What Is Rheumatic Heart Disease?

Rheumatic heart disease is referred to as rheumatic heart disease, which refers to heart valve disease caused by rheumatic fever activities that affect the heart valve. One or more of the mitral, tricuspid, and aortic valves are narrowed and / or closed. Clinically, stenosis or insufficiency often coexists, but it is usually dominated by one. In the early stage of the disease, there are often no obvious symptoms, and in the later stage, it is manifested as cardiac decompensation such as palpitation, shortness of breath, fatigue, cough, lower limb edema, cough pink foamy sputum and so on.

Basic Information

nickname: Rheumatic heart disease
English name: rheumatic heart disease
Visiting department: Cardiology

Common locations: heart
Common causes: Allergy caused by group B hemolytic streptococcus infection
Common symptoms: Palpitation, shortness of breath, fatigue, cough, edema, pink foamy sputum
Contagious: no

Causes of rheumatic heart disease

Rheumatic heart disease is part of the allergic reaction caused by group B hemolytic streptococcal infection and belongs to autoimmune disease. Pathological changes in the heart mainly occur in the heart valve. The mitral valve is the most common site of involvement.

Clinical manifestations of rheumatic heart disease

Due to the disease of the heart valve, the heart has problems in the process of transporting blood, such as stenosis of the valve, which increases the resistance to blood flow. In order to eject enough blood, the heart relaxes and contracts more laboriously, which increases the strength of the heart. , The efficiency is reduced, the heart is prone to fatigue, and over time, it causes cardiac hypertrophy. For example, when the mitral valve stenosis reaches a certain level, the increased pressure of the left atrium causes the pressure of the pulmonary veins and pulmonary capillaries to increase, resulting in pulmonary congestion. After pulmonary congestion, the following symptoms are likely to occur: difficulty breathing; cough; There is also a husky voice and difficulty swallowing. The common clinical heart valve diseases are as follows:

1. Mitral valve insufficiency

Patients with rheumatic mitral insufficiency often have only mild symptoms. When rheumatic activity, infective endocarditis, or rupture of chordae tend to worsen, 75% of patients with mitral insufficiency develop atrial fibrillation and atrial fibrillation. May increase left atrial pressure. Excessive left ventricular volume is another important reason for mitral regurgitation and shortness of breath in patients. The later stages of the disease may include pulmonary edema, hemoptysis, and right heart failure.

Aortic stenosis

Patients with aortic valve stenosis may be asymptomatic during the compensatory period. Most patients with severe stenosis have burnout, dyspnea (labour or paroxysmal), angina pectoris, dizziness or syncope, and even die suddenly.

(1) Angina pectoris can occur in 20% to 60% of patients, and the pain increases with age and the severity of the valve orifice. The presence of angina pectoris indicates that the aortic valve stenosis has become quite severe. Angina can occur after exertion or at rest, suggesting that it is not necessarily related to exertion and physical activity.

(2) Dizziness or syncope About 30% of patients have vertigo or syncope, and the duration can be as short as 1 minute and more than half an hour. Some patients are associated with Alzheimer's syndrome or arrhythmia. Dizziness or syncope often occurs after work or when the body is bent forward, sometimes in a resting state, a sudden change of body position, or when nitroglycerin is administered sublingually to treat angina pectoris.

(3) Dyspnea Labor dyspnea is often a manifestation of cardiac insufficiency, often accompanied by fatigue and paroxysmal elevation of venous pressure. With the increase of heart failure, paroxysmal dyspnea at night, sitting breath, coughing pink foamy sputum may occur.

(4) Sudden death may occur in 20% to 50% of cases. Most cases may have recurrent angina pectoris or syncope before sudden death, but it may also be the first symptom. The cause may be related to severe and fatal arrhythmias, such as ventricular fibrillation.

(5) Sweating and palpitations These patients are particularly sweaty. Due to increased myocardial contraction and arrhythmia, patients often feel palpitations. Sweating often occurs after palpitations, which may be related to autonomic nervous dysfunction and increased sympathetic tone.

3. Tricuspid stenosis

The clinical manifestations of tricuspid stenosis can be less significant due to the coexisting mitral stenosis or be confused with the symptoms of mitral stenosis. Patients are more prone to fatigue, often complaining of discomfort or pain in the right upper quadrant and edema around the body. The obvious pulsation of the jugular vein often gives the patient a fluttering discomfort in the neck. In addition, due to gastrointestinal congestion, patients often complain of loss of appetite, nausea, vomiting, or belching. Few patients may also experience syncope, periodic cyanosis or discomfort behind the sternum, and may have difficulty breathing.

4. Tricuspid insufficiency

The symptoms of tricuspid regurgitation without pulmonary hypertension are relatively mild. When pulmonary hypertension and tricuspid insufficiency coexist, the cardiac output decreases and the symptoms of right heart failure are obvious. May manifest as weakness, general edema, abdominal cavity fluid and hepatic congestion caused by right quarter rib area and right upper quadrant pain. There is a pulsating sensation in the neck or abdomen, especially during physical exertion or emotional agitation. Occasionally, eye pulsation may occur, and some patients may have mild jaundice. In many patients with tricuspid valve insufficiency, as the disease progresses, the pulmonary stasis caused by concurrent mitral valve disease can be reduced, but the symptoms of weakness, fatigue, and other decreased cardiac output become obvious.

5. Combined valve disease

Combined valve disease has the following combinations: two or more valves are involved in the same cause, the most common is mitral and aortic valve or other valve disease caused by rheumatism; the other is infective endocarditis. Mitral, aortic, tricuspid, or pulmonary valves.

The disease originates from one valve, which can affect or involve another valve as the disease progresses, resulting in relative stenosis or insufficiency. Such as rheumatic mitral stenosis can cause pulmonary hypertension, pulmonary hypertension can overload the ventricular pressure, cause the right ventricle to expand and cause tricuspid valve insufficiency. Two or more causes involve different valves, such as rheumatic mitral valve disease with infectious aortic valve inflammation. The effect of combined valve disease on cardiac function is comprehensive. Many valve lesions have a worse prognosis than single valve disease. Surgical treatment is often worse than simple valvular disease.

Rheumatic Heart Disease

Check-up

According to the different invaded valves, corresponding signs appear on examination, and in the later stage, signs of decompensation of heart function or complications.

(1) The heart is generally enlarged, tachycardia is not proportional to body temperature, the first heart sound of the apex is weakened, and the diastolic rhythm is run. High-level apex above , systolic full-range murmurs, and soft, short, low-profile mid-diastolic murmurs;

(2) signs of heart failure such as fine wet rales can be seen at the bottom of both lungs;

(3) some have pericardial friction sounds, which may be accompanied by pleural friction sounds;

(4) joint redness, swelling, and limited movement;

(5) A small number of patients can see pale red ring-shaped erythema on the inner skin of the trunk or limbs, and the center is pale; 2 to 5 mm can be seen on the large joint extension side, especially the elbow, knee, and wrist joints, occipital region or chest, lumbar spinous process Subcutaneous nodules, no tenderness, no adhesion to the skin, removable;

(6) Children can see unconscious and uncoordinated movements of hands, feet, and eyebrows, etc.

(7) Rheumatism manifestations outside the heart: there may be manifestations of pleurisy, pneumonia, peritonitis, nephritis, vasculitis, and encephalopathy.

2. Auxiliary inspection

(1) As a non-invasive method, Doppler echocardiography has been one of the main methods for evaluating various valve lesions. Not only can it measure the size of the heart cavity and ventricular function, but it can also measure the transvalvular pressure difference, valve opening area, pulmonary artery Indicators such as stress.

(2) X-ray examination can understand changes in heart size and lungs.

(3) Electrocardiogram It is possible to determine the patient's heart rhythm, whether there is myocardial ischemia change, whether it is associated with atrial fibrillation, and so on.

(4) Cardiovascular angiography For some patients older than 45 years, the electrocardiogram indicates that there is a change in myocardial ischemia, and the cardiographer can determine whether there is a coronary artery disease.

Rheumatic heart disease diagnosis

The diagnosis can be made based on the etiology, clinical manifestations and imaging examination.

Rheumatic heart disease treatment

Regardless of whether the valvular disease is narrow, incompletely closed, or coexisting, obvious clinical symptoms are required for surgical treatment to repair or replace the diseased valve.

1. Treatment of rheumatic heart disease during asymptomatic period

The principle of treatment is mainly to maintain and enhance the compensatory function of the heart. On the one hand, it is necessary to avoid overloading the heart, such as heavy physical labor and strenuous exercise. Improve the heart's reserve capacity. Proper physical activity and rest, limiting sodium intake and prevention and treatment of respiratory infections. Pay attention to prevent rheumatic fever and infective endocarditis. When combined with heart failure, digitalis preparations, diuretics and vasodilators are used.

2. Surgical treatment of rheumatic heart disease

For patients with chronic rheumatic heart valve disease who are asymptomatic, surgery is generally not required; for those who are symptomatic and meet the indications for surgery, mitral valve closed expansion or artificial valve replacement can be selected.

Indications for surgery: Asymptomatic patients with grade 1 cardiac function do not require surgery. Patients with cardiac function and should undergo surgical treatment. Cardiac function class IV should be treated first with heart strengthening, diuresis, etc., and surgery should be performed after the cardiac function improves. Patients with atrial fibrillation, pulmonary hypertension, systemic embolism, and functional tricuspid valve insufficiency should also be operated, but the risk of surgery is increased. Patients with rheumatic activities or bacterial endocarditis should undergo surgery 6 months after rheumatic activities and endocarditis are completely controlled.

3. Treatment of complications of rheumatic heart disease

(1) Treatment of cardiac insufficiency.

(2) Rescue of acute pulmonary edema.

(3) Treatment of atrial fibrillation.

Rheumatic heart disease prevention

1. Prevention and treatment of Streptococcus infection

Prevent rheumatism and aggravate the condition caused by respiratory infections.

2. Work and rest

When the patient's symptoms are not obvious, some light physical work can be done properly. Proper exercise and physical work can increase the heart's ability to compensate, but do not participate in heavy physical work to avoid increasing the burden on the heart. Patients with absolute cardiac insufficiency or rheumatism should be absolutely bed rested, and all life should be assisted by family members. Be patient with patients and avoid bad stimuli. Many patients with rheumatic heart disease are nervous and emotional, and they are prone to sudden tachycardia, which increases the burden on the heart and causes cardiac insufficiency.

3. Reasonable diet

People with cardiac insufficiency should control water intake and limit sodium in the diet. It is advisable to take less than 10 grams per day, and avoid salted products. Reduce high-fat diet; slow-moving beverages; those taking diuretics should eat fruits such as bananas, oranges, etc .; abstain from irritating diet and excitatory drugs; control sexual life.

4. Not suitable for strenuous activities

Regular outpatient follow-up should be performed, and patients with atrial fibrillation should not engage in strenuous activities. At the appropriate time, surgical treatment should be considered, and when it should be performed, it should be determined by the doctor based on the specific situation.

5. For extraction or other minor surgery

Antibiotics should be used to prevent infection before surgery.