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What
is Rheumatic heart disease?--
It is a condition in which the heart suffers an immunological damage
due to a previous streptococcal infection.
Why does it occur?--
The streptococi commonly cause pharyngitis.The body develops an immune
response against these organisms. However some of the proteins of
these organisms closely resemble the heart proteins. Hence the antibodies
against these proteins also attack the heart. The heart thus suffers
the immunological damage due to resemblance of proteins.
what is acute rheumatic fever?--
This is the acute phase of the fever. The features are--
- Fever
- Migratory
polyarthritis--Patient has pain & swelling of the large joints
of the body e.g.. knee, ankle. However the pain & the swelling
does not remain constant. All the joints are not involved at the
same time. First one joint is affected ;a few days later it gets
better when the same complains start in some other joint.
- Carditis--the
heart is involved.
- Sydenham's
chorea--these are abnormal movements. Seen much later in the course
of the disease.
- Some rash
like lesions are seen on the body especially on the bony prominences.
How
is the diagnosis confirmed?--
- ASO titer--This
is a proof of any preceding streptococcal infection.
- ECG--can
provide useful information about heart involvement.
Affection
of the heart in RHD--
Most common affection is that of the heart valves. These valves are
present between the various chambers of the heart. Due to RHD either
the valvular aperture narrows or the valves become incompetent. This
impairs the cardiac hemodynamics. & the full blown picture of
RHD emerges if not treated.
Why is penicillin given to these patients?--
Penicillin is effective against streptococci. If the patient gets
reinfected with streptococci; it would aggravate the RHD. hence as
a precaution to prevent any further infection with streptococci, penicillin
is given to the patient. It should be given to the patient every 3
weeks. However it has no effect on the damage that has already occurred.
How
does R.H.D. manifest?--
It can
manifest with any of the following--
- Breathlessness
on exertion.
- Palpitation
- Blood in
the coughed out sputum.
- Recurrent
lung infections.
- Chest pain
- Sudden
attacks of giddiness, fall & unconsciousness (transient) especially
on exertion.
What
is the treatment?--
Depending on the extent of damage, different valvular surgeries are
required. Early cases can be managed without open heart surgery with
less invasive methods. However more advanced cases require open heart
surgery with replacement of the valve by artificial valve.
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