Rheumatic Heart DiseasePrepared by, Toh Chia Thing 080100273

Complications

Congestive heart failure: Mortality is related to patient’s functional status. Before the era of CHF medicine advances, New York Heart Association (NYHA) IV patients 10-year survival was 0% compared to 80% for NYHA I.

Atrial fibrillation: occurs in over 45% of mitral stenosis patients Atrial arrhythmias Pulmonary edema Pulmonary Hypertension: mean survival without surgery 2.4 years Thromboembolic events: mostly occur in patients with atrial fibrillation, but can happen

in normal sinus rhythm in patients with mitral stenosis. If valve replacement is necessary, complications related to an artificial (prosthetic) valve, such as blood clots (embolism) or bleeding, may ensue.

Bacterial endocarditis results from infection of a valve by bacteria transmitted through the bloodstream from the mouth or genitourinary tract. Bacterial endocarditis is easily preventable with prophylactic antibiotics.

Prognosis

Manifestations of acute rheumatic fever resolve over a period of 12 weeks in 80% of patients and may extend as long as 15 weeks in the remaining patients.

Following the development of antibiotics, the mortality rate remained 1-10% in developing countries.

Before penicillin, 60-70% of patients developed valve disease as compared to 9-39% of patients since penicillin was developed.

In general, the incidence of residual rheumatic heart disease at 10 years is 34% in patients without recurrences but 60% in patients with recurrent rheumatic fever.

Disappearance of the murmur, when it occurs, happens within 5 years in 50% of patients. Thus, significant numbers of patients experience resolution of valve abnormalities even 5-10 years after their episode of rheumatic fever. The importance of preventing recurrences of rheumatic fever is evident.

Severe heart failure, which may be life-threatening if appropriate medical and surgical therapy is not instituted.

The failure to put patients with acute rheumatic fever (ARF) on antibiotic prophylaxis to prevent future attacks leads to repeated episodes of ARF, scarring of the heart valves, chronic valvular heart disease, heart failure, and death, usually before middle age.

If treated, 75% of people with rheumatic fever recover completely.

http://medicine.ucsf.edu/education/resed/Chiefs_cover_sheets/acute_rheumatic_fever_and_rheumatic_heart_disease.pdfhttp://www.mdguidelines.com/rheumatic-heart-disease-chronic/complicationshttp://emedicine.medscape.com/article/891897-followupHURST’s The Hearthttp://www.who.int/cardiovascular_diseases/en/cvd_atlas_02_rheumaticHD.pdf