Rheumatic Heart Disease Year 4 Internal Medicine Notes

Rheumatic Heart Disease Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / RHEUMATOLOGY -- ● Objectives:\n● Know​ ​that​ ​ ​RHD​ ​is​ ​prevalent​ ​in​ ​our​ ​region​ ​and​ ​has​ ​economic​ ​burden.\n● Know​ ​how​ ​to​ ​diagnose​ ​the​ ​disease​ ​and​ ​how​ ​to​ ​approach​ ​a​ ​patient​ ​with​ ​RHD.\n● Know​ ​the​ ​principles​ ​of​ ​management.\n● Know​ ​how​ ​to​ ​prevent​ ​RHD​ ​;​ ​who​ ​needs​ ​prophylaxis​ ​and​ ​for​ ​how​ ​long.\n● Recognize​ ​complications​ ​and​ ​how​ ​to​ ​manage​ ​them.\n\n [​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​] \n● Resources:\n● 435​ ​slides ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​[​ ​ ​ ​ ​Editing​ ​file​ ​ ​ ​ ​ ​ ​ ​ ​ ​Feedback​ ​ ​ ​ ​ ​ ​ ​ ​ ​Share​ ​your​ ​notes​ ​ ​ ​ ​ ​ ​ ​ ​ ​Shared​ ​notes​ ​ ​ ​ ​ ​ ​ ​Twitter​ ​ ​ ​ ​]\n\n ● Done​ ​by:​ ​Lina​ ​Alshehri​ ​ Kawthar​ ​Almousa​ ​ ​ ​Khawla​ ​AlAmmari​ ​ ​ ​Fahad​ ​AlAbdullatif\n● Team​ ​sub-leader:​ ​Mana​ ​AlMuhaideb\n● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif\n● Revised​ ​by:​ ​Ahmed​ ​Alyahya \n\n RHD​ ​Vs.​ ​ARF\n\n ● Epidemiologic​ ​Background:\n- Globally​ ​RHD​ ​is​ ​the​ ​most​ ​common​ ​CVD​ ​in​ ​young​ ​people​ ​25​ ​yrs​ ​old​.\n- The​ ​overall​ ​incidence​ ​of​ ​ARF​ ​is​ ​5-51/100000​ ​people,​ ​with​ ​a​ ​mean​ ​of​ ​19​ ​per​ ​100000​ ​people.\n- In​ ​children​ ​5-14​ ​yrs​ ​old​ ​0.8-5.7​ ​per​ ​1000​ ​children​ ​with​ ​a​ ​median​ ​of​ ​1.3​ ​per​ ​1000.\n- The​ ​incidence​ ​of​ ​RF​ ​and​ ​the​ ​prevalence​ ​of​ ​RHD​ ​has​ ​declined​ ​substantially​ ​in​ ​Europe,​ ​North\nAmerica​ ​and​ ​other​ ​developed​ ​nations.​ ​This​ ​decline​ ​has​ ​been​ ​attributed​ ​to​ ​improved​ ​hygiene,\nreduced​ ​household​ ​crowding,​ ​and​ ​improved​ ​medical​ ​care.\n- The​ ​major​ ​burden​ ​is​ ​currently​ ​found​ ​in​ ​low​ ​and​ ​middle​ ​income​ ​countries(India,middle​ ​east),\nand​ ​in​ ​selected​ ​indigenous​ ​populations​ ​of​ ​certain​ ​developed​ ​countries​ ​(Australia​ ​and​ ​New\nZealand).\n- ​ ​A​ ​disease​ ​of​ ​poverty​ ​and​ ​low​ ​socioeconomic​ ​status.​ ​(these​ ​patients​ ​don’t​ ​seek​ ​medical\nattention​ ​when​ ​the​ ​get​ ​pharyngitis)\n- In​ ​underdeveloped​ ​countries​ ​RHD​ ​is​ ​the​ ​leading​ ​cause​ ​of​ ​CV​ ​death​ ​during​ ​the​ ​first​ ​five\ndecades​ ​of​ ​life.\n● Global​ ​burden:\n- Total​ ​cases​ ​with​ ​RHD​ ​:​ ​20​ ​Millions\n- 3​ ​Million​ ​have​ ​congestive​ ​heart​ ​failure.\n- 1​ ​Million​ ​require​ ​Valve​ ​surgery\n- Annual​ ​incidence​ ​of​ ​RF:​ ​0.5​ ​Million,​ ​nearly​ ​half​ ​develop​ ​carditis\n- Estimated​ ​deaths​ ​from​ ​RHD:​ ​230,000/YR.\n➔ Imposes​ ​a​ ​substantial​ ​burden​ ​on​ ​healthcare​ ​systems​ ​with​ ​limited​ ​budgets.\n➔\n● What​ ​is​ ​the​ ​difference​ ​between​ ​rheumatic​ ​fever​ ​and​ ​rheumatic​ ​heart​ ​disease? \nRheumatic​ ​fever​ ​is​ ​an​ ​inflammatory​ ​disorder​ ​caused​ ​by​ ​a​ ​Group​ ​A​ ​strep​ ​throat​ ​infection.​ ​It\naffects​ ​the​ ​connective​ ​tissue​ ​of​ ​the​ ​body,​ ​causing​ ​temporary,​ ​painful​ ​arthritis​ ​and​ ​other\nsymptoms​ ​(see​ ​JONES​ ​criteria​ ​below)​.​ ​In​ ​some​ ​cases​ ​rheumatic​ ​fever​ ​causes​ ​long-term​ ​damage\nto​ ​the​ ​heart​ ​and​ ​its​ ​valves.​ ​This​ ​is​ ​called​ ​rheumatic​ ​heart​ ​disease​ ​(the​ ​late​ ​manifestation).​ ​ \nRHD​ ​is​ ​a​ ​long-term​ ​complication​ ​of​ ​ARF. \nA.​ ​Acute​ ​Rheumatic​ ​fever: 7​ ​:​ ​24​ ​minutes \n● Acute​ ​rheumatic​ ​fever​ ​usually​ ​affects​ ​children​ ​(most​ ​commonly​ ​between​ ​5​ ​and​ ​15​ ​years)​ ​or\nyoung​ ​adults​ ​ ​but​ ​the​ ​heart​ ​complications​ ​don't​ ​start​ ​to​ ​appear​ ​until​ ​20​ ​-30yr.\n● The​ ​most​ ​common​ ​cause​ ​of​ ​acquired​ ​heart​ ​disease​ ​in​ ​childhood​ ​and​ ​adolescence.\n● The​ ​condition​ ​is​ ​triggered​ ​by​ ​an​ ​immune-mediated​ ​delayed​ ​response​ ​(manifestations​ ​appearing\nafter​ ​a​ ​period​ ​of​ ​2-4​ ​weeks)​ ​to​ ​infection​ ​with​ ​specific​ ​strains​ ​of​ ​group​ ​A​ ​streptococci​,​ ​which​ ​have\nantigens​ ​that​ ​may​ ​cross-react​ ​with​ ​cardiac​ ​myosin​ ​and​ ​sarcolemmal\nmembrane​ ​protein.​ ​Antibodies​ ​produced​ ​against​ ​the​ ​streptococcal​ ​antigens Incidence​ ​and cause​ ​inflammation​ ​in​ ​the​ ​endocardium,​ ​myocardium​ ​and​ ​pericardium,\npathogenesis as​ ​well​ ​as​ ​the​ ​joints​ ​and​ ​skin.\n● Histologically,​ ​fibrinoid​ ​degeneration​ ​is​ ​seen​ ​in​ ​the​ ​collagen​ ​of​ ​connective\ntissues.​ ​Aschoff​ ​nodules​ a​ re​ ​pathognomonic​ ​and​ ​occur​ ​only​ ​in​ ​the​ ​heart.\nThey​ ​are​ ​composed​ ​of​ ​multinucleated​ ​giant​ ​cells​ ​surrounded​ ​by\nmacrophages​ ​and​ ​T​ ​lymphocytes,​ ​and​ ​are​ ​not​ ​seen​ ​until​ ​the​ ​subacute​ ​or​ ​chronic​ ​phases​ ​of\nrheumatic​ ​carditis.​ ​There​ ​is​ ​no​ ​bacteria\n​ ​Anitschkow​ ​cells​ ​are​ ​enlarged​ ​macrophages​ ​found​ ​within​ ​granulomas​ ​(called​ ​Aschoff​ ​bodies​)​ ​associated​ ​with​ ​the​ ​disease.Larger​ ​Anitschkow​ ​cells\nmay​ ​coalesce​ ​to​ ​form​ ​multinucleated​ ​Aschoff​ ​gi