Rheumatic Heart Disease
Rheumatic heart disease (RHD) is a condition in which permanent damage to heart valves is caused by rheumatic fever. Rheumatic fever begins with a strep throat from streptococcal (STREP'to-KOK'al) infection. As many as 39% of patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve insufficiency, heart failure, pericarditis, and even death.
With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in many countries including in Indonesia.
What are the symptoms of rheumatic heart disease?
The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.
How to treat of rheumatic heart disease :
Medical therapy is directed toward eliminating the group A streptococcal pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment for congestive heart failure. But the specific treatment for rheumatic heart disease will be determined by your physician based on:
Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin.
Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.
Can Rheumatic Heart Disease be Prevented?
The best way to prevent rheumatic heart disease is to seek immediate medical attention to a strep throat and not let it progress to rheumatic fever. The Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by Group A streptococci(especially Group A β Hemolytic Streptococcus pyogenes).
Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage.
With chronic rheumatic heart disease, patients develop valve stenosis with varying degrees of regurgitation, atrial dilation, arrhythmias, and ventricular dysfunction. Chronic rheumatic heart disease remains the leading cause of mitral valve stenosis and valve replacement in adults in many countries including in Indonesia.
The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.
- Fever.
- Weight loss.
- Fatigue.
- Stomach pains.
- Joint inflammation - including swelling, tenderness, and redness over multiple joints. The joints affected are usually the larger joints in the knees or ankles. The inflammation "moves" from one joint to another over several days.
- Small nodules or hard, round bumps under the skin.
- A change in your child's neuromuscular movements (this is usually noted by a change in your child's handwriting and may also include jerky movements).
- Rash (a pink rash with odd edges that is usually seen on the trunk of the body or arms and legs).
Medical therapy is directed toward eliminating the group A streptococcal pharyngitis (if still present), suppressing inflammation from the autoimmune response, and providing supportive treatment for congestive heart failure. But the specific treatment for rheumatic heart disease will be determined by your physician based on:
- your overall health and medical history
- extent of the disease
- your tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Since rheumatic fever is the cause of rheumatic heart disease, the best treatment is to prevent rheumatic fever from occurring. Oral penicillin V remains the drug of choice for treatment of group A streptococcal pharyngitis. When oral penicillin is not feasible or dependable, a single dose of intramuscular benzathine penicillin G is therapeutic. For patients who are allergic to penicillin, administer erythromycin or a first-generation cephalosporin.
Other options include clarithromycin for 10 days, azithromycin for 5 days, or a narrow-spectrum (first-generation) cephalosporin for 10 days. To reduce inflammation, aspirin, steroids, or non-steroidal medications may be given. Surgery may be necessary to repair or replace the damaged valve.
The best way to prevent rheumatic heart disease is to seek immediate medical attention to a strep throat and not let it progress to rheumatic fever. The Nurses also have a role in prevention, primarily in screening school-aged children for sore throats that may be caused by Group A streptococci(especially Group A β Hemolytic Streptococcus pyogenes).
Persons who have previously contracted rheumatic fever are often given continuous (daily or monthly) antibiotic treatments, possibly for life, to prevent future attacks of rheumatic fever and lower the risk of heart damage.
Rheumatic Heart Disease
Rheumatic heart disease is a complication of rheumatic fever in which the heart valves are damaged. Rheumatic fever is an inflammatory disease that begins with strep throat. It can affect connective tissue throughout the body, especially in the heart, joints, brain and skin. Although rheumatic fever can strike people of all ages, it is most common in children between 5 and 15 years old. The best way to prevent rheumatic fever is to treat strep throat with antibiotics.
symptoms
symptoms
The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage.
Typically, symptoms of rheumatic fever appear about two weeks after the onset of an untreated strep throat infection. Apart from the sore throat caused by the strep infection, children have a fever and feel ill. Commonly, the child will have a very painful, swollen and red joint — usually a large joint like a knee, ankle, elbow or shoulder — that goes away after a day or two only to be replaced by the same problem in another joint. Short-lived skin rashes may occur, but are not common. Even if the heart is affected, it is usually not severe enough to cause symptoms, although occasionally the child may be short of breath.
diangress
The first step in diagnosing rheumatic heart disease is establishing that your child recently had a strep infection. The doctor may order a throat culture, a blood test, or both to check for the presence of strep antibodies. However, it is likely that signs of the strep infection may be gone by the time you take your child to the doctor. In that case, the doctor will need you to try to remember if your child recently had a sore throat or other symptoms of a strep infection.
The doctor will do a physical examination and check your child for signs of rheumatic fever, including joint pain and inflammation. The doctor also will listen to your child's heart to check for abnormal rhythms or murmurs that may signify that the heart has been strained.
In addition, there are a couple of tests that may be used to check the heart and assess damage, including:
treatment
Although having rheumatic fever leaves a child more susceptible to heart damage, it does not always permanently damage the heart. However, when the inflammation caused by rheumatic fever leaves one or more of the heart valves scarred, the result is rheumatic heart disease. The mitral valve and the aortic valve are usually the ones damaged by the disease. Years later, the mitral valve may become narrowed, a condition known as mitral stenosis.
Treatment of acute rheumatic fever includes antibiotics to treat the strep infection and additional medications to ease the inflammation of the heart and other symptoms. Usually aspirin is given in large doses until the joint inflammation goes away; rarely, steroids are needed. Once the acute illness has gone away, patients need to take penicillin, or an equivalent antibiotic, for many years to prevent recurrences. This is a very important treatment because the risk of heart valve damage increases if rheumatic fever recurs
Typically, symptoms of rheumatic fever appear about two weeks after the onset of an untreated strep throat infection. Apart from the sore throat caused by the strep infection, children have a fever and feel ill. Commonly, the child will have a very painful, swollen and red joint — usually a large joint like a knee, ankle, elbow or shoulder — that goes away after a day or two only to be replaced by the same problem in another joint. Short-lived skin rashes may occur, but are not common. Even if the heart is affected, it is usually not severe enough to cause symptoms, although occasionally the child may be short of breath.
diangress
The first step in diagnosing rheumatic heart disease is establishing that your child recently had a strep infection. The doctor may order a throat culture, a blood test, or both to check for the presence of strep antibodies. However, it is likely that signs of the strep infection may be gone by the time you take your child to the doctor. In that case, the doctor will need you to try to remember if your child recently had a sore throat or other symptoms of a strep infection.
The doctor will do a physical examination and check your child for signs of rheumatic fever, including joint pain and inflammation. The doctor also will listen to your child's heart to check for abnormal rhythms or murmurs that may signify that the heart has been strained.
In addition, there are a couple of tests that may be used to check the heart and assess damage, including:
treatment
Although having rheumatic fever leaves a child more susceptible to heart damage, it does not always permanently damage the heart. However, when the inflammation caused by rheumatic fever leaves one or more of the heart valves scarred, the result is rheumatic heart disease. The mitral valve and the aortic valve are usually the ones damaged by the disease. Years later, the mitral valve may become narrowed, a condition known as mitral stenosis.
Treatment of acute rheumatic fever includes antibiotics to treat the strep infection and additional medications to ease the inflammation of the heart and other symptoms. Usually aspirin is given in large doses until the joint inflammation goes away; rarely, steroids are needed. Once the acute illness has gone away, patients need to take penicillin, or an equivalent antibiotic, for many years to prevent recurrences. This is a very important treatment because the risk of heart valve damage increases if rheumatic fever recurs
No comments:
Post a Comment