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    Rheumatic Heart Disease

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    Ryo Kelvin
    This document discusses rheumatic heart disease (RHD), which is an inflammatory systemic non-purulent disease caused by delayed autoimmunity affecting collagen vascular or connective tissue abnormalities. RHD can cause rheumatic carditis, which is heart damage from rheumatic fever. The disease is caused by Group A streptococcus bacteria and risk factors include genetics, age, socioeconomic status, ethnicity, climate, and weather changes. Symptoms may include chest pain, shortness of breath, fever, joint pain, and murmurs found on physical exam. Diagnosis involves elevated inflammatory markers, EKG changes, echocardiogram findings and evidence of prior strep infection. Complications include valvular heart lesions and

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    Rheumatic Heart Disease

    Uploaded by

    Ryo Kelvin
    63 views39 pages
    This document discusses rheumatic heart disease (RHD), which is an inflammatory systemic non-purulent disease caused by delayed autoimmunity affecting collagen vascular or connective tissue abnormalities. RHD can cause rheumatic carditis, which is heart damage from rheumatic fever. The disease is caused by Group A streptococcus bacteria and risk factors include genetics, age, socioeconomic status, ethnicity, climate, and weather changes. Symptoms may include chest pain, shortness of breath, fever, joint pain, and murmurs found on physical exam. Diagnosis involves elevated inflammatory markers, EKG changes, echocardiogram findings and evidence of prior strep infection. Complications include valvular heart lesions and

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    This document discusses rheumatic heart disease (RHD), which is an inflammatory systemic non-purulent disease caused by delayed autoimmunity affecting collagen vascular or connective tissue abnormalities. RHD can cause rheumatic carditis, which is heart damage from rheumatic fever. The disease is caused by Group A streptococcus bacteria and risk factors include genetics, age, socioeconomic status, ethnicity, climate, and weather changes. Symptoms may include chest pain, shortness of breath, fever, joint pain, and murmurs found on physical exam. Diagnosis involves elevated inflammatory markers, EKG changes, echocardiogram findings and evidence of prior strep infection. Complications include valvular heart lesions and

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    63 views39 pages

    Rheumatic Heart Disease

    Uploaded by

    Ryo Kelvin
    This document discusses rheumatic heart disease (RHD), which is an inflammatory systemic non-purulent disease caused by delayed autoimmunity affecting collagen vascular or connective tissue abnormalities. RHD can cause rheumatic carditis, which is heart damage from rheumatic fever. The disease is caused by Group A streptococcus bacteria and risk factors include genetics, age, socioeconomic status, ethnicity, climate, and weather changes. Symptoms may include chest pain, shortness of breath, fever, joint pain, and murmurs found on physical exam. Diagnosis involves elevated inflammatory markers, EKG changes, echocardiogram findings and evidence of prior strep infection. Complications include valvular heart lesions and

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    Veronica Lusiana Sinurat

    1461050185
    DEFINISI
     Demam Reumatik (DR) merupakan suatu
    penyakit inflamasi sistemik non supuratif dengan
    proses “delayed autoimmun” pada kelainan vaskular
    kolagen atau kelainan jaringan ikat.
     Penyakit Jantung Reumatik (PJR) merupakan
    kelainan jantung yang terjadi akibat DR, atau
    disebut juga kelainan karditis reumatik.

    Buku Ajar Ilmu Penyakit Dalam


    DEFINISI
     Rheumatic carditis, in childhood and early adult life, often
    causes later chronic valve disease.
     The presence of carditis strongly suggests that a febrile
    illness, with joint pains is rheumatic fever.
     Rheumatic carditis can be a pancarditis, involving the
    endocardium, myocardium, and pericardium. The damage
    which result is often progressive and leads to the different
    lesions which are collectively known as chronic rheumatic
    heart disease.

    Cardiac Diagnosis, Peter Carson


    EPIDEMIOLOGI
     Ditemukan di seluruh dunia.
     Diderita semua umur, 90% serangan pertama
    umur 5-15 tahun.

    Buku Ajar Ilmu Penyakit Dalam


    a. Men b. Women.

    Mendis, S., Puska, P. Global Atlas on Cardiovascular Disease Prevention and Control. Geneva, WHO, 2011.
    Oxford Journals
    RHD prevalence per 1000 persons for each WHO region

    A) The Americas B) Europe C) Africa


    D) Eastern Mediterranean E) Western Pacific F) Southeast Asia
    http://openi.nlm.nih.gov/
    ETIOLOGI
     Etiologi: Bakteri Streptococcus.
     Streptococcus:
    - Alpha streptococcus/streptococcus viridans: slight hemolysis of RBC.
    - Beta hemolytic streptococcus: frank hemolysis of RBC.
    - Gamma streptococcus: no hemolysis of RBC.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


    ETIOLOGI
     Streptococcus elaborate a specific carbohydrate:

    Group A, B, C, D, etc. With but few exceptions, all


    the streptococci pathogenic for man belong to group A.

    Group A (includes the beta hemolytic class) can be


    further divided into > 40 types, depending on the
    presence of protein M and T.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


    ETIOLOGI
    Streptococcus group A can elaborate one or
    more of the following substances:

    1. Streptokinase (fibrinolysin).

    2. Hemolysins or streptolysins.

    3. Proteolytic enzymes: streptococcus proteinase,


    hyaluronic acid and hyaluronidase.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


    FAKTOR RESIKO
     Genetik

     Umur

     Keadaan sosial dan Ekonomi yang buruk

     Golongan Etnik dan Ras

     Iklim dan Geografis

     Perubahan Cuaca

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


    PATOFISIOLOGI
    KELAINAN KATUP JANTUNG
    PADA PJR

    MITRAL VALVE
    AORTIC VALVE

    Regurgitasi aorta: PJR kronik.


    KATUP YANG JARANG

     Stenosis trikuspid selalu disebabkan oleh PJR.

     Stenosis pulmonal dan regurgitasi pulmonal.

    Buku Ajar Ilmu Penyakit Dalam


    KRITERIA DIAGNOSIS
    Duckett Jones (1944)
    Buku Ajar Ilmu Penyakit Dalam
    PENEGAKAN DIAGNOSIS
     Anamnesis (Alloanamnesa)

    1. Identitas pasien

    2. Keluhan utama: dada nyeri, sesak, demam

    3. Lokasi

    4. Onset

    5. Kuantitas & kualitas:

    - Dada sesak hilang timbul

    - Demam naik turun


    6. Faktor memperberat & memperingan:

    - Sesak dada saat beraktivitas, berkurang saat istirahat

    - Demam naik saat sore-malam, turun jika diberi obat

    7. Kronologi

    8. Keluhan lain:

    - Sendi tubuh (lutut, kaki, belikat) nyeri, pernah bengkak, kemerahan,


    hangat bila diraba

    - Batuk kambuh-kambuhan sejak kecil (umur 3-5 tahun)

    - Cepat lelah
    9. Tinjauan sistem:
    - Nyeri saat menelan
    - Batuk berdahak putih
    - Dada berdebar-debar
    - Mual bisa sampai diikuti muntah
    10. Riwayat Penyakit Dahulu (RPD)
    11. Riwayat Penyakit Keluarga (RPK)
    12. Riwayat Kebiasaan Pasien (RKP): makanan, sosial, ekonomi, gaya
    hidup, olahraga.
    13. Review
    14. Edukasi
     Pemeriksaan Fisik

    - Status generalis

    - Vital sign: takikardi, takipneu

    - JVP (n: 5 – 4-8)

    - Auskultasi jantung: murmur (+)

    - Bengkak pada persendian


    TES LABORATORIUM
     Laju Endap Darah (LED) dan protein C reaktif

    LED pada PJR meningkat. Tidak hanya digunakan untuk


    mendiagnosis, tapi juga dalam pengobatan pasien. Protein C reaktif
    juga ditemukan meningkat.

     Jumlah Sel Darah Putih

    Adanya peningkatan SDP polimorfonuklear dan adanya


    pergeseran ke kiri. SDP bisa mencapai 25.000/ml. Kembali normal
    setelah beberapa minggu atau periode tertentu.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


     Sel Darah Merah (SDM)

    Terjadi anemia mikrositik, jumlah Hb jatuh sampai 8 gram/dL.


    Keadaan ini bukan keadaan spesifik PJR.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


    Buku Ajar Ilmu Penyakit Dalam
     Histologi

    Ditemukan Aschoff Body. Badan ini terdapat pada septum


    fibrosa intervaskular, di jaringn ikat vaskular dan di daerah
    subendotelia
     Seroimunologi

    Peninggian titer antistreptoksin O (ASTO) dan antideoxyribonuklease


    B (anti DNA-ase B), biakan usap tenggorok positif streptokokus hemolitikus.

    Anti-DNase B is a blood test to look for antibodies to a substance


    produced by Group A Streptococcus, the bacterium that causes strep throat.

    This test is most often done to tell if you have previously had a strep infection
    and if you might have rheumatic fever or kidney problems
    (glomerulonephritis) due to that infection.

    Normal:
    • Adults: less than 85 units/mL
    • School-age children: less than 170 units/mL
    • Preschool children: less than 60 units/mL

    Bisno AL, Stevens DL.Streptococcus pyogenes


    Low DE. Nonpneumococcal streptococcal infections, rheumatic fever. In: Goldman L, Schafer Al, eds. Goldman's Cecil Medicine
    X-RAY THORAX

    KARDIOMEGALI

    Clinical Roentgenology of the Cardiovascular System. Springfield, C. C. Thomas, 1937.


    ELEKTROKARDIOGRAM
    Prolongation of the P-R
    interval and prolongation of the Q-T
    interval often occurs during the course
    of acute rheumatic fever, but even when
    present, are not specific for rheumatic
    fever.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


     T wave changes (not specific), but RS-T
    deviations characteristic of myocardial
    injury indicate the presence of a complicating
    pericarditis.

    Heart Disease: Its Diagnosis and Treatment, Emanuel Goldberger


    EKOKARDIOGRAFI
    Menilai beratnya penyumbatan atau kebocoran katup tersebut.
    Biasa dipakai: Ekokardiografi Doppler.
    Stenosis Aortic Valve
    KOMPLIKASI

    Darah ke ventrikel
    Stenosis Mitral
    tidak adekuat
    Hipertrofi
    Ventrikel

    Darah ke aorta dan


    Regurgitasi Mitral
    kembali ke atrium kiri

    GAGAL JANTUNG
    PENATALAKSANAAN
    PENGOBATAN
    PENCEGAHAN

     Primer: pencegahan infeksi SGA supaya tidak menderita PJR.

    Buku Ajar Ilmu Penyakit Dalam


     Sekunder: mencegah menetapnya SGA pada bekas pasien
    DR.

    Buku Ajar Ilmu Penyakit Dalam

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