Rheumatic Heart Disease Definition: streptococcal infection. children Pathology: - Anti-gen antibody reaction mediate inflammation. - * Clinical Feature; - Major Manifestation; 2

1- Carditis: - breatness- palpitation- chest pain Polyarthritis - 3- Chorea: - 4-Erythema marginatum. II. Minor Manifestation: Fever - Arthralgia-Raised ESR- Leucocytosis- ASO 3

Investigation 1-Evidence of systemic illness; Leucocytosis. ESR. 2- Preceding streptococcal infection - Increase ASO. Child Adult Throat Culture. 4

3- Carditis: X-ray: Cardiomegaly. ECG.: 1 st Heart block. Treatment: -1.2 m pencillin\ bedrest\Aspirin\corticosteriods\ m pencillin monthly. 5

Chronic Rheumatic Heart Disease Chronic valvular heart disease develop in half of patient with rheumatic heart disease. I. Mitral Stenosis -Valve orifice by progressive fibrosis and calcification of the valve leaflets and fusion of cusps. -Blood flow Lt AP.pulmonary venous con - Dilatation of Lt atrium and ventricle. 6

Clinical Feature Symptoms: Breathlessness-Fatigue- Odema-Palpitation. Haemoptysis-Signs: - Auscultation: - Auscultation: loud 1 st HS- MD murmer - Palpation: Shifted apex. 7

Investigation - ECG: Atrial Fabrilation. - X-ray: atrial enlargement. - Cardiac Cathetrization. Treatment A- Medical : B- Surgery. 8

II. Mitral Regurgitation Abnormal leaking of blood through the mitral valve Dysfunction of any valve part. * Clinical Feature: Symptoms: Dyspnea-Fatigue.Palpitation.Oedema.Ascitis. Signs: Apex shift- Pansystoloc murmer. 9

* Investigation: 1- X-ray: enlarged lt atrium and ventricle. 2- Echo: Dilated LA and LV. 3- Dopller: 4- Cardiac Catherterization. Managment Managment a) Medical : a) Medical : Diuretics,vasodilators.anticoagulant.antibioti b) Surgical : 10

Aortic Stenosis - Valvular heart disease caused by incomplete opening of the valve. - Causes: - Acquired: RF. - Congenital : bicusped aortic valve. - * Clinical Feature: - Mild and moderate are free. - Exertional dyspnea 11

Angina. Extertional syncope. Sudden death. Signs: Signs: - Ejection systolic murmer. - Narrow pulse pressure. *Investigation *Investigation : - ECG:Left ventricular hyperatrophty. - x-ray : enlarged left ventricle. 12

Doppler : to detect the severity.Treatment: - Medical: B –blockers. - Surgical. - Aortic Regurgitation - Leaking of the aortic valve. - Causes : in the valve cusps or root 1- Congenital. 2- Acquired: 13

Pathology: - Disease in the valve cusps: fibrosis and fusion of the cusps retraction of the cusps. - In the root: progressive dilatation of the root - failure of the cusps to coapt. - * Clinical Picture: Symptoms ( in sever cases) Brethnessness..Angina. 14

Signs: - Wide pulse presure. - Systolic murmer. - Crepitation. - 4th heart sound. * Investigation: * Investigation: - ECG: inverted T wave. - X-ray/ - Echo: dilated lt ventricle. - Catherterization. 15

Tricusped Stenosis: -Causes. Clinical Feature Clinical Feature Symptoms: Fatigue- Anarexia- peripheral odema. Signs: Raised jagular venous pressure. Mid diastolic murmer. 16

*Investigation * Treatment: Medical : -Salt restriction. -Diuretics. Surgical: 17

Tricusped Regurgitation Leaking of the tricusped valve commonly from functional dilatation of the Rt ventricle- or valvular damage. Clinical Feature: Symptoms: oedema.abdominal pain nausea. Signs: Ascitis.Anorexia. *Treatment: *Treatment: - Relieving ventricular dilatation: -- If dilatation in the valve: annuloplasty ring. 18

Pulmonary Stenosis - In conginital,carcinoid syndrome. - * Clinical Feature: a) Symptoms - Usually free. - If sever: Exertional Dyspnea. Headness. b) Signs: Ejection click—Wide splitting of S2 19

Investigation: - ECG: Rt ven. Hyperatrophy. - X-ray. - Doppler. - Echo. * Treatment: * Treatment: - Mild and moderate: no - Sever: Ballon Valvuplasty. - Valvotomy. 20

Pulmonary Regurgitation - Rarely isolated..Usualy associated with pulmonary artery dilatation due to pulmonary hypertension. Clinical Feature: a) Symptoms:- - Symptomatic. - Symptoms appear with marked increase in BP and RV failure: - Dyspnea on exertion--- Oedema 21

Investigation 1- x-ray: enlarged RV. 2- Doppler: 3- ECG.*Treatment: I.Medical: -Supportive: treat RT ventricular failure. - Treat pulmonary dilatation. II. Surgical. 22

23