RHEUMATIC HEART DISEASE slide seminar.pptx

rheumatic fever seminar

1. RHEUMATIC HEART DISEASE - Kalpana R

2. Introduction The sequelae of RF consists of mitral, aortic & t ricuspid valve disease.

3. Mitral regurgitation Commonest Haemodynamics Systolic leak of blood to the LA, Systemic circulation. LA &LV dilatation Volume overload in LA & LV

4. A/c Mitral regurgitation LA size normal Increased volume reaching LA causes increase in LA pressure Pulmonary venous congestion LVF

5. Chronic Mitral regurgitation Only volume hypertrophy of LA & LV Increasing LA pressure Features of LVF absent

6. Clinical features Commonest is fatigue Tachycardia Cardiac apex displaced downwards and outwards Hyperdynamic apex Pansystolic murmur radiating to axilla & left sternal border

7. Investigations ECG- Sinus tachycardia ECHO- Enlarged LA & LV

8. Differential diagnosis ASD Coarctation of aorta Left ventricular fibroelastosis Congenitally corrected transposition of great arteries Marfan’s & Hurler syndrome Anomalous origin of left coronary artery from pulmonary artery

9. TREATMENT MEDICAL Vasodilators-ACE Inhibitors, calcium channel blockers Treatment of LVF Penicillin prophylaxis . SURGICAL Mitral valve replacement

10. Mitral Stenosis Less common than MR in children Haemodynamics obstruction of blood through mitral valve during left ventricular diastole LA Compensates- by inc. the pressure LA Hypertrophy Pulmonary congestion

11. Clinical features Main symptom is dyspnoea Boys twice affected as that of girls Cough Haemoptysis PND a/c pulmonary edema Atypical angina Pulse volume is low, regular Apex beat-tapping Palpable S2 Low pitched Mid-diastolic murmur with presystolic accentuation in the mitral area without any radiation Features of RVF

12. Assesment of severity Accentuated first sound, the mitral opening snap and delayed diastolic murmur with late diastolic accentuation.

13. Differential diagnosis Individual pulmonary veins Left atrial myxoma

14. TREATMENT MEDICAL Beta blockers diuretics SURGICAL Balloon mitral valvulotomy / percutaneous trans septal mitral commissurotomy . Long term follow up is needed because of re- stenosis .

15. Aortic regurgitation Clinically, pure AR without mitral valve d/s is rare. Haemodynamics backward leak from aorta into LV during diastole L VH As there is impaired forward flow: 1.Compensatory peripheral vasodilatation-decrease in DBP 2.Increased ejection fraction from LV during early systole-increase in SBP In LVF, left ventricular diastolic pressure increases, resulting in increased LA presuure & pulmonary congestion.

16. Clinical features More common in boys Palpitation-large stroke volume Dyspnoea -LVF Peripheral signs of AR 1.Corrigan’s sign-dancing carotids 2.Duroziez’s sign-systolic murmur on compression of femoral artery proximally & diastolic murmur on compression of femoral artery distally. 3.Hill’s sign-increase in femoral artery SBP>20 mm Hg above the brachial artery SBP 4.De musset’s sign – head nodding 5.Traube’s sign- pistol shot sound produced after pressing the stethoscope over the femoral artery 6.Quincke’s sign – visible capillary pulsation 7.Locomotor brachialis 8.water hammer pulse

17. Others Pulsation of uvula-Muller’s sign Liver- Rosenbach’s sign Spleen- G erhardt’s sign Light house sign-alternate flushing and blanching of forehead Becker’s sign-pulsation of retinal artery

18. wide pulse pressure Heaving apex beat High pitched decrescendo diastolic murmur best heard 3 rd ICS along the left sternal edge

19. DD’s PDA AV fistula VSD vith AR Anemia Thyrotoxicosis Marfan’s syndrome

20. Treatment Medical ca channel blocker Surgical valve replacement

21. Tricuspid regurgitation 20 – 50% May be organic or functional

22. Hemodynamics Systolic backflow of blood from right ventricle to right atrium Volume load at right atrium and RV Pulmonary hypertension

23. Clinical features No specific symp Dyspnea may be relieved to some extent in pts with MR There will be features of either MS or MR

24. Diagnosis Investigation echo doppler Management decongestive measures- mitral valvulotomy+tricuspid annuloplasty

25. T hank you