CARDITIS RHEUMATIC HEART DISEASE and CLINICAL ASPEC Nahar Taufiq RS DR Sardjito Yogyakarta
An Overview Carditis Acute Rhematic Fever (RF) and Rhematic heart disease (RHD) Consequences of Haemodynamic When to Intervention? Consequences of Anticoagulant Therapy
An Overview Carditis Acute Rhematic Fever (RF) and Rhematic heart disease (RHD) Consequences of Haemodynamic When to Intervention? Consequences of Anticoagulant Therapy
Carditis Myocarditis is an inflammatory disorder of the myocardium with necrosis of the myocytes and associated inflammatory infiltrate. The term of Carditis It is caused by viral infection Part of Acute Rheumatic Fever
Viral Carditis The WHO reports that incidence of cardiovascular involvement after enteroviral infection is 1-4%. Incidence varies greatly among countries and is related to hygiene and socioeconomic conditions. Occasional epidemics of viral infections have been reported with an associated higher incidence of myocarditis
Viral Carditis Enteroviruses, such as coxsackie virus and echovirus, and adenoviruses, particularly types 2 and 5, are the most commonly involved organisms With suspected coxsackievirus B, the mortality rate is higher in newborns (75%) than in older infants and children (10-25%). Complete recovery of ventricular function has been reported in as many as 50% of patients. Some patients develop chronic myocarditis (ongoing or resolving) and/or dilated cardiomyopathy and may eventually require cardiac transplantation.
Viral Carditis Investigation Virus identification 1 ) Cultures from blood , stools and throat. 2 ) Acute & convalescent sera ECG Chest X Ray Echocardiogram Biopsi miocardium
Viral Carditis Management Bed rest or limitation of activity in the acute phase Management ADHF Management of CHF
An Overview Carditis Acute Rhematic Fever (RF) and Rhematic heart disease (RHD) Consequences of Haemodynamic When to Intervention? Consequences of Anticoagulant Therapy
Rheumatic Heart Disease Rhematic Fever (RF) and or Rhematic heart disease (RHD) is a a major health hazard in most developing countries as well as sporadically in developed economies
Rheumatic Heart Disease Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease that occurs a few weeks following an episode of group A streptococcal pharyngitis. Major involvement of systemic connective tissue, it often violate connective tissue of heart, joint, skin, and subcutaneous and vascular connective tissue. Key pathologic features is Rheumatic Granuloma
Acute Rheumatic Heart Disease Infection by GABHS 2 – 5 days intubation URI infection high fever, sore throat, headache, body weakness, and increase in WBC count 3% of them develop RF after Several weeks Major : Carditis, Polyarthritis, Chorea, erythema marginatum, Subcutaneus nodule Minor : Clinis : arthralgia , fever Lab : Erythrocyt cedimen rate, C – reactive protein prolonged PR interval,positive throat culture,etc 2 Major or 1 major 2 minor Evidence for recent GAS infection Acute Rheumatic Fever Acute Rheumatic Heart Disease
Chorea Sydenham. Erthema marginatum
Acute Rheumatic Heart Disease Divided into rheumatic endocarditis, rheumatic myocarditis and rheumatic pericarditis, often for rheumatic pancarditis.
Management of ARF – Acute RHD 1. Eradicate the GABHS Benzathine Penicilin G , < 27 kg : 600.000 U –IM (once) > 27 kg : 1,200,000 U – IM (once) Erythromycin estolate, 20-40mg/kg/2-4 times daily (10 days) Erythromycin Ethylsuccinate 40mg/kg/2-4 times (max 1 g/d) (10 days)
Management of ARF – Acute RHD 2. Suppress the Inflamatory response Aspirin 90-120 mg/kg/day for 10 weeks and tapered in the next 2 weeks > 20 kg: Prednison 60 mg/day three weeks and tapered in the next nine weeks < 20 kg : prednison 40 md/day
Management of ARF – Acute RHD Benzathine Penicilin G 1,200,000/ 3-4 weeks – IM Penicilin V 25 mg twice daily – oral Erythromycin 250 mg twice daily -oral
Acute R Fever – Acute RHD Acute rheumatic endocarditis: small (diameter 1- to 2-mm) vegetations along the mitral valve margin, insufficient to cause valvular deformation.
Chronic Rheumatic Heart Disease
Stages of Progression of VHD
Diagnostic Testing-Diagnosis and Follow Up
Frequency of Echo in asymptomatic patient with VHD and normal LV
An Overview Carditis Acute Rhematic Fever (RF) and Rhematic heart disease (RHD) Consequences of Haemodynamic When to Intervention? Consequences of Anticoagulant Therapy
Mitral Regurgitation
Mitral Regurgitation
Mitral Regurgitation
Mitral Regurgitation
Mitral Regurgitation Porcine model, 6M
Indication for Surgery for Mitral Regurgitation
Mitral Stenosis
Mitral Stenosis
Mitral Stenosis
Mitral Stenosis
Indications for Surgery for Rheumatic Mitral Stenosis
Aortic Regurg – Austin Flint Murmur Aortic Regurgitation Aortic Regurg – Austin Flint Murmur Due to the vibration of the anterior leaflet of the mitral valve as it is buffetted simultaneously by the blood jets from the left atrium and the aorta.
Aortic Regurgitation
Aortic Regurgitation
Aortic Regurgitation
Aortic Regurgitation
Indication for Surgery for Chronic aortic Regurgitation
Aortic Stenotic
Aortic Stenotic
Indication for Surgery for Chronic aortic Stenosis
An Overview Carditis Acute Rhematic Fever (RF) and Rhematic heart disease (RHD) Consequences of Haemodynamic When to Intervention? Consequences of Anticoagulant Therapy
Anticoagulation for Prosthetic Valve
Resume Carditis is an inflammation disease Viral carditis Chronic Myocarditis Dilated Chamber of heart Chronic Heart failure Carditis part of Acute Rheumatic heart Disease Sequele in the valve Heart failure Replacement of the valve long term anticoagulant
TERIMA KASIH
Acute Rheumatic Heart Disease Acute Rheumatic Fever Acute Rheumatic Heart Disease Dr. T Duckett Jones Major Manifestation Carditis, Arthritis, subcutaneous nodules, erythema marginatum and chorea Minor manifestation Fever, arthralgia Essensial Criteria
Acute rheumatic endocarditis: small (diameter 1- to 2-mm) vegetations along the mitral valve margin, insufficient to cause valvular deformation.
Small vegetations (verruca) are visible along the line of closure of the mitral valve leaflet (arrows).
Advanced: vegetations organization, recurrent organization cause chronic heart valve disease ( valvular stenosis and / or valvular insufficiency )
Mitral stenosis with diffuse fibrous thickening and distortion of the valve leaflets, commissural fusion (arrows), and thickening and shortening of the chordae tendineae.
Rheumatic Heart Disease Rhematic Fever (RF) and or Rhematic heart disease (RHD) is a systemic inflamatory disease with protean manifestation primarily affecting the connective tissue and usually preceded by a group A beta hemolytic streptococcal (GABHS) infection characterized by acute exacerbation and recurrencces
Template Jogja Cardiology Update
Jogja Cardiology Update
Jogja Cardiology Update