acquired heart disease

1. Aparna Sunilkumar Sulekha
Group 6

2. Acquired Heart Diseases
Acute Rheumatic Fever
Kawasaki Disease
Infective Endocarditis
Myocarditis
Pericarditis
Cardiomyopathy

3. Rheumatic Fever
 Rheumatic fever is an inflammatory disease
that occurs after infection of pharynx with
group A B-hemolytic streptococcus.
 It affect the heart, joints, brain, cutaneous and
subcutaneous tissues
 Cardiac valve damage (referred to as
rheumatic heart disease) is the most
significant complication of RF.
 The mitral valve is most often affected.
 It is most common in children 6 to 15 years
old.

4. CLINICAL MANIFESTATIONS
 Joint Pain-migrating Polyarthritis
 Carditis – (50%) chest pain , dyspnea , palpitation
pericarditis myocarditis ,valvulitis( MR,AF,HF)
 Subcutaneous Nodule- Collagen collection- found mc in hands,
wrist elbows and knee
 Erythema marginatum – non itchy rash
 Sydenham’s Chorea – Involuntary jerky muscle movement
Mc- in face and limbs
Major Jones Criteria
Minor Jones Criteria
 CRP Increased > 3mg/Dl
 Arthralgia- joint stiffness
 ESR >60mm/H
 Prolonged PR Interval
 Leukocytosis
1 major and 2 minor, or 2
major with evidence of
recent group A
streptococcal disease
strongly suggest the acute
rheumatic fever.

5.  Ecg -1° Av Block Most Commonly
2°/3° Blocks Possible
 Chest X Ray- congestion, cardiomegaly
 Throat Culture
 Serology-anti Streptolysin O, Anti Deoxyribonuclease B
 Echocardiogram – Effusion , valvular Dysfunction
DIAGNOSIS
 Bed rest 2-6 weeks(till inflammation subsided)
 Antibiotics-benzathine Benzylpenicillin / Oral Erythromycin
 Cardiac Medication-ace, Diuretics
 Chorea-carbamazepine, Valproic Acid
Treatment

6. Kawasaki disease
 Kawasaki syndrome, is an acute febrile vasculitis syndrome of early
childhood.
 It is an autoimmune disease in which the medium sized blood vessels
throughout the body become inflamed.
 It is largely seen in children under five years of age.
Signs and Symptom

7. Diagnosis
Treatment
IV Immunoglobulins
Aspirin -Continued For 4-6 Weeks
Steroids
infliximab (Anti Tnf α)

8. INFECTIVE ENDOCARDITIS
Infective endocarditis- Microbial infection of the heart valves or the mural
endocardium
It consist a mass of platelets, fibrin, microcolonies of microorganisms, and
scant inflammatory cells
Most frequently - 45 & 65 years of age, male>female
MC left sided infection(80-90%),
Right sided (10-20%) – Intravenous drug abusers
Causative Organisms
Staphylococcus Aureus
Streptococcus Viridans
Coagulase-Negative Staphylococcus
Streptococcus Bovis
Enterococcus
Fungal (Candida species)

9. CLINICAL FINDINGS
Splinter hemorrhages Roth spots Janeway lesions
non painful
Osler’s nodes, painful

10. Diagnosis
 Blood Culture
 Echocardiography- Transthoracic echo –
most accurate
-
Transoesophageal echo
 CBC- Anaemia
Leucocytosis
Elevated ESR
 Urine analysis – Microscopic haematuria
 Chest X-ray- Nodular infilterates
Penicillin +/- aminoglycoside
Ceftriaxone alone
Vancomycin +/- aminoglycoside
Flucloxacillin +/- aminoglycoside
Surgical Therapy

11. Acute pericarditis
Acute pericarditis is painful inflammation of the pericardium, the fluid-filled pouch surrounding
your heart
The pain usually gets worse when you’re lying down or when you breathe in.
Common:- Viral: Coxsackie B-
Acute MI
Less common:- Uraemia
Malignant disease-Trauma (blunt chest injury)
Connective tissue disease (SLE)
Rare:Bacterial infection
Rheumatic fever
TB
Etiology

12. Chest pain - pleuritic pain aggravated by change position, deep inspiration, coughing or swallowing.
Dyspnea
General symptoms:- Fever, sweating, chills
Signs:- Tachycardia- Rapid respiratory rate
Atrial arrhythmias
Clinical features
Chest X-ray
ECG:- elevation of ST segments,
flattening of T waves.
Bed rest
Salicylates 2-6 gm/day
Severe cases:- Anti inflammatory drugs
indomethacin 100-200 mg/day
ibuprofen 600-1600 mg/day
Colchicine 2-6 mg/day
Surgical treatment: Aspiration of the pericardium , Drainage of the pericardiumS

13. Myocarditis
Acute or chronic inflammation of the myocardium is characterized by inflammatory cell infiltrates,
myocyte necrosis, or myocyte degeneration .
The most common etiology are viral infections , others like: myocardial toxins, drug exposures,
hypersensitivity reactions, and immune disorders may also lead to myocarditis
Viral :Adenovirus ,Parvovirus, Coxsackievirus
Hepatitis C virus, Human immunodeficiency
Bacterial :Mycobacteria, Streptococcus spp.
Mycoplasma pneumoniae ,Treponema
pallidum
Fungal :Aspergillus Candida Coccidioides
Cryptococcus Histoplasma

14. Fever, respiratory distress, tachycardia, chest pain ,hypotension, gallop rhythm, and cardiac murmur
CHF.
Associated findings may include a rash or evidence of end organ involvement such as hepatitis or
aseptic meningitis
Clinical Manifestations
Electrocardiographic : sinus tachycardia, atrial or
ventricular arrhythmias, heart block, diminished QRS
voltages, and nonspecific ST and T-wave changes
CXR : cardiomegaly, pulmonary vascular prominence,
pulmonary edema, or pleural effusions.
Echocardiography : diminished ventricular systolic function,
cardiac chamber enlargement, mitral insufficiency, and
occasionally evidence of pericardial infusion
Endomyocardial biopsy: identifying inflammatory cell
infiltrates or myocyte damage and performing molecular
viral analysis using polymerase chain reaction (PCR)
techniques.
Systemic corticosteroid
ACE Inhibitor
Milrinone
Diuretics
Digoxin

15. Cardiomyopathy
Cardiomyopathy refers to conditions that affect the myocardium. Cardiomyopathy can make your
heart stiffen, enlarged or thickened and can cause scar tissue.