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Transcript
Mitral Stenosis The valve opening narrows, impairing blood flow; the valve does not open or close properly. Rheumatic Heart Disease (RHD) With chronic rheumatic heart disease, patients develop valve stenosis with various degrees of blood reflux, atrial dilation, arrhythmias, and ventricular dysfunction. The leading cause of mitral valve stenosis and valve replacement in adults in the United States is Rheumatic Heart Disease. Process for development of rheumatic heart disease Cross-reactive antibodies bind to cardiac tissue facilitating infiltration of streptococcal-primed CD4+ T cells, which then trigger an autoimmune reaction releasing inflammatory chemical messengers called cytokines. Because few proteins that stimulate the immune system (IL-4) – producing cells are present in heart valve tissue inflammation persists, leading to valve lesions. Burke, A. (2013). Pathology of rheumatic heart disease. Retrieved from Medscape website: emedicine.medscape.com/article/1962779-overview Chin, T. K. (2012). Pedriatic rheumatic heart Disease treatmetn & management Retrieve from: Medscape website: emedicine.medscape.com/article/891897-treatment By: Amparo Elizabeth Bayless Rheumatic Heart Disease DDiseasediseas Rheumatic Heart Disease Rheumatic heart disease is triggered by an autoimmune reaction to infection caused by group A streptococci. The acute condition of heart inflammation involves inflammation of the myocardium, endocardium and epicardium. Chronic disease appears with heart valve fibrosis, resulting in stenosis and/or insufficiency. Rheumatic fever, the cause of rheumatic heart disease incidence, is most common in children and adolescents. Symptoms may include difficulty breathing, exercise intolerance, rapid heart rate, and a heart murmur. Diagnosed by ECG and findings of increased sedimentation rate (ERS). in blood work. RHD Cardiac Manifestations Valve deformities, blockage of blood vessels by blood clots, cardiac hemolytic anemia, and atrial arrhythmias are the most common cardiac manifestations of chronic rheumatic heart disease (CRHD). Mitral stenosis occurs in 25% of patients with CRHD and is associated with mitral valve insufficiency in another 40%. Aortic stenosis from CRHD is associated with aortic insufficiency. The valve commissures and cusps become adherent and fused. Thromboembolism, blockage of blood vessels, occurs as a complication of mitral stenosis. The frequency of this complication has decreased with the use of anticoagulants. Cardiac hemolytic anemia is related to the disruption of RBCs by a deformed valve. Diagnosis Made after confirming antecedent rheumatic fever. Rheumatic fever may occur following group A beta hemolytic streptococcal (GABHS) pharyngitis infection. Rheumatic fever in adults with streptococcal pharyngitis left untreated with antibiotics has been demonstrated. Prevention and Treatment Rheumatic heart disesae can be prevented by prompt treatment of A beta streptococcal infections with penicillin. Prophylactic antibiotic treatment is recommended to reduce recurrence of rheumatic fever, especially before dental or surgical procedures. Surgical repair or replacement of affected valves as indicated . Aspirin therapy is used to manage inflammation.