RHEUMATIC HEART

DISEASE
 RHEUMATIC HEART
DISEASE
 Rheumatic Heart Disease is the permanent heart valve damage resulting
from one or more attacks of ARF.
 It is thought that 40-60% of patients with ARF will go on to developing
RHD.
 Mitral valve>aortic valve
 Mitral Insufficiency
 Increased atrial pressure- pulmonary congestion and symptoms of left-sided heart failure
 Mild- signs of heart failure are not present, precordium is quiet; auscultation= high pitched holosystolic
murmur at the apex radiating to the axilla
 Severe mitral insufficiency- signs of acute or chronic heart failure; The heart is enlarged,
with a heaving apical left ventricular (LV) impulse and often an apicalsystolic thrill. The
second heart sound (S2) may be accentuated if pulmonary hypertension is present. A third
heart sound or gallop is generally prominent.
 Ausculation of diastolic murmure: relative mitral stenosis (Carey-Coombs murmur)
 Mitral Stenosis
 Mild stenosis- asymptomatic
 Exercise intolerance and dyspnea
 Critical lesions- orthopnea, paroxysmal nocturnal dyspnea, overt pulmonary edema,

atrial arrythmias
 JVP is increased- severe disease with heart failure, tricuspid valve

disease/regurgitation, or severe pulmonary hypertension

 principal auscultatory findings- loud first heart sound, an opening snap of the mitral

valve, and a long, low-pitched, rumbling mitral diastolic murmur with presystolic
accentuation at the apex
 Atrial fibrillation- common late manifestation
 Aortic Insufficiency
 Palpitations; sweating and heat intolerance; Dyspnea on exertion can progress to
orthopnea and pulmonary edema; angina
 Nocturnal attacks with sweating, tachycardia, chest pain, and hypertension may

occur
 Water hammer or Corrigan pulse
 Murmur begins immediately with S2 and continues until late in diastole. The

murmur is heard over the upper left and mid-left sternal border with radiation to the
apex and upper right sternal border
 Austin Flint murmur
Tricuspid Valve Disease
 Prominent pulsations of the jugular veins, systolic pulsations of the liver, blowing
holosystolic murmur at the lower left sternal border that increases in intensity
during inspiration

Pulmonary Valve Disease

 Occurs on a functional basis secondary to pulmonary hypertension and is a late
finding with severe mitral stenosis
 Graham Steell murmur
 Treatment
 Mild mitral insufficiency- prophylaxis against recurrences of ARF is all that is
required
 More significant insufficiency- corticosteroids are added in the acute phase
 ACEi and ARBs
 Diuretics
 Surgical treatment- indicated for patients with persistent heart failure, dyspnea

with moderate activity, and progressive cardiomegaly, often with pulmonary

hypertension