MAGEZI

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RHEUMATIC HEART DISEASE

Posted by SAMUEL ISABIRYE on February 5, 2013 at 4:55 PM

A valvular complication of rheumatic fever.

 

The valves commonly involved are:

 

z

Mitral valves leading to stenosis, incompetence

or both

 

z

Aortic valve leading to stenosis and incompetence

 

Cause

 

z

As for acute rheumatic fever

 

Clinical features

 

z

Heart failure

 

z

Arrythmias

 

z

Thromboembolic problems eg. stroke

 

z

Palpitations

 

z

Heart murmurs depending on valves affected and

nature of effect caused

 

z

The patient may be asymptomatic and the

valvular lesion discovered as an incidental finding

 

z

Increased cardiac demand as in pregnancy and

anaemia may lead to congestive cardiac failure

as a presentation

 

UCG 2010

207

 

 

 

9. Cardiovascular diseases

Differential diagnosis

 

z

Other causes of cardiac failure

 

Investigations

 

¾

Chest X-ray

¾

ECG where available

¾

Echocardiography

 

Management

 

f

Treat heart failure if present

 

f

benzathine penicillin 2.4 MU IM once monthly

or phenoxymethylpenicillin (Penicillin V)

750mg every day

 

Child:

 

f

benzathine penicillin <30kg: 0.6 MU once

monthly

>30kg: 1.2 MU once monthly

-

continue either medicine up to 30 years of

age

-

If allergic to penicillin give

erythromycin 250 mg per day

 

 

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