RHD is permanent heart valve damage caused by repeated attacks of Rheumatic Fever, which occurs after Streptococcal throat infection.
- Most Commonly Affected Valve: Mitral Valve (Followed by Aortic Valve).
- Mnemonic: "RHD = Repeated Heart Damage"
CAUSES & RISK
FACTORS OF RHD
1. Non-Modifiable
(Cannot Be Changed)
• Genetics → Family history increases risk.
• Young Age (5-15 years) → Most common in children.
• Poor Hygiene & Overcrowding → Common in developing
countries.
Mnemonic: "Y-G-O" (Young Age, Genetics, Overcrowding)
2. Modifiable
(Can Be Controlled)
• Untreated Strep Throat Infection (Most Important Cause).
• Poor Access to Medical Care (Lack of Treatment for Strep Throat).
Mnemonic: "S.P." (Strep Throat, Poor Medical Care)
HOW RHD DEVELOPS?
(PATHOPHYSIOLOGY)
- Step 1: Strep Throat Infection → Immune System Attacks Heart, Joints, Brain & Skin (Autoimmune Reaction).
- Step 2: Acute Rheumatic Fever (ARF) → Inflammation of Heart, Joints, Skin, Brain.
- Step 3: Repeated Attacks → Permanent Valve Damage (RHD).
Mnemonic: "S.A.R." (Strep → Acute RF → RHD)
SYMPTOMS OF
RHEUMATIC FEVER (J♥NES Criteria)
• Major Symptoms (J♥NES Criteria):
- Joint Pain (Polyarthritis – Migratory Joint Pain).
- ♥ Carditis (Heart Inflammation – Murmurs, Heart Failure).
- Nodules (Small, Painless Lumps on Joints & Spine).
- Erythema Marginatum (Red, Ring-Shaped Rash).
- Sydenham’s Chorea (Jerky, Uncontrolled Movements).
Mnemonic: "J♥NES" (Joints, Heart, Nodules, Erythema, Sydenham’s Chorea)
• Minor Symptoms:
- Fever, Raised
ESR, CRP
- Prolonged PR Interval on ECG
Diagnosis: 2 Major OR 1 Major + 2 Minor + Strep Evidence (ASO Test).
SYMPTOMS OF RHEUMATIC
HEART DISEASE
• Due to Valve Damage (Mostly Mitral & Aortic Valve):
- Breathlessness (Dyspnea, Worse on
Exertion).
- Palpitations (Irregular Heartbeat).
- Chest Pain & Fatigue.
- Swelling in Legs (Heart Failure Sign).
Mnemonic: "B.P.C.S." (Breathless, Palpitations, Chest Pain, Swelling)
INVESTIGATIONS
FOR RHD
Blood Tests:
- ASO Titre (Antistreptolysin O Test) →
Confirms Past Strep Infection.
- ESR & CRP (Inflammation Markers).
ECG:
- Prolonged PR Interval (Suggests Heart
Inflammation).
Echocardiography (ECHO – Best Test!)
- Detects Valve Damage & Heart
Enlargement.
Chest X-ray:
- Shows Enlarged Heart & Pulmonary
Congestion (If Severe).
Mnemonic: "A-E-E-C" (ASO, ESR, ECHO, Chest X-ray)
TREATMENT OF
RHEUMATIC HEART DISEASE
1. TREATMENT OF
ACUTE RHEUMATIC FEVER
- Bed Rest (Reduce Heart Stress).
- Aspirin (Reduces Joint Inflammation).
- Steroids (For Severe Carditis).
- Antibiotics (To Kill Strep – Penicillin Injection).
Mnemonic: "B.A.S.A." (Bed Rest, Aspirin, Steroids, Antibiotics)
2. LONG-TERM
MANAGEMENT OF RHD
- Lifelong Antibiotic Prophylaxis (To Prevent Strep Throat).
- Diuretics & Beta-Blockers (If Heart Failure Develops).
- Heart Surgery (Valve Repair or Replacement – If Severe Damage).
Mnemonic: "P.D.S." (Penicillin, Diuretics, Surgery)
COMPLICATIONS OF
RHD
• Severe Valve Damage → Heart Failure.
• Arrhythmias (Irregular Heartbeats → Atrial Fibrillation).
• Stroke (Due to Clot Formation in Atrial Fibrillation).
Mnemonic: "H.A.S." (Heart Failure, Arrhythmia, Stroke)
PREVENTION OF
RHEUMATIC HEART DISEASE
- Early Treatment of Strep Throat (Penicillin).
- Regular Antibiotics (For Those With History of RF).
- Improve Hygiene & Living Conditions.
Mnemonic: "T.A.I." (Treat Strep, Antibiotics, Improve Hygiene)
FINAL REVISION WITH MNEMONICS
- Definition = "RHD = Repeated Heart Damage"
- Causes = "Y-G-O" (Young Age, Genetics, Overcrowding) & "S.P." (Strep Throat, Poor Medical Care)
- Pathophysiology = "S.A.R." (Strep → Acute RF → RHD)
- Symptoms of Rheumatic Fever = "J♥NES" (Joints, Heart, Nodules, Erythema, Sydenham’s Chorea)
- Symptoms of RHD = "B.P.C.S." (Breathless, Palpitations, Chest Pain, Swelling)
- Diagnosis = "A-E-E-C" (ASO, ESR, ECHO, Chest X-ray)
- Treatment of Acute RF = "B.A.S.A." (Bed Rest, Aspirin, Steroids, Antibiotics)
- Long-Term Treatment of RHD = "P.D.S." (Penicillin, Diuretics, Surgery)
- Complications = "H.A.S." (Heart Failure, Arrhythmia, Stroke)
- Prevention = "T.A.I." (Treat Strep, Antibiotics, Improve Hygiene)