Rheumatic Heart Diseases

Ahmad Osailan

Fast review of the heart

Valves of the heart

• Function- prevent blood from flowing backwards

• Responds to changes in pressure

• Two types of valves in heart

Atrioventricular valves (AV)

Semi-lunar valves

What is Rheumatic Heart Disease

• is a rare form of heart disease that typically impacts children. It is caused by having rheumatic fever, which itself is a complication from the strep throat bacteria.

• The inflammation from rheumatic fever causes the heart valves to become weaker and not push through the blood as they should, thus creating heart disease.

What is Rheumatic Fever

• Rheumatic fever is an inflammatory disease that is developed when the streptococcal bacteria is not treated.

• This bacteria is the cause of strep throat and fever. While adults can get Rheumatic fever, it is typically a children’s illness, especially for children between the ages of 5 – 16

• Streptoccocus affects different area of the heart:

• Endocardium Endocarditis • Myocardium Myocarditis• Pericardium Pericarditis• Resulting in:• Distortion and scaring of the valves causing

stenosis or widening• Endocardium is the most affected one

Symptoms of Rheumatic Heart Disease

• Fever• Swollen and red joints• Murmur• Breathlessness (dyspnea)• Fatigue• Chest pain• Fainting attacks• Palpitations

RHD mostly is the cause of Valve Heart disease

Types of Valve Diseases

• Mitral Stenosis• Mitral Regurgitation• Mitral Valve Prolapse• Aortic Stenosis• Aortic regurgitation• Tricuspid valve is affected infrequently – Tricuspid stenosis – causes Rt HF– Tricuspid regurgitation –causes venous overload

Mitral Stenosis

• Is a thickening of Valve by fibrosis or calcification.

• What happen to the valve?

• Valve leaflets fuse and become stiff and the cordae tendineae contract

What happen after mitral stenosis

• These narrows the opening and prevents normal blood flow from the LA to the LV

• LA pressure increases left atrium dilates, Pulmonary Artery Pressure increasesthe RV hypertrophies.

• Pulmonary congestion and right sided heart failure occurs.

Objective findings of mitral stenosis

–Pulse may be normal to A-Fib

–Apical diastolic murmur is heard

Mitral Regurgitation

• caused by papillary muscle rupture form congenital, infective endocarditis.

• Abnormality prevents the valve from closing• Blood flows back into the right atrium during

systole• During diastole the regurg output flows into

the LV with the normal blood flow and increases the volume into the LV

Aortic Stenosis

• Valve becomes stiff and fibrotic, impeding blood flow with LV contraction

• Results in LV hypertrophy, increased O2 demands, and pulmonary congestion

• Caused by – rheumatic fever, congenital, arthrosclerosis

• Complications – right sided heart failure, pulmonary edema, and A-fib.

Diagnosis

• History and physical findings• EKG• Chest x-ray• Cardiac cath• Echocardiogram

Surgical Management of Valve Disease

• Most of the valve disease of the heart are treated surgically by

• VALVE REPLACEMENT• There are 2 types of Valve Replacement • 1- Mechanical Valve • 2- Tissue Valve

Difference between Mechanical V and Tissue V

• Artificial Valves tissue Valves

• Life expectancy (20) 10-15 years, Limited durability

• High Susceptibility of Blood clot Less likely for clotting• Patient on Antiplatelet patient is on immune

supressant

Rehabilitation for Post valve replacement

• Will be discussed in Cardiac rehabilitation lecture.