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RHEUMATIC HEART DISEASE
Dr Ubaid N P
Community Medicine
Pariyaram Medical College
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Introduction
• Rheumatic fever –febrile disease affecting connective tissues, esp. heart and joints
• Sequele to throat infection by group A beta haemolytic streptococci
• RF is not a communicable disease – results from a communicable disease
• RF often leads to Rheumatic Heart Disease (RHD)
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Problem statement
• 15 million cases of RHD worldwide
• 220000 deaths due to RHD in 2008
• Major cause of mitral insufficiency and stenosis
• In India prevalence more common on 5 – 15 age group (5-7/ thousand children)
• RF is said to occur in 1-3% of all streptococcal infections in children
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• Severity of valve disease is directly related to:
- no of previous attacks of RF
- Length of time between onset of disease & start of therapy
- Sex (F > M)
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Agent
• Group A beta Haemolytic Streptococcus
• Onset of RF is preceded by a streptococcal sore throat
• High carrier rate – convalescent, transcient and chronic carriers
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Host & Environment Factors
• Typically a childhood and adolescent disease (5 – 15 years)
• High incidence of ‘Juvenile mitral stenosis in India’
• Prevalence in M = F, but prognosis is more worse in Female
• Disease is related to low standard of living
• High risk groups – school age children, slum dwellers, those living in closed community (e.g: barracks)
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Clinical features• Fever – acute, may last 12 weeks or longer, recurs
• Polyarthritis – occurs in 90% cases, Large joints affected more commonly
• Carditis – valves and all layers involved, manifested by tachycardia, murmers, enlargement, pericarditis, heart failure, first degree AV block in ECG
• Nodules – small, painless nodules below skin
• Brain involvement – abnormal jerky movements of arms, legs and the body
• Skin involvement - various skin rashes
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Diagnosis
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Diagnosis
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Prevention
a) Primary prevention
b) Secondary prevention:
- one i/m injection of benzathine pencillin (1.2 million in adults & 600,000 units in children)
- given at an interval of 3 weeks, for at least 5 years or till the age of 18 years(which ever later)
- severe valvular disease and post valve surgery cases need life long treatment
c) Non medical measures
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