Rheumatic Heart Disease

Rheumatic fever, or Rheumatic Fever, is considered to be one of the diseases of the connective tissue immune system or colloid system. So far, the disease is still quite common in developing countries (including Vietnam) and is a leading cause of heart valve disease in young people. The disease is usually between 6-15 years old, but many cases occur in the 20s.
Why rheumatic heart?
Today, the cause of the disease has been found to be caused by streptococcal group A streptococcal infection (streptocuccus A). Therefore, rheumatic heart disease has now been reversed and is quite rare in developed countries

. In our country, we can also completely control the disease if we have good health education measures, the comprehensive development of nutritional hygiene as well as timely detection for low vaccination will limit progress. developing danger to the heart valves.
Rheumatic heart disease can progress quite quietly, but until a complication into the heart is discovered Nearly 50% of patients with valvular heart disease suffer from rheumatic heart disease without a history of joint pain.




The strong link between pharyngitis and rheumatic fever has been known since 1930. The evidence is a clear increase in streptolysin O streptococcal antibody in the serum of patients with rheumatic heart disease. In addition, the apparent effectiveness of antibiotics in preventing rheumatism is one of the supporting evidence for the mechanism.
Rheumatic heart disease is not caused directly by streptococcus but by immune mechanisms. Typically, after about 3 weeks of respiratory infections in patients with new symptoms of low heart. Another aspect is that rheumatic heart disease rarely occurs in patients under 5 years of age, when the immune system is not complete, the cross-reactivity of the body is not effective enough to cause low heart. The antigen layer is the proteins M, T and R in the outer shell of streptococcus A which are the most important factors causing cross-reactivity with the body Because the body has produced antibodies against proteins in the connective tissue organizations of the body, which have a risk-polymerization feature with bacterial proteins.



Of these, the M protein is not only immune-specific, but also the most potent low-causing factor. About 3% of patients with Group A streptococcal infection who do not receive adequate treatment will develop rheumatic heart disease, and about 50% of patients will have recurrent rheumatic heart disease. Skin streptococcal infection usually rarely causes low heart.
How to know it?
Signs of heart inflammation
Inflammation of the heart is a severe pathological manifestation of rheumatic and quite specific. Approximately 41-83% of rheumatoid patients present with heart inflammation. Manifestations of heart inflammation may include endocarditis, pericarditis, and myocarditis. Heart inflammation may range from asymptomatic to signs of severe heart failure or death. The possible clinical symptoms are: increased heart rate, systolic murmur, heart enlargement, arrhythmia, palpitations, heart failure .



.. Heart failure is less common in the acute stage, but if encountered Dill is severe and due to myocarditis. One of the most noticeable and serious complications of rheumatoid arthritis is valvular heart disease. Mitral valve opening is one of the most common manifestations, while aortic valve regurgitation is less common and is often accompanied by mitral regurgitation. Pericarditis can cause chest pain, pericardial rub, heart palpitations.
Arthritis
Arthritis is the most common manifestation of rheumatism (80%) but is less specific. Symptoms of arthritis are swelling, heat, redness, and joint pain.



Often occurs in large joints (knees, ankles, wrists, elbows, shoulders, etc.) and is movable. Arthritis responds very well to aspirin within 48 hours. If in the case of giving adequate aspirin and within 48 hours of arthritis does not improve, you must think of other causes than rheumatic heart. Rheumatoid arthritis usually leaves no sequelae.
Sydeham dance
This is a manifestation of extrapyramidal lesions and is quite specific for rheumatic heart disease. Manifestations are aimless movements and involuntary movements in the facial muscles, limbs, decreased muscle tone, and disturbance. The initial manifestations may be difficult to write, difficult to speak or walk.



These manifestations are usually apparent when the patient is touched or awakened and disappears when the patient sleeps. Sydeham is one of the late manifestations of rheumatic heart disease, which usually occurs about 3 months after an upper respiratory infection. Sydeham's chorea usually presents as solitary in the lower heart and occurs in about 30%. This symptom usually goes away after 2-3 months. Need differential diagnosis with a number of other conditions such as, convulsive reactions in some diseases, epilepsy, behavioral disorders.
Note under the skin
These are nodules with a diameter of about 0.5-2 cm, hard, painless, mobile and often appear right on the big joints or around joints. Nodular nodules can be encountered in about 20% of patients with rheumatic heart disease and usually disappear after a few days.



The skin on this nodule usually remains normal and does not show any signs of inflammation.
Erythema marginatum (erythema marginatum): This is a type of rash on the skin of patients with pink and pale in the middle of the barbell.

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