Rheumatic heart disease Flashcards
What can be said about rheumatic heart disease from an epidemiological standpoint?
That it is essentially a disease of poverty
Incidence has decreased dramatically in western countries, even before penicillin was discovered, and even in poor countries prevalence is much lower in children who are educated than those who are not
What is an average prevalence rate in children in developing countries?
Around 40 per 1000
Differs quite a bit though, eg 62/1000 in Kenya, 21.5/1000 in Cambodia, etc
Is rheumatic heart disease mainly about the chronic valvular manifestations?
No, the pancarditis of ARF is also included in rheumatic heart disease
What valves are most commonly affected by rheumatic heart disease?
Mitral and aortic
Sometimes tricuspid, but is usually subclinical
In rheumatic heart disease, which of mitral or aortic can alone be regurgitant?
Mitral
Not normal to have only aortic regurg but you can have only mitral regurg
Which of the mitral leaflets is most commonly affected?
The anterior leaflet
What seems to cause the mitral regurgitation seen in rheumatic heart disease?
Annular dilation and chordal elongation
What is the main cause of LV dilation and HF seen in rheumatic heart disease?
MR with/out AR
Known because LV dimensions decrease dramatically following valve surgery
What are some ECG findings in rheumatic heart disease?
Any degree of heart block including AV dissociation
Is there a good chance that acute rheumatic fever will progress to rheumatic heart disease if left unteated?
Yes
Upwards of 70% will progress
How does age change which valves you would expect to be affected by rheumatic heart disease?
MR when early in life
MS when middle aged
Mixed when older
Is screening for rheumatic heart disease in endemic areas appropriate?
Yes, very
What is the best method of screening?
Echocardiography
