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

2. 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)

3. Problem statement 15 million cases of RHD worldwide
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

4. 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)

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

6. 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)

7. 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

10. Diagnosis

11. Diagnosis

12. 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