Rheumatic Heart DiseaseDefinition: streptococcal infection. children 5-15.

•Pathology:- Anti-gen antibody reaction mediate

inflammation.

- * Clinical Feature;- Major Manifestation;

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1- Carditis:- breatness- palpitation- chest pain.- 2- Polyarthritis- 3- Chorea:- 4-Erythema marginatum.

II. Minor Manifestation:Fever- Arthralgia-Raised ESR-

Leucocytosis- ASO

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InvestigationInvestigation1-Evidence of systemic illness; Leucocytosis . ESR.2- Preceding streptococcal infection- Increase ASO. Child ---------- Adult---------- Throat Culture.

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3- Carditis: X-ray: Cardiomegaly. ECG.: 1 st Heart block.

Treatment:-1.2 m pencillin\ bedrest\Aspirin\

corticosteriods\- 1.2 m pencillin monthly.

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Chronic Rheumatic Heart Chronic Rheumatic Heart DiseaseDisease

Chronic valvular heart disease develop in half of patient with rheumatic heart disease.

I.I. Mitral StenosisMitral Stenosis-Valve orifice by progressive fibrosis and

calcification of the valve leaflets and fusion of cusps.

-Blood flow Lt AP .pulmonary venous con- Dilatation of Lt atrium and ventricle.

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Clinical FeatureClinical FeatureSymptoms:Breathlessness-Fatigue- Odema-

Palpitation.Haemoptysis-

Signs:Signs:- Auscultation: Auscultation: loud 1st HS- MD murmer- Palpation: Shifted apex.

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InvestigationInvestigation- ECG: Atrial Fabrilation.- X-ray: atrial enlargement.- Cardiac Cathetrization.

TreatmentTreatmentA- Medical :A- Medical :

B- Surgery.B- Surgery.

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II. Mitral RegurgitationII. Mitral RegurgitationAbnormal leaking of blood through the mitral valveDysfunction of any valve part.

* Clinical Feature:* Clinical Feature:Symptoms: Dyspnea-Fatigue.Palpitation.Oedema.Ascitis.Signs:Apex shift- Pansystoloc murmer.

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* Investigation:* Investigation:1- X-ray: enlarged lt atrium and ventricle.2- Echo: Dilated LA and LV.3- Dopller:4- Cardiac Catherterization.

ManagmentManagment

a)a)Medical : Medical : Diuretics,vasodilators.anticoagulant.antibioti

b)b)Surgical :Surgical :

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Aortic StenosisAortic Stenosis- Valvular heart disease caused by

incomplete opening of the valve.

- Causes:Causes:- Acquired: RF.- Congenital : bicusped aortic valve.

- * Clinical Feature:* Clinical Feature:- Mild and moderate are free.- Exertional dyspnea

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Angina.Extertional syncope .Sudden death.

• Signs:Signs:- Ejection systolic murmer.- Narrow pulse pressure.

*Investigation*Investigation:- ECG:Left ventricular hyperatrophty.- x-ray : enlarged left ventricle.

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Doppler : to detect the severity.

Treatment:Treatment:- Medical: B –blockers.- Surgical. - Aortic RegurgitationAortic Regurgitation- Leaking of the aortic valve.- Causes : in the valve cusps or root1- Congenital.2- Acquired:

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Pathology:Pathology:- Disease in the valve cusps: fibrosis and

fusion of the cusps retraction of the cusps.

- In the root: progressive dilatation of the root

- failure of the cusps to coapt.- * Clinical Picture: * Clinical Picture: Symptoms ( in sever cases) Brethnessness..Angina. Cardiology dr.mon5@hotmail.com 14

Signs:- Wide pulse presure.- Systolic murmer.- Crepitation .- 4th heart sound.

* Investigation:* Investigation:- ECG: inverted T wave.ECG: inverted T wave.- X-ray/X-ray/- Echo: dilated lt ventricle.Echo: dilated lt ventricle.- Catherterization.Catherterization.Cardiology dr.mon5@hotmail.com 15

Tricusped Stenosis:Tricusped Stenosis:-Causes.

• Clinical FeatureClinical FeatureSymptoms:Fatigue- Anarexia- peripheral odema.Signs:Raised jagular venous pressure.Mid diastolic murmer.

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*Investigation*Investigation* Treatment:* Treatment:Medical : -Salt restriction.-Diuretics.Surgical:

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Tricusped RegurgitationTricusped Regurgitation Leaking of the tricusped valve commonly from functional dilatation of the Rt ventricle- or valvular damage.

Clinical Feature:Clinical Feature:Symptoms: oedema.abdominal pain

nausea.Signs: Ascitis.Anorexia.

*Treatment:*Treatment:- Relieving ventricular dilatation:-- If dilatation in the valve: annuloplasty ring.

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Pulmonary StenosisPulmonary Stenosis- In conginital,carcinoid syndrome.- * Clinical Feature:a) Symptoms- Usually free.- If sever: Exertional Dyspnea. Headness.b) Signs:Ejection click—Wide splitting of S2

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Investigation:Investigation:- ECG: Rt ven. Hyperatrophy.- X-ray.- Doppler.- Echo.

* Treatment:* Treatment:- Mild and moderate: noMild and moderate: no- Sever: Ballon Valvuplasty.Sever: Ballon Valvuplasty.- Valvotomy.Valvotomy.

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Pulmonary RegurgitationPulmonary Regurgitation- Rarely isolated..Usualy associated

with pulmonary artery dilatation due to pulmonary hypertension.

Clinical Feature:Clinical Feature:a)Symptoms:-- Symptomatic.- Symptoms appear with marked

increase in BP and RV failure:- Dyspnea on exertion--- OedemaCardiology dr.mon5@hotmail.com 21

Investigation1- x-ray: enlarged RV.2- Doppler:3- ECG.

*Treatment:*Treatment:I.Medical:-Supportive: treat RT ventricular failure.- Treat pulmonary dilatation.II. Surgical.

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