RHEUMATIC HEART DISEASE Dr Ubaid N P Community Medicine Pariyaram Medical College

Introduction Rheumatic fever –febrile disease affecting connective tissues, esp. heart and joints Sequele to throat infection by group A beta haemolytic streptococci RF is not a communicable disease – results from a communicable disease RF often leads to Rheumatic Heart Disease (RHD)

Problem statement 15 million cases of RHD worldwide 220000 deaths due to RHD in 2008 Major cause of mitral insufficiency and stenosis In India prevalence more common on 5 – 15 age group (5-7/ thousand children) RF is said to occur in 1-3% of all streptococcal infections in children

Severity of valve disease is directly related to: - no of previous attacks of RF - Length of time between onset of disease & start of therapy - Sex (F > M)

Agent Group A beta Haemolytic Streptococcus Onset of RF is preceded by a streptococcal sore throat High carrier rate – convalescent, transcient and chronic carriers

Host & Environment Factors Typically a childhood and adolescent disease (5 – 15 years) High incidence of ‘Juvenile mitral stenosis in India’ Prevalence in M = F, but prognosis is more worse in Female Disease is related to low standard of living High risk groups – school age children, slum dwellers, those living in closed community (e.g: barracks)

Clinical features Fever – acute, may last 12 weeks or longer, recurs Polyarthritis – occurs in 90% cases, Large joints affected more commonly Carditis – valves and all layers involved, manifested by tachycardia, murmers, enlargement, pericarditis, heart failure, first degree AV block in ECG Nodules – small, painless nodules below skin Brain involvement – abnormal jerky movements of arms, legs and the body Skin involvement - various skin rashes

Diagnosis

Diagnosis

Prevention Primary prevention Secondary prevention: - one i/m injection of benzathine pencillin (1.2 million in adults & 600,000 units in children) - given at an interval of 3 weeks, for at least 5 years or till the age of 18 years(which ever later) - severe valvular disease and post valve surgery cases need life long treatment Non medical measures