

2. Pericarditis /bread and butter/$ due to fibrinous

inflammation

&. 0ndocarditis edema$ inflammation and fibrindeposits on valve leaflets (ve"etations) alon" lines

of closure. Mostly mitral and aortic valves.

schoff nodules are uncommon in the valves.4


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B. Chronic phase

cute chan"es may resolve completely or pro"ressto scarrin" and development of chronic valvular

deformities many years after the acute disease.

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Clinical features of Acute Rheumatic

e!erOccurs -' days to 1 +ee%s after pharyn"itis

Pea% incidence - years.

3ardiac manifestations pericardial friction rubs$ +ea% heart

sounds$ tachycardia and arrhythmias.

0!tracardiac fever$ mi"ratory polyarthritis of lar"e #oints$

arthral"ia$ s%in lesions$ chorea.

Pharyn"eal culture may be ne"ative$ but anti streptolysin O

(SO) titer +ill be hi"h. 6


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CHR"#IC RHEUMATIC

HEART DISEASE0ndocarditis heals by pro"ressive fibrosis. 3hronic scarrin" of thevalves constitutes the most important lon"term se4uelae of

rheumatic fever$ and usually becomes clinically manifest decades

after the acute process.

5eft sided valves (mitral and aortic) are more commonly

involved than the ri"ht.

6ibrosis of valve leaflets 7 stenosis.

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6ibrosis of chordae tendonae 7 re"ur"itation

(improper closure).

"ther car$iac complications%

-. Subacute bacterial endocarditis.

2. rrhythmia.

&. 3hronic heart failure

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Mitral !al!e stenosis%5eads to left atrial dilatation and failure$ chronic

venous con"estion of the lun"$ lun" fibrosis$

pulmonary hypertension and chronic ri"ht sided heart

failure.

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Mitral !al!e incompetence%

5eads to left ventricular dilatation and failure$ left

atrial dilatation and failure$ chronic pulmonary

con"estion$ lun" fibrosis$ pulmonary hypertension

and chronic ri"ht sided heart failure.

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Infecti!e En$ocar$itis


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Definition% infection of the cardiac valves or mural

surface of the endocardium$ resultin" in the

formation septic ve"etations (thrombi).

Di!i$e$ into%

a. Acute infecti!e en$ocar$itis.&. Su&acute infecti!e en$ocar$itis.

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Acute infecti!e en$ocar$itis

Etiolog'%

cute suppurative inflammation that affectshealthy valves.

Or"anisms 8i"hly virulent as staph. ureus$

strept.hemolyticus and "onococci.

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(esions

Mitral 9 aortic valves are most commonly affected.

Tricuspid is affected in :; dru" abusers.

The mural endocardium may be also affected.

The affected valve and mural endocardium sho+

acute suppurative inflammation < ve"etations.

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Complications). Em&olic complications%

• Detached septic ve"etations leads to

systemic pyemia.

*. To+emic complications%

• Severe to!emia

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Prognosis

Rapidly fatal due to,

-. Severe to!emia (septicemia).

2. 3usp perforation (acute heart failure).

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Su&acute infecti!e en$ocar$itis

Etiology:

Subacute inflammation that affects abnormalvalves in, Rheumatic valvulitis

3on"enitally abnormal valves.

Prosthetic valves.3aused by 5ess virulent bacteria as

strept.viridans

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Complications19

). Em&olic complications%Infarctions% in %idney$ spleen and brain$ retina$ heart.

M'cotic aneur'sms% mainly in cerebral and mesenteric.

Petechial hemorrhage% in s%in$ mucous membranes and

serous membranes.

"sler,s no$ules% small. tender$ intracutaneous nodules in

pulps of fin"ers 9 toes.


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*. To+emic complications%

Moderate to!emia fever$ anemia$ clubbin" of fin"ers$

splenome"aly$ petechial hemorrha"e and focal

"lomerulonephritis (flea bitten %idney)

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Prognosis8eal by fibrosis leads to valve lesion either stenosis or

incompetence.

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Than- 'ou

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Rheumatic heart disease.pptx