Rheumatic heart disease
Etiology
1. **Untreated Strep Infections:** Failure to promptly and completely treat streptococcal infections, especially strep throat, increases the risk.
2. **Geography and Socioeconomic Factors:** Rheumatic heart disease is more prevalent in economically disadvantaged populations and certain regions with limited access to healthcare.
3. **Age and Gender:** It often occurs in children and young adults, and there may be a higher risk in females.
4. **Genetic Factors:** Genetic susceptibility may play a role, influencing how the immune system responds to streptococcal infections.
5. **Overcrowded Living Conditions:** Close living quarters and increased exposure to infections can contribute to the spread of streptococcal bacteria.
6. **Poor Hygiene:** Lack of proper hygiene practices may increase the risk of streptococcal infections.
The pathophysiology of rheumatic heart disease
1. **Streptococcal Infection:** Initial infection with Group A streptococcus, often manifesting as strep throat or skin infections.
2. **Immune Response:** In some individuals, the body's immune system mounts an exaggerated response to the streptococcal infection.
3. **Autoimmune Reaction:** The immune system mistakenly targets and attacks its own tissues, including the heart valves.
4. **Inflammation:** This autoimmune reaction causes inflammation in the heart, particularly in the heart valves. The inflammation can lead to swelling, scarring, and damage to the valve tissues.
5. **Valve Dysfunction:** Over time, repeated episodes of inflammation can result in the thickening and scarring of the heart valves, affecting their ability to function properly.
6. **Impaired Blood Flow:** The damaged valves may not open and close efficiently, leading to problems with blood flow through the heart. This can result in complications such as heart murmurs, heart failure, and other cardiovascular issues.
Clinical manifestations of rheumatic heart disease
1. **Heart Murmurs:** Abnormal sounds during heartbeat, detectable with a stethoscope.
2. **Carditis:** Inflammation of the heart muscle, lining, and valves.
3. **Polyarthritis:** Joint inflammation, usually affecting multiple joints.
4. **Subcutaneous Nodules:** Small, painless nodules under the skin, typically near joints.
5. **Sydenham's Chorea:** Involuntary movements and muscle weakness, especially in the face and limbs.
6. **Fever:** Elevated body temperature, often associated with acute rheumatic fever.
7. **Fatigue and Weakness:** General feelings of tiredness and weakness.
8. **Shortness of Breath:** Difficulty breathing due to heart valve dysfunction.
Diagnostic evaluation for rheumatic heart disease
1. **Clinical History and Physical Examination:** Gathering information about the patient's symptoms, medical history, and conducting a thorough physical examination, with a focus on heart sounds and signs of inflammation.
2. **Blood Tests:** Checking for markers of inflammation (such as erythrocyte sedimentation rate and C-reactive protein) and streptococcal antibodies.
3. **Electrocardiogram (ECG or EKG):** Recording the heart's electrical activity to identify irregularities or signs of strain.
4. **Chest X-ray:** Examining the size and shape of the heart and assessing lung congestion.
5. **Echocardiogram:** Using ultrasound to visualize the heart's structure and function, particularly focusing on the heart valves and any abnormalities.
6. **Throat Culture:** Identifying the presence of streptococcal bacteria.
7. **Joint Aspiration (if arthritis is present):** Collecting fluid from an inflamed joint for analysis.
8. **MRI or CT Scan:** Providing detailed images of the heart, which can be useful in assessing valve damage and overall cardiac structure.
management
1. **Antibiotic Therapy:** Administering antibiotics to treat active streptococcal infections and prevent recurrent episodes. Long-term prophylactic antibiotics may be prescribed to reduce the risk of further infections.
2. **Anti-inflammatory Medications:** In cases of acute inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may be prescribed to alleviate symptoms and reduce inflammation.
3. **Heart Failure Management:** If heart failure is present, medications such as diuretics, ACE inhibitors, or beta-blockers may be prescribed to manage symptoms and improve cardiac function.
4. **Monitoring and Follow-up:** Regular follow-up appointments and monitoring are essential to assess the progression of the disease, manage symptoms, and adjust treatment as needed.
5. **Surgery:** In severe cases with significant valve damage, surgical intervention, such as valve repair or replacement, may be necessary.
6. **Lifestyle Modifications:** Encouraging a heart-healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking, can contribute to overall well-being.
7. **Education and Prevention:** Patient education about the importance of completing antibiotic courses, recognizing and promptly treating streptococcal infections, and understanding the need for ongoing medical follow-up is crucial.
Surgical management
1. **Valvuloplasty:** This procedure aims to repair a damaged heart valve. Surgeons may attempt to reconstruct the valve to restore proper function.
2. **Valve Replacement:** In cases where valve damage is extensive and repair is not feasible, valve replacement surgery may be recommended. This can involve mechanical valves (made of artificial materials) or bioprosthetic valves (made from animal tissue).
3. **Balloon Valvuloplasty:** This minimally invasive procedure involves using a balloon to widen a narrowed heart valve, improving blood flow. It's often used in cases of mitral stenosis.
4. **Subvalvular or Supravalvular Repair:** In some cases, there may be involvement of structures below or above the valve. Surgical repair may be necessary in these areas to address the overall functionality of the heart.
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Rheumatic heart disease