1. RHEUMATIC HEART DISEASE (RHD)

2. OUTLINE INTRODUCTION EPIDEMIOLOGY OF RHD ETIOLOGY(CAUSES) OF RHD
PATHOPHYSIOLOGY OF RHD
DIAGNOSIS OF RHD
TREATMENT AND PROGNOSIS OF RHD
PREVENTION OF RHD
CONCLUSION

3. INTRODUCTION What do we mean by Rheumatic heart disease?
Rheumatic heart disease is the result of damage to the heart valves which occur after repeated episodes of acute rheumatic fever (ARF).
Early diagnosis and treatment of RHD are important to prevent progression of the disease.

4. Rheumatic Heart Disease and Rheumatic fever
Introduction(cont)
Rheumatic Heart Disease and Rheumatic fever
Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease that occurs a few weeks following an episode of group A streptococcal pharyngitis (sore throat).
Rheumatic heart disease most often results from cumulative valve damage due to recurrent episodes of acute rheumatic fever

5. EPIDEMIOLOGY OF RHD
Rheumatic heart disease causes at least – premature deaths every year,3 and is the major cause of cardiovascular death in children and young adults in developing countries.
Women of childbearing age do have a higher prevalence of established rheumatic heart disease than do men due to social factors (such as child rearing, which might result in repeated exposure to group A streptococcus).
The worst affected areas are sub-Saharan Africa, south-central Asia, the Pacific and indigenous populations of Australia and New Zealand.

6. ETIOLOGY(CAUSES) OF RHD
Rheumatic heart disease most often results from cumulative valve damage due to recurrent episodes of acute rheumatic fever.
Research seems to point to a different theory, however. This theory suggests that the disease is caused by the body’s immune system acting inappropriately.. Due to a resemblance between Group A streptococcus bacteria’s antigens and antigens present on the body’s own cells, the antibodies mistakenly attack the body itself.

7. PATHOPHYSIOLOGY OF RHD

8. Complications of RHD Valve Regurgitation suggests that heart valves
Are thickened and sticky against the walls of the heart
Do not meet in the middle
Leak (the blood flows backwards over the valve)
Valve Stenosis suggests that heart valves
Become stuck to each other a.k.a fish mouth
Do not allow blood to flow through easily (restricted forward flow)

9. PATHOPHYSIOLOGY OF RHD
• The consequences of valve damage(Valve Regurgitation and stenosis) are heart murmurs, cardiac hypertrophy and/or dilatation and cardiac failure.
• Other complications are arrhythmias, thromboembolic events (such as stroke) and infective endocarditis.

10. Fig 2. Diagram showing Damage on mitral valve caused by rheumatic heart disease

11. DIAGNOSIS OF RHD Echocardiography ECG heart test Throat swab
Endomyocardial biopsy
Radionuclide imaging
Radionuclide techniques are simple, noninvasive modalities that have been commonly used to evaluate a variety of cardiovascular disorders.

12. Sign and Symptoms

13. MANAGEMENT AND TREATMENT OF RHD
The use of Antibiotic prophylaxis(Penicillin) is useful in tackling rheumatic fever.
Management generally includes
restricting physical activity and salt intake
administering secondary prophylaxis (Benzathine penicillin can be continued during pregnancy)
avoiding community-acquired infectious diseases
education about monitoring own signs and symptoms and seeking care if shortness of breath
close monitoring of heart function (specifically in women who have symptoms of RHD).

14. PREVENTION OF RHD
Prevention of the development of RF involves proper diagnosis of initial strep throat infections
Prevention of RF recurrence requires continued antibiotic treatment, perhaps for life.
Prevention of complications of already-existing RF heart disease requires that the patient always take a special course of antibiotics when he or she undergoes any kind of procedure (even dental cleanings) that might allow bacteria to gain access to the bloodstream.

15. Enlightenment and Education of RHD is a very important step in reducing its occurrence in our society.

16. CONCLUSION
Although proven inexpensive cost-effective strategies for the prevention and control of streptococcal infections and their resultant diseases - acute rheumatic fever and rheumatic heart disease, are available, these diseases remain significant public health problems in the world today, particularly in developing countries.
Therefore recognition and mitigation of RHD is necessary in order to maintain good health.

17. REFERENCES
Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685–94. 
Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470–76.
Nkgudi B, Robertson KA, Volmink J, Mayosi BM. Notifi cation of rheumatic fever in South Africa—evidence for underreporting by health care professionals and administrators. S Afr Med J 2006; 96: 206–08. 
Robertson KA, Volmink JA, Mayosi BM. Towards a uniform plan for the control of rheumatic fever and rheumatic heart disease in Africa—the Awareness Surveillance Advocacy Prevention (A.S.A.P.) programme. S Afr Med J 2006; 96: 241.
Sliwa K, Carrington M, Mayosi BM, Zigiriadis E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: insights from the heart of Soweto study. Eur Heart J 2010; 31: 719–27