Dr. Ch. Venkat Kumar Raju, Dr. R Krishna Kumar, Dr. C Jayakumar
Amrita Institute of Medical sciences
Fourteen year old female from Tirunelveli presented with complaints of breathing difficulty since 2 years. Child noticed breathing difficulty when she was playing with her peers. Which was gradually progressing.
After a year she had dyspnea even climbing a plight of stairs. With these complaints she was evaluated and was diagnosed to have a heart disease. Child was brought to our hospital for further evaluation and management
No history of joint pain in the past and not on any regular medications
h/o Palpitations during dyspnea+
H/o Sore throat and fever 2 months prior to the illness
H/o hospital admission 1 month prior, due to fever
No h/o edema, cough, abdominal distention or other signs of heart failure
Child afebrile , alert active
CVS examination- Apical impulse seen lateral to MCL at 6 intercoastal space, on palpation it hyper dynamic and non heaving type.
On auscultation child has an Opening snap with MDM at left parasternal border, No thrill, no radiation , no other murmurs heard
At this point our D/D were
1) Rhuematic Heart Disease
2) Cardiomyopathy (Dilated or Hypertrophic)
3Congenital heart disease with or with out shunt
4)Mitral valve prolapse
5)Myocarditis
6)SLE with heart disease
On examination
CXR showed cardiomegaly and straightening of left heart border
ECG done, showed Right axis deviation, Normal rhythm, Biatrial enlargement
ECHO done showed
Rheumatic Mitral stenosis
Severe thickening of Anterior Mitral leaflet and posterior mitral leaflet
Severe Sub valvular deformation
Moderate Mitral regurgitation
To conform the diagnosis ASO titer done which was 400 IU (<200IU is normal)
Child was initially stabilized in cardiac ICU. Anti failure medications were added, surgery was planned on review
Child was discharged on Inj Benzathine 12 lakhs penicillin (her weight is 35kg ), Deep Im every 3 weeks, Tab prednisone, Tab Aldactone, furosemide, metoprolol, and digoxin
Prophylaxis is planned to continue till 21 years of age
Rheumatic Heart disease
Prevention
Effective early intervention can prevent premature mortality from rheumatic heart disease.
There are three levels of prevention for rheumatic heart disease: reducing the risk factors for rheumatic fever (primordial prevention); primary prevention of rheumatic fever and rheumatic heart disease; and secondary prevention (prophylaxis) of rheumatic fever and rheumatic heart disease.
Primordial prevention aims to avoid episodes of strep throat tackling poverty, improving living and housing standards, and increasing access to health care.
Primary prevention of rheumatic fever can be achieved through the effective treatment of strep throat with appropriate antibiotics (penicillin).
Secondary prophylaxis: Once a patient has been identified as having had rheumatic fever, it is important to prevent additional streptococcal infections as this could cause a further episode of rheumatic fever and additional damage to the heart valves. The strategy to prevent additional streptococcal infection is to treat a patient with antibiotics over a long period of time. The antibiotic treatment that is most effective in preventing further infection is benzathine penicillin G, which is given intramuscular injection every 3-4 weeks over many years.