RHEUMATIC HEART
DISEASE
D. HANA OMER
OBJECTIVES
• To know definition, symptoms, signs, diagnosis
of Rheumatic fever.
• To know the treatment of Rheumatic fever.
• Rheumatic fever is an acute, multisystem inflammatory
disease that follows a group A (β-hemolytic) streptococcal
(GAS) throat infection.
• It is a disease of school-aged children.
• The incidence between 5 and 15 years of age.
• The most serious aspect of rheumatic fever is :1. chronic valvular disorders .
2. heart failure .
PATHOPHYSIOLOGY
Acute stage
• The acute stage of rheumatic fever includes a history of an
initiating streptococcal infection and subsequent involvement
of the connective tissue of the heart, blood vessels, joints,
and subcutaneous tissues.
• It is characterized by present of lesion called the Aschoff body
( which is a localized area of tissue necrosis surrounded by
immune cells in the heart valve) .
the Aschoff body
the Aschoff body
recurrent phase
• The recurrent phase usually involves extension of the cardiac
effects of the disease.
chronic phase
• The chronic phase of rheumatic fever is characterized by
permanent deformity of the heart valves and is a common
cause of mitral valve stenosis .
• Chronic rheumatic heart disease usually does not appear until
at least 10 years after the initial attack .
Clinical features
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Symptoms before the onset of rheumatic fever :Sore throat .
headache.
Fever .
abdominal pain .
nausea.
vomiting .
swollen glands (usually at the angle of the jaw).
Clinical features
• Clinical features associated with an acute episode of
rheumatic fever :• Carditis .
• Migratory polyarthritis of the large joints .
• Erythema marginatum .
• Subcutaneous nodules .
• Sydenham’s chorea.
Carditis.
• The carditis can affect the pericardium, myocardium, or
endocardium, and all of these layers of the heart usually are
involved.
• The involvement of the endocardium and valvular structures
produces the permanent and disabling effects of rheumatic
fever.
• Although any of the four valves can be involved, the mitral
and aortic valves are affected most often.
• During the acute inflammatory stage of the disease, the
valvular structures become red and swollen; small vegetative
lesions develop on the valve leaflets .
• small vegetative lesions develop on the valve leaflets .
• development of fibrous scar tissue .
• deformity of the valve leaflets and shortening of the chordae
tendineae.
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The manifestations of acute rheumatic carditis include :heart murmur .
Cardiomegaly .
friction rub .
congestive heart failure .
Carditis .
Arthritis
• The arthritis involves the larger joints, particularly the knees,
ankles, elbows, and wrists .
• It is almost always is migratory, affecting one joint and then
moving to another.
• It is usually response (usually within 48 hours) to salicylates.
migratory polyarthritis of the large
joints
Erythema marginatum
• lesions are maplike, macular areas most commonly seen on
the trunk or inner aspects of the upper arm and thigh.
• they are transitory and disappear during the course of the
disease.
erythema marginatum
subcutaneous nodules
• The subcutaneous nodules are 1 to 4 cm in diameter.
• They are hard, painless, and freely movable and usually
overlie the extensor muscles of the wrist, elbow, ankle, and
knee joints.
subcutaneous nodules .
Sydenham’s chorea
• Is the major central nervous system manifestation.
• It is seen most frequently in girls.
• The choreic movements are spontaneous, rapid, purposeless,
jerking movements that interfere with voluntary activities.
• The chorea is self-limited, usually running its course within a
matter of weeks or months.
Sydenham’s chorea.
Diagnosis
Treament
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The treatment is based on :Antibiotics .
Anti-inflammatory drugs .
selective restriction of physical activities are prescribed.
• Penicillin also is the antibiotic of choice for treating the acute
illness.
• Salicylates and corticosteroids are used as apain killer and
disease control .
• Penicillin is the treatment of choice for secondary prophylaxis,
but sulfadiazine or erythromycin may be used in penicillinallergic individuals .
• The duration of prophylaxis could extend to 10 years .
THANK YOU