case rhd udah fiks

7/29/2019 Case Rhd Udah Fiks

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RHEUMATIC HEART DISEASE

Diana Khusnety

0608120166

LecturerDr. Riza Irianai Nst, SpA


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Rheumatic Heart DiseaseDEFINITION

Rheumatic heart disease is a chroniccondition charectorised by scaring andfibrosis of valves and layers of the heartsecondary to rheumatic fever


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INCIDENCE

Acute rheumatic fever appear most often inchildren between the age 5 and 15 years

Increased vulnerability to reactivation of thedisease with subsequent pharyngeal infections.

Carditis is likely to worsen with each recurrenceand damage is cumulative.

99% of cases of mitral stenosis is due to RHD.Mitral valve alone-65 to 70% of the cases.

Mitral and aortic valve -25% .


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Rheumatic Fever

A sequelae of rheumatic fever, can be acuteor chronic.

Rheumatic fever is an acuteimmunologically mediated multi systemInflammatory disease.

It occurs 10 days to 6 weeks after anepisode of group A (Beta-hemolytic)streptococcal (pharyngitis) and ofteninvolves the heart.

Diagnosed by Jones Criteria: Either two of the major manifestations or

one major and two minor manifestations.


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JONES CRITERIA

MAJOR CRITERIA

1.Carditis

2.Poly arthritis

3.Chorea:-aneurologicdisorder with involuntary

purposeless rapid movements.

4.Erythema

Marginatum5.Subcutaneous

Nodules

MINOR CRITEIA

1.Fever

2.Arthralgia

3.Previous History of RF4.Increased

a.E.S.R

b.C-Reactive Protein

c.Leucocytosis5.Prlonged PR intravel


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PathogenesisHypersensitivity reaction.Autoimmune mech. has been proposed

Antibodies directed against the M proteins of certainstrains of streptococci cross-react with tissue

glycoprotein in the heart, joints and other tissues.

Progressive fibrosis of both healing of the acuteinflammatory lesion.

Formation of chronic sequelae

And the turbulence induced by ongoing valvulardeformities.


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CLINICAL FEATURES

Pericardial friction rubs,

Weak heart sounds

Tachycardia

COMPLICATIONS Arrhythmias Functional mitral valve insufficiency

Heart failure.

INVOLVEMENT OF VALVES

99% of cases of mitral stenosis is due to RHD.

Mitral value alone-65 to 70% of the cases.

Mitral and aortic valve -25% .


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Extracardiac Lesions

Polyarthritis

Subcutaneous nodules

Erythema maginatum Chorea minor


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Description of the case

Patient W, , 12 yrs, came to AA Hospital

with

chief complain:

Shortness of the breath since 2 weeks ago


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Present Illness History

Shortness of the breath since 2 weeksago particularly during activity such asclimbing stairs. Shortness decrease when

resting, and the patient more comfortablewhen sleeping use some pillow. Patientalso complained of frequent chestpounding


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Patient also complained of pain inthe joints and the pain is felt to

move. Patient feel the body feel weak,

fever (-), abdominal pain (-),decreased appetite, and lookedpale.


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1 month ago patients fever for 3dayscontinuously, fever up and down,higher at night, chills (-), bleedinggums or nose (-), seizures (-).

Patient also complained of cough withphlegm and runny nose, painful

swallowing (+), pain in the ear (-) Defecation and urination no complaints


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Past Illness History

Patients often experiencesore throat


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Physical Examination

Generalized condition

Conciousness : composmentis

Vital Sign

BP : 100/70 mmHg

HR : 106x/i RR : 26x/i

T : 37,4C


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Head and neck : normal head size, conjunctiva anemis

(+/+), enlarged lymph nodes

Thorax :

Lung : normaly

Heart:

Ins peksi :ictus cordis seenPalpasi : ictus cordis palpable at SIC V, 2 finger

lateral LMCS

Perk usi : Kanan ; Linea sternalis dekstra SIK IV

Kiri ; 1 finger lateral LMCS SIK V

Auskultasi: systolic murmur (+)


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Abdomen : Normal

Genitourinary : Normal

Lymph node : Normal

Extremity : clubbing fingger (-), edema (-)


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Investigation

Routine blood test, serological : ASTOand CRP

Rontgen thorak PA Echocardiografi

EKG


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Laboratory test results

Routine blood test :

Hb: 8,1 g/dL Ht : 23,7% Led:105 mm/jam

Trombosit:483.000/uL Leukosit : 12.900/uL

Serological

ASTO : reaktif 800 IU/ml ( < 200 IU/ml )

CRP : reaktif 192 mg/l ( < 6 mg/l )


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Rontgen Thorax 20-2-2013

Rontgen thorak : impression

cardiomegali


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Echocardiografi:

Impression : MR moderate ec RHD


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Working diagnosis

RHD with kardiomegali + karditis +anemia


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Therapy

Berikan O2 2 L/menit (k/p)

IVFD D5 NS 10 tpm

Penisilin prokain 600.000 UI ( 10 hari ) IM

Lasix 30 mg/24 jam

Captopril 2 x 6,25 mg Diet makan lunak RDA x BBI = 60 x

26,5 = 1590 kkal


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case rhd udah fiks

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