Simplified Rheumatic Heart Disease

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Get a brief information about Rheumatic Heart Disease. What is the clinical presentations of rheumatic heart disease (RHD)? What is pericarditis? What is Rheumatic Polyarthritis? Rheumatic Heart Disease (RHD) is a chronic disease which the heart muscle and valves damage due to rheumatic fever caused by Streptococcus pyogene - a group A beta-hemolytic infection. The cardinal anatomic changes of the valves include: 1. leaflet thickening, 2. commissural fusion and 3. shortening and thickening of the tendinous cords. RHD is characterized by consistent involvement of myocardium, endocardium and pericardium into a pathologic process. The person may develop isolated diffuse or focal myocarditis, endocarditis and pericarditis. ## Most significant finding of RHD - Mitral valvulitis can occur causing thickening of the leaflets. A murmur is created by increased blood flow across the thickened mitral valve. This can be distinguished from rheumatic mitral valve stenosis by the absence of an opening snap. - The murmur is described as a 'low-frequency mid-diastolic murmur' which can be best heard at the mitral listening post with the bell of the stethoscope with the patient in the left lateral decubitus position at end of deep expiration. As the rheumatic valvulitis resolves, the murmur disappears. Rheumatic heart disease will most commonly reveal the murmur of mitral stenosis. ## Basal protodiastolic murmur in aortic regurgitation Affection of aortic valve manifests with basal protodiastolic murmur, typical for aortic regurgitation which begins immediately after II tone. As for character – high frequent, blowing, diminishing. It’s auscultated best of all along left edge of sternum after deep inspiration at forward inclination of body. Ultrasound examination at aortic valve’s valvulitis allows revealing diastolic fibrillation of mitral folds with small amplitude in 50% of children. In some patients thickening of echo signal from aortic valve folds and aortic regurgitation may be present. These signs are objective criteria of rheumatic endocarditis diagnostics.