7/29/2019 Case Rhd Udah Fiks
1/25
7/29/2019 Case Rhd Udah Fiks
2/25
RHEUMATIC HEART DISEASE
Diana Khusnety
0608120166
LecturerDr. Riza Irianai Nst, SpA
7/29/2019 Case Rhd Udah Fiks
3/25
Rheumatic Heart DiseaseDEFINITION
Rheumatic heart disease is a chroniccondition charectorised by scaring andfibrosis of valves and layers of the heartsecondary to rheumatic fever
7/29/2019 Case Rhd Udah Fiks
4/25
INCIDENCE
Acute rheumatic fever appear most often inchildren between the age 5 and 15 years
Increased vulnerability to reactivation of thedisease with subsequent pharyngeal infections.
Carditis is likely to worsen with each recurrenceand damage is cumulative.
99% of cases of mitral stenosis is due to RHD.Mitral valve alone-65 to 70% of the cases.
Mitral and aortic valve -25% .
7/29/2019 Case Rhd Udah Fiks
5/25
Rheumatic Fever
A sequelae of rheumatic fever, can be acuteor chronic.
Rheumatic fever is an acuteimmunologically mediated multi systemInflammatory disease.
It occurs 10 days to 6 weeks after anepisode of group A (Beta-hemolytic)streptococcal (pharyngitis) and ofteninvolves the heart.
Diagnosed by Jones Criteria: Either two of the major manifestations or
one major and two minor manifestations.
7/29/2019 Case Rhd Udah Fiks
6/25
JONES CRITERIA
MAJOR CRITERIA
1.Carditis
2.Poly arthritis
3.Chorea:-aneurologicdisorder with involuntary
purposeless rapid movements.
4.Erythema
Marginatum5.Subcutaneous
Nodules
MINOR CRITEIA
1.Fever
2.Arthralgia
3.Previous History of RF4.Increased
a.E.S.R
b.C-Reactive Protein
c.Leucocytosis5.Prlonged PR intravel
7/29/2019 Case Rhd Udah Fiks
7/25
PathogenesisHypersensitivity reaction.Autoimmune mech. has been proposed
Antibodies directed against the M proteins of certainstrains of streptococci cross-react with tissue
glycoprotein in the heart, joints and other tissues.
Progressive fibrosis of both healing of the acuteinflammatory lesion.
Formation of chronic sequelae
And the turbulence induced by ongoing valvulardeformities.
7/29/2019 Case Rhd Udah Fiks
8/25
CLINICAL FEATURES
Pericardial friction rubs,
Weak heart sounds
Tachycardia
COMPLICATIONS Arrhythmias Functional mitral valve insufficiency
Heart failure.
INVOLVEMENT OF VALVES
99% of cases of mitral stenosis is due to RHD.
Mitral value alone-65 to 70% of the cases.
Mitral and aortic valve -25% .
7/29/2019 Case Rhd Udah Fiks
9/25
Extracardiac Lesions
Polyarthritis
Subcutaneous nodules
Erythema maginatum Chorea minor
7/29/2019 Case Rhd Udah Fiks
10/25
Description of the case
Patient W, , 12 yrs, came to AA Hospital
with
chief complain:
Shortness of the breath since 2 weeks ago
7/29/2019 Case Rhd Udah Fiks
11/25
Present Illness History
Shortness of the breath since 2 weeksago particularly during activity such asclimbing stairs. Shortness decrease when
resting, and the patient more comfortablewhen sleeping use some pillow. Patientalso complained of frequent chestpounding
7/29/2019 Case Rhd Udah Fiks
12/25
Patient also complained of pain inthe joints and the pain is felt to
move. Patient feel the body feel weak,
fever (-), abdominal pain (-),decreased appetite, and lookedpale.
7/29/2019 Case Rhd Udah Fiks
13/25
1 month ago patients fever for 3dayscontinuously, fever up and down,higher at night, chills (-), bleedinggums or nose (-), seizures (-).
Patient also complained of cough withphlegm and runny nose, painful
swallowing (+), pain in the ear (-) Defecation and urination no complaints
7/29/2019 Case Rhd Udah Fiks
14/25
Past Illness History
Patients often experiencesore throat
7/29/2019 Case Rhd Udah Fiks
15/25
Physical Examination
Generalized condition
Conciousness : composmentis
Vital Sign
BP : 100/70 mmHg
HR : 106x/i RR : 26x/i
T : 37,4C
7/29/2019 Case Rhd Udah Fiks
16/25
Head and neck : normal head size, conjunctiva anemis
(+/+), enlarged lymph nodes
Thorax :
Lung : normaly
Heart:
Ins peksi :ictus cordis seenPalpasi : ictus cordis palpable at SIC V, 2 finger
lateral LMCS
Perk usi : Kanan ; Linea sternalis dekstra SIK IV
Kiri ; 1 finger lateral LMCS SIK V
Auskultasi: systolic murmur (+)
7/29/2019 Case Rhd Udah Fiks
17/25
Abdomen : Normal
Genitourinary : Normal
Lymph node : Normal
Extremity : clubbing fingger (-), edema (-)
7/29/2019 Case Rhd Udah Fiks
18/25
Investigation
Routine blood test, serological : ASTOand CRP
Rontgen thorak PA Echocardiografi
EKG
7/29/2019 Case Rhd Udah Fiks
19/25
Laboratory test results
Routine blood test :
Hb: 8,1 g/dL Ht : 23,7% Led:105 mm/jam
Trombosit:483.000/uL Leukosit : 12.900/uL
Serological
ASTO : reaktif 800 IU/ml ( < 200 IU/ml )
CRP : reaktif 192 mg/l ( < 6 mg/l )
7/29/2019 Case Rhd Udah Fiks
20/25
Rontgen Thorax 20-2-2013
Rontgen thorak : impression
cardiomegali
7/29/2019 Case Rhd Udah Fiks
21/25
Echocardiografi:
Impression : MR moderate ec RHD
7/29/2019 Case Rhd Udah Fiks
22/25
Working diagnosis
RHD with kardiomegali + karditis +anemia
7/29/2019 Case Rhd Udah Fiks
23/25
Therapy
Berikan O2 2 L/menit (k/p)
IVFD D5 NS 10 tpm
Penisilin prokain 600.000 UI ( 10 hari ) IM
Lasix 30 mg/24 jam
Captopril 2 x 6,25 mg Diet makan lunak RDA x BBI = 60 x
26,5 = 1590 kkal
7/29/2019 Case Rhd Udah Fiks
24/25
7/29/2019 Case Rhd Udah Fiks
25/25
Recommended