Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Rheumatic Heart Disease

Advanced Pathophysiology MSN 2012-2013
by

Loreto Dacoroon

on 26 November 2012

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Rheumatic Heart Disease

Rheumatic Fever Rheumatic Heart Disease IMMUNE SYSTEM Streptococcus
Beta-Hemolytic
Lancefield Group A Bacterial Infection Multi Systemic Immune Mediated Non-Suppurative Inflammation CNS
JOINTS
SKIN
SUBCUTANEOUS
HEART Motor Distirbances

SYDENHAN'S CHOREA (<5-30%)
"St. Vitus Dance"
a neurologic disorder with involuntary purposeless rapid, jerky movements of the face and arms. Inflammation of Synovial Joints

POLYARTHRITIS (60-75%)
A temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
ARTHRALGIA Skin Lesions

ERYTHEMA MARGINATUM (<5%)
A type of skin rash which begins as pink macules that clear centrally, leaving a serpiginous, spreading edge. SUBCUTANEOUS NODULES (<5-10%)
Painless, small (0.5-2cm), mobile lumps beneath the skin overlying bony prominences which last for just a few days up to 3 weeks. 97% 3% Diagnosis:
No definitive test
JONES CRITERIA
Combination of TWO MAJOR manifestations or
ONE MAJOR & TWO MINOR manifestations: MINOR MANIFESTATION
1. Fever of 38.2–38.9 °C (101–102 °F)
2. Arthralgia: Joint pain without swelling
3. Raised ESR or CRP
4. Leukocytosis
5. ECG changes as a prolonged PR interval (Cannot be included if carditis is present as a major symptom)
6. Previous episode of rheumatic fever or inactive
heart disease MAJOR MANIFESTATION:

1. Chorea
2. Polyarthritis
3. Erythema Marginatum
4. Subcutaneous Nodules
5. Carditis

RHEUMATIC CARDITIS (50-60%)
Inflammation of the heart muscle (myocarditis) which can manifest as CHF with shortness of breath, pericarditis with a rub, or a new heart murmur. Cross-reactivity
due to Antigen Mimicry RHEUMATIC PERICARDITIS 1. RHEUMATIC PERICARDITIS

2. RHEUMATIC MYOCARDITIS

3. RHEUMATIC ENDOCARDITIS PANCARDITIS Inflammation of the entire heart. Acute Pericarditis/ Fibrinous Pericarditis/ Bread & Butter Pericarditis GABHS triggers Autoimmune response

Release of Inflammation Mediators in to surrounding tissue

INFLAMMATION caused by friction against Pericardial Layers

Vessel wall will LEAK fluids and proteins (FIBRINOGEN) from capillaries and DEPOSIT them to the pericardial sac.

Accumulation of fibrous exudates in the pericardial space
"Bread and Butter Appearance"


Contents of cavity autolyze and Progress to deposition of scar tissue &
gradually be absorbed into form adhesion bet. the layers of the
healthy tissues. serous pericardium.
"Chronic Adhesive Pericarditis"

** Generally, no long term sequelae . CARDINAL MANIFESTATIONS:

1. PERICARDIAL PAIN

2. PERICARDIAL RUB

3. ECG Changes - Elevated ST segment with NO significant changes in QRS complexes.

4. PULSUS PARADOXUS - Significant decrease in Systolic BP(10mm/Hg) & PR during inspiration. RECOMMENDED TESTS IN CASE OF POSSIBLE ACUTE RF WBC Count
Erythrocyte Sedimentaton Rate - Increased ESR indicates inflammation
C-Reactive Protein - Increased levels indicate inflamm. & Bact'l infection
Blood Cultures - if febrile.
Rep. BC if possible endocarditis.
ECG - Rep. in 2 wks and 2 mos if prolong PR interval or other rhythm abnormality.
Echocardiogram - Consider repeating after 1 month if negative.
CXR - If clinical or echocardiographic evidence of carditis.
Throat swab RHEUMATIC MYOCARDITIS GABHS triggers autoimmune reaction

INFLAMMATION

Left ventricular myocardial hypertrophy;
(Hypokinetic & poorly contractile)
becomes loose & flabby

Formation of Immune mediate lesion
"Aschoff Bodies" in the myocardium - small pinhead immune mediated granuloma in connective tissues

. ***Acute stage: can lead to heart failure
. features and sudden death

If none, no long term (Chronic) sequelae Constitutes a foci of fibrinoid necrosis surrounded at first by lymphocytes and macrophages with an occasional plasma cell

Aschoff boddies are nodules formed by a reaction to inflammation with accompanying swelling and fragmentation of collagen fibers.

As they reach full maturity, plump modified histiocytes appear in the inflammatory infiltrate called ANITSCHKOW CELLS or ASCHOFF CELLS, they become more fibrous, and scar tissue is formed in the myocardium ASCHOFF BODY RHEUMATIC ENDOCARDITIS GABHS triggers Autoimmune reaction

Endocardium: valvular endocardium affected

Rheumatic valvulitis- inflammation of valves

Erosions on endothelial lining leaflets/ line of closures of the valve

Platelet formation & fibrin aggregation on the erosion

Platelets release Platelet Derived Growth Factor

Formation of Rheumatic Vegetations on the valve due to immume mediated injury

Collagenization
Edges of the valve/leaflets will fuse/ adhere

Valves become fibrotic and disorted IV. Infectious Disease of the Heart Group A Beta-Hemolytic
Streptococcus THANK YOU for listening! SEE YOU LATER! ;) RHEUMATIC HEART DISEASE
Full transcript