Chronic Rheumatic Heart Disease

Сентябрь 12, 2022

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Chronic Rheumatic Heart Disease

Содержание

2. The diagnosis of heart disease must be * Etiological: → (Congenital - Rheumatic) * Anatomical: →
3. Occurs in severe cardiac involvement during initial or recurrent attacks of ARF Left - sided heart
4. MITRAL REGURGE (MR, Insufficiency, Regurgitation, Incompetence) The mitral valve consists of: an annulus 2 leaflets (
5. Healing of ARF results in Fibrosis & contracture of leaflets Shortening & thickening of chordea tendinea.
6. Mild MR → no symptoms Severe MR → Symptoms of HF, pulmonary congestion, pulmonary edema dyspnea
7. Signs: Apex → (LV apex), shifted downward, localized, forcible, hyperdynamic (ill sustained) with systolic thrill. S1
8. Mitral regurge CXR Mitral regurge Echocardiography
9. 1- VSD: -maximal intensity over the 3rd & 4th left intercostal spaces -propagated in fan manner
10. Prophylaxis → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against infective endocarditis Medical treatment of heart
11. MITRAL STENOSIS (MS) Pathophysiology -Thickening of valve leaflets - Fusion of commissures - Shortening & thickening
12. The clinical course depends on the severity of MS. Symptoms: Dyspnea on exertion. Orthopnea & paroxysmal
13. Signs Signs of RV hypertrophy: a- The apex is diffuse and shifted outward (RV apex), diastolic
14. Mitral stenosis CXR Mitral stenosis echo
15. Mitral flow murmur (functional MS) associated with large VSD, PDA, MR, AR (Austin flint murmur) -
16. Prophylaxis → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against infective endocarditis Medical treatment: Heart failure
17. Combined MS and MR Dilatation, scaring and narrowing → stenosis & leakage Obstruction and leakage of
18. Which of the following pathological change occur in rheumatic mitral stenosis ? Increased left atrial pressure
19. Rheumatic AR is the result of fibrosis and contracture of the aortic valve structure Hemodynamically AR
20. Symptoms Depend on the severity. In moderate and severe cases: Effort intolerance, palpitation, dyspnea, orthopnea &
21. The rapid run off of the blood from aorta during diastole causes the signs of hyperdynamic
22. * Manifestations of LV enlargement. The apex is shifted downword, forcible, localized and hyperdynamic (ill sustained)
23. Aortic regurge CXR Aortic regurge Echocardiography
24. Prophylaxis → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against infective endocarditis Surgery: Aortic valve replacement.
25. AORTIC STENOSIS - Commissural adhesions occur slowly and progressive → narrowing and calcification of the orifice
26. In cases with severe stenosis: Chest pain, exercise intolerance, dyspnea, syncope. Clinical manifestations: Symptoms:
27. - The apex: Localized, forceful & sustained (pressure overload). - Systolic thrill is common on Rt
28. Aortic stenosis CXR Aortic stenosis Echocardiography shows morphology of the valve and degree of stenosis.
29. → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against infective endocarditis Surgical intervention by valve replacement.
30. A case with dilated left ventricle and normal size of the other chamber. The most likely
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Слайд 2

The diagnosis of heart disease must be
* Etiological: → (Congenital -

Rheumatic)
* Anatomical: → (VSD - TOF - MR - MS)
* Functional: → HF {decompensated}
OR
no HF {compensated}
* Complication: →
rheumatic activity - infective endocarditis - PH - arrhythmia - chest infection

Слайд 3

Occurs in severe cardiac
involvement during initial or
recurrent attacks of

ARF
Left - sided heart valves are most often affected, (mitral followed by the aortic valves)
Mitral regurge is the commonest lesion in children and adolescent with RHD

RHEUMATIC HEART DISEASE

Слайд 4

MITRAL REGURGE (MR, Insufficiency, Regurgitation, Incompetence)
The mitral valve consists of:
an annulus

2 leaflets
( anterior & posterior )
- chordae tendinea
- 2 papillary muscles

Слайд 5

Healing of
ARF results in
Fibrosis & contracture of leaflets
Shortening &

thickening of chordea tendinea.
Leaflets cannot coapt and separated
LA and LV volume overload and enlargement.
Pulmonary venous congestion, PH, RVH

Pathophysiology

Слайд 6

Mild MR → no symptoms
Severe MR → Symptoms of HF, pulmonary

congestion, pulmonary edema
dyspnea - orthopnea - paroxysmal nocturnal dyspnea

Clinical Manifestations: Symptoms

Слайд 7

Signs:
Apex → (LV apex),
shifted downward, localized, forcible, hyperdynamic (ill sustained)

with systolic thrill.
S1 is usually normal
S2 is usually normal except in PH
Pansystolic murmur maximal intensity at the apex, radiating to the axilla.
Short middiastolic murmur over the apex may be heard (functional MS)
Ejection systolic murmur on 2nd Lt ics (PH)

Слайд 8

Mitral regurge CXR
Mitral regurge
Echocardiography

Слайд 9

1- VSD:
-maximal intensity over the 3rd &
4th left intercostal

spaces
-propagated in fan manner
2- Tricuspid regurge:
- maximal intensity on lower left sternal border
- increases in intensity during inspiration.
3- Mitral regurge of Carditis:
- maximal intensity on the apex
- soft, musical, not associated with thrill, changeable

Differential Diagnosis of MR

Слайд 10

Prophylaxis
→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against

infective endocarditis
Medical treatment of
heart failure
arrhythmia
infective endocarditis
Captoprile ( After load reducing agent)
Surgical treatment (Annuloplasty or valve replacement ) is indicated in severe mitral regurge with:
Recurrent heart failure
cardiomegaly with pulmonary hypertension.

Management

Слайд 11

MITRAL STENOSIS (MS)
Pathophysiology
-Thickening of valve leaflets
- Fusion of commissures
- Shortening

& thickening of chordae tendineae.
- Funnel shaped valve apparatus → marked obstruction to blood flow from LA to LV
LA enlargement (Not LV), pulmonary venous congestion, PH, RV & RA dilation
Right side HF

Слайд 12

The clinical course depends
on the severity of MS.
Symptoms:
Dyspnea on exertion.
Orthopnea

& paroxysmal nocturnal dyspnea.
Poor growth and development.
Tachycardia and atrial fibrillation.
Congestive heart failure may be present.

Clinical manifestations:

Слайд 13

Signs
Signs of RV hypertrophy:
a- The apex is diffuse and shifted

outward (RV apex), diastolic thrill
b- Left parasternal pulsations
c- Epigastric pulsations
loud S1
Apical, rumbling mid-diastolic murmur.

Слайд 14

Mitral stenosis CXR
Mitral stenosis echo

Слайд 15

Mitral flow murmur (functional MS)
associated with large VSD, PDA,

MR, AR (Austin flint murmur)
- Normal S1
- No presysolic accentuation or opening snap
- Original lesion
Carditis (Carey Coombs murmur).
Soft , low pitched
Changeable
Not associated with thrill.
Normal or muffled S1

Differential Diagnosis of MS

Слайд 16

Prophylaxis
→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against

infective endocarditis
Medical treatment:
Heart failure and atrial fibrillation (AF).
Surgical or baloon trans-catheter valvotomy
.

Management:

Слайд 17

Combined MS and MR
Dilatation, scaring and narrowing →
stenosis

& leakage
Obstruction and leakage of mitral valve → LA , RV & LV hypertrophy
LV enlargement is going with MR and against pure MS
RV enlargement is going with MS and unusual with MR

Слайд 18

Which of the following pathological change occur in rheumatic mitral stenosis

?
Increased left atrial pressure
Left atrium dilatation
(3) Left ventricular hypertrophy
(4) Left ventricular hypertrophy
(5) Embolization of clots

Слайд 19

Rheumatic AR is the result of
fibrosis and contracture of the

aortic valve structure
Hemodynamically
AR → LV volume overload
Rheumatic AR is almost always associated with mitral valve disease.

AORTIC REGURGE (AR, Insufficiency, Regurgitation, Incompetence)

Слайд 20

Symptoms
Depend on the severity.
In moderate and severe cases:
Effort intolerance, palpitation,

dyspnea, orthopnea & paroxysmal nocturnal dyspnea, excessive sweating.
Manifestations of pulmonary congestion and edema.

Clinical manifestations:

Слайд 21

The rapid run off of the blood from aorta
during diastole

causes the signs of
hyperdynamic circulation:
- The pulse is collapsing (water hammer)
- BP: wide pulse pressure (high systolic & low diastole)
- Corrigan’s sign prominent carotid pulsation in the neck.
- Capillary pulsation is visible (alternative systolic flushing and diastolic blanching as pressure is applied to finger nails )
- Pistol shots heard over the femoral arteries due opening of collapsed arteries during systole
Duroziez’s murmur: a systolic and diastolic murmur detected by applying mild pressure by the stethoscope over the femoral artery.
- Musset’s sign: Head movement in time with heart beat.

Signs

Слайд 22

* Manifestations of LV enlargement.
The apex is shifted downword, forcible,
localized

and hyperdynamic (ill sustained)
- The S1 & S2 are normal
* Early diastolic murmur
begins immediately after the S2. maximum intensity at the 2nd aortic area, the patient sitting and leaning forward & the breath held in expiration.
* Austin flint murmur
Apical (mid diastolic), rumbling in
Character (functional mitral stenosis)

Слайд 23

Aortic regurge CXR Aortic regurge Echocardiography

Слайд 24

Prophylaxis
→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against

infective endocarditis
Surgery:
Aortic valve replacement. It could be recommended at earlier stages of the disease.

Management

Слайд 25

AORTIC STENOSIS
- Commissural adhesions occur slowly and progressive → narrowing and

calcification of the orifice leads to significant aortic stenosis.
- Obstruction of LV emptying results in LV hypertrophy.

Слайд 26

In cases with severe stenosis:
Chest pain, exercise intolerance, dyspnea, syncope.
Clinical manifestations:

Symptoms:

Слайд 27

- The apex: Localized, forceful & sustained (pressure overload).
- Systolic thrill

is common on Rt sternal border radiates to the neck.
- Normal S1
- Normal or single S2
Beyond childhood, scarring & calcification decrease mobility of the valve and thus the intensity of aortic component decreases (single)
- Ejection systolic murmur maximally on 2nd Rt or 3rd Lt ics radiates to the neck.

Signs

Слайд 28

Aortic stenosis CXR
Aortic stenosis Echocardiography
shows morphology of

the valve and degree of stenosis.

Слайд 29

→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against infective

endocarditis
Surgical intervention by valve replacement.
Trans-catheter balloon dilatation is considered in some cases.

Management

Слайд 30

A case with dilated left ventricle and normal size of the

other chamber. The most likely diagnosis is :
mitral stenosis
mitral regurgitation
(3) aortic stenosis
(4) aortic regurgitation
8 year old child with history of rheumatic fever and pansystolic murmur of mitral regurge. What is your management
prophylaxis against infective endocarditis when indicated
long acting penicillin every 3 weeks
(3) salicylates 70 mg/kg for 6 weeks
(4) Both 1 and 2
(5) All 1, 2 and 3

Chronic Rheumatic Heart Disease

Содержание

The diagnosis of heart disease must be* Etiological: → (Congenital -

Occurs in severe cardiac involvement during initial or recurrent attacks of

MITRAL REGURGE (MR, Insufficiency, Regurgitation, Incompetence) The mitral valve consists of:an annulus

Healing of ARF results inFibrosis & contracture of leaflets Shortening &

Mild MR → no symptomsSevere MR → Symptoms of HF, pulmonary

Signs:Apex → (LV apex), shifted downward, localized, forcible, hyperdynamic (ill sustained)

Mitral regurge CXRMitral regurge Echocardiography

1- VSD: -maximal intensity over the 3rd & 4th left intercostal

Prophylaxis → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against

MITRAL STENOSIS (MS) Pathophysiology-Thickening of valve leaflets- Fusion of commissures- Shortening

The clinical course depends on the severity of MS.Symptoms:Dyspnea on exertion.Orthopnea

Signs Signs of RV hypertrophy:a- The apex is diffuse and shifted

Mitral stenosis CXR Mitral stenosis echo

Mitral flow murmur (functional MS) associated with large VSD, PDA,

Prophylaxis → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against

Combined MS and MRDilatation, scaring and narrowing → stenosis

Which of the following pathological change occur in rheumatic mitral stenosis

Rheumatic AR is the result of fibrosis and contracture of the

SymptomsDepend on the severity.In moderate and severe cases:Effort intolerance, palpitation,

The rapid run off of the blood from aorta during diastole

* Manifestations of LV enlargement.The apex is shifted downword, forcible, localized

Aortic regurge CXR Aortic regurge Echocardiography

Prophylaxis → Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against

AORTIC STENOSIS- Commissural adhesions occur slowly and progressive → narrowing and

In cases with severe stenosis:Chest pain, exercise intolerance, dyspnea, syncope. Clinical manifestations:

- The apex: Localized, forceful & sustained (pressure overload).- Systolic thrill

Aortic stenosis CXR Aortic stenosis Echocardiography shows morphology of

→ Against rheumatic recurrences (LONG ACTING PENECILLIN) → Against infective

A case with dilated left ventricle and normal size of the

Похожие презентации

The diagnosis of heart disease must be
* Etiological: → (Congenital -

Occurs in severe cardiac
involvement during initial or
recurrent attacks of

MITRAL REGURGE (MR, Insufficiency, Regurgitation, Incompetence)
The mitral valve consists of:
an annulus

Healing of
ARF results in
Fibrosis & contracture of leaflets
Shortening &

Mild MR → no symptoms
Severe MR → Symptoms of HF, pulmonary

Signs:
Apex → (LV apex),
shifted downward, localized, forcible, hyperdynamic (ill sustained)

Mitral regurge CXR
Mitral regurge
Echocardiography

1- VSD:
-maximal intensity over the 3rd &
4th left intercostal

Prophylaxis
→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against

MITRAL STENOSIS (MS)
Pathophysiology
-Thickening of valve leaflets
- Fusion of commissures
- Shortening

The clinical course depends
on the severity of MS.
Symptoms:
Dyspnea on exertion.
Orthopnea

Signs
Signs of RV hypertrophy:
a- The apex is diffuse and shifted

Mitral stenosis CXR
Mitral stenosis echo

Mitral flow murmur (functional MS)
associated with large VSD, PDA,

Prophylaxis
→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against

Combined MS and MR
Dilatation, scaring and narrowing →
stenosis

Rheumatic AR is the result of
fibrosis and contracture of the

Symptoms
Depend on the severity.
In moderate and severe cases:
Effort intolerance, palpitation,

The rapid run off of the blood from aorta
during diastole

* Manifestations of LV enlargement.
The apex is shifted downword, forcible,
localized

Prophylaxis
→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against

AORTIC STENOSIS
- Commissural adhesions occur slowly and progressive → narrowing and

In cases with severe stenosis:
Chest pain, exercise intolerance, dyspnea, syncope.
Clinical manifestations:

- The apex: Localized, forceful & sustained (pressure overload).
- Systolic thrill

Aortic stenosis CXR
Aortic stenosis Echocardiography
shows morphology of

→ Against rheumatic recurrences (LONG ACTING PENECILLIN)
→ Against infective