Rheumatic - this is the most significant manifestation of rheumatic fever, which allows you to determine the severity of the underlying disease and the tactics of the patient.Rheumatic heart may be the only sign isolated rheumatism, or enter into a clinical symptom, along with other manifestations of the underlying pathology.
classical form of rheumatic heart disease
reasons rheumatic heart disease
main trigger in the development of the classical form of rheumatic heart disease as a manifestation of rheumatic fever, is an acute streptococcal infection, localized in the mucosa of the upper respiratory tract, as evidenced by numerous findings of randomized trials.Thus, 80% of the surveyed patients with rheumatic heart disease, high titers antistreptokokkovyh detected antibodies of different serotypes.
pathogenetic mechanisms of development of rheumatic heart disease poorly understood, but among immunologists and cardiologists is believed that the basis for the formation of the inflammatory process in the fibers of the heart wall includes a massive passive or active toxic effects of infectious agents to the heart tissue on a cellular level.In addition, as a result of the destruction of most of the streptococcus produces a huge amount of exoenzymes providing direct tissue damage to the heart.
Note that the return form of rheumatic heart disease may be completely absent signs antistreptokokkovogo immune response, so has not yet ruled out the role of other etiopathogenic factors in the occurrence of rheumatic heart disease, such as viral.
great importance in the development of rheumatic heart disease has a so-called "genetic predisposition", since not all patients who have had a strep infection, even severe, as a result suffer from rheumatic heart disease.The basis for the development of rheumatic heart disease predisposition on the theory of individual hyperimmune reaction of the body in response to the receipt of streptococcal antigens which has a genetic nature.On the topic of the search of the defective gene responsible for the development of hypersensitivity to streptococcal infection, carried out a large amount of research that has yet to have a positive result.
Symptoms and signs of rheumatic heart disease
clinical development of symptoms and the intensity of those or other manifestations of rheumatic heart disease depend on the localization of the inflammatory process and its prevalence.The most active symptoms of acute rheumatic heart disease is different, at which the primary lesion of the endocardium and fast dynamics of the growth of clinical manifestations that may be specific and somatic character.
Rheumatic heart disease with isolated lesion of the endocardium is short duration and is no different clinical manifestations of activity.Patients with this form of heart disease do not show active complaints and do not feel a substantial disorder of their own health status, revmokardichesky endocarditis can be classified as "chance finds" during routine medical check-ups.Experienced specialist in karyotype may be suspected if the patient revmokardicheskogo endocarditis on the basis of physical examination (diastolic bland type of noise in the projection apex of the heart, as well as a rough systolic murmur auscultation points in hearing the aorta and cardiac apex).
Provided further spread of the inflammatory process formed the development of clinical myocarditis with focal lesion, which is characterized by the appearance of unpleasant sensations in the heart, not related to physical activity and wearing transient.In some situations, the first manifestation of rheumatic myocarditis becomes a violation of the rhythm of the heart.In the case of a limited defeat mioakardialnogo layer of the patient never developed cardiodynamic violations.
only in diffuse endomyocarditis rheumatic origin formed the typical clinical picture, which is the appearance of severe shortness of breath, feeling disruptions of the heart, the appearance of dry cough during vigorous exercise.In the long the patient has bouts of cardiac asthma and pulmonary edema.At the initial examination of the patient with severe rheumatic heart disease found all the signs of congestive heart failure (typical position of the patient in the position orthopnea, cyanosis of the skin in the distal extremities, generalized edema syndrome, increased heart rate with symptoms of arrhythmia).
In connection with diffuse disease of the heart, has been a sharp expansion of the boundaries of cardiac dullness and muted tones of the heart, which is celebrated on the background auscultation a rough systolic murmur in all points of auscultation.Listening to heart sounds may be complicated due to the presence of changes in the lungs in the form of the multitude of scattered moist rales of various calibers, a reflection of the growing interstitial pulmonary edema.
rheumatic heart disease with changes in the pericardium occurs with the same clinical symptoms as pericardial not infectious nature and greatly exacerbates the underlying disease.An interesting fact is that patients with revmoperikarditom not complain of pain, and increasingly showing signs of increase symptoms of congestive heart and lung failure.A typical auscultatory criterion pericarditis rheumatic nature of a pericardial friction noise leaves no more than two days, followed by the addition of exudative processes in the pericardial cavity.
Primary rheumatic heart disease of any severity usually ends with the formation of valvular heart disease, while recurrent rheumatic heart disease develops in the already formed blemish.
Treatment of rheumatic heart disease
When choosing tactics and method of treating a patient with rheumatic heart disease should take into account the degree of inflammatory activity, the severity of the cardiac wall and the degree of impairment of cardiac hemodynamics.All cases of rheumatic heart disease to be the primary hospital care in cardiorheumatological department, after which the patient is recommended to undergo rehabilitation treatment in a sanatorium cardiology and undergo a planned inspection at the cardiologist in the outpatient setting.
predetermine factor in the appointment of a mode of stay of the patient in the ward is the severity of the condition and severity of hemodynamic disturbances.
Drug treatment of rheumatic heart disease is to assign adequate scheme of anti-inflammatory therapy, the drugs of choice which are NSAIDs.
Primary rheumatic heart disease in children is an indication for aspirin initial average daily dose of 1.5 g or brufen at a dose of 20 mg per kg body weight of the child.Treatment of adult patients with the category of mild to moderate severity of rheumatic process also recommended to start with the use of acetylsalicylic acid in the average daily dose of 4 g orally, and the appearance of adverse reactions from its use should be replaced by a daily dose of diclofenac 100 mg.
indications for drugs of corticosteroids is the lack of a positive result from the use of non-steroidal anti-inflammatory drugs, signs of congestive heart failure, pulmonary with underlying heart rhythm.In this situation it is necessary to use a short course of low dose prednisolone (1 mg per 1 kg of body weight p.o.) in order to avoid adverse reactions.Cancel prednisolone should be accompanied by the addition of Diclofenac in order to consolidate the anti-inflammatory effect.Some cardiologists practicing the use of hormonal pulsterapii, but due to lack of data on the effectiveness of this method of treatment, it can not be regarded as a classic version of the treatment of rheumatic heart disease.
In the active phase of rheumatic heart disease, there can be no question of the application of surgical treatment, which is shown only after the formation of a heart defect in remission rheumatism.Currently cardio practice proves the effectiveness of vulvoloplastiki as a means of eliminating cardiohemodynamic violations.
Breakout type of rheumatic heart disease is subject to the application of the same amount of medication as the primary lesion of the heart with the addition of drugs symptomatic orientation.When signs of congestive heart failure character appropriate to use diuretics (Lasix in a daily dose of 80 mg), cardiac glycosides (digoxin average daily dose of 1 g), ACE inhibitors (Enap 5 mg in the morning).
As preventive measures that prevent recurrence of rheumatic heart disease, should be considered timely sanitation of chronic foci of infection, as a means of preventing the spread of streptococcal infection.