RHEUMATIC HEART DISEASE

Dr Ubaid N P

Community Medicine

Pariyaram Medical College

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)

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

• 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)

Agent

• Group A beta Haemolytic Streptococcus

• Onset of RF is preceded by a streptococcal sore throat

• High carrier rate – convalescent, transcient and chronic carriers

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)

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

Diagnosis

Diagnosis

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