rheumatic heart disease
Introduction
Introduction to rheumatic heart disease Rheumatic heart disease (rheumatic heart disease) referred to as rheumatic heart disease refers to heart disease caused by rheumatic fever activity involving the heart valve. There are one or several stenosis and/or regurgitation in the mitral, tricuspid, and aortic valves. In the early stage of the disease, there are often no obvious symptoms. In the later stage, the performance of heart function decompensation such as palpitation, shortness of breath, fatigue, cough, lower extremity edema, and coughing pink foam sputum. The disease occurs mostly in winter and spring, cold, humid and crowded environment, the initial age is more than 5-15 years old, and the recurrence is more than 3-5 years after the initial onset. Rheumatic heart disease is a partial manifestation of allergic reactions caused by group A hemolytic streptococcus infection, and belongs to autoimmune diseases. Pathological changes in the heart mainly occur in the heart valve. The mitral valve is the most common site of involvement. Valvular lesions, whether stenotic, incomplete or coexisting, require surgical treatment in the presence of significant clinical symptoms, repair or replacement of the diseased valve. basic knowledge Sickness ratio: 0.05% Susceptible people: mostly occur in teenagers Mode of infection: non-infectious Complications: arrhythmia Infective endocarditis Heart failure
Cause
Causes of rheumatic heart disease
Streptococcus (25%):
Streptococcus is a very common pathogenic bacterium, and the bacteria in the ball are arranged in chains, usually in the respiratory tract. This kind of bacteria is in a balanced situation with the human body in normal times, and it is hidden like an undercover, which is also the cause of rheumatic heart disease.
Second-hand smoke (12%):
Second-hand smoke is particularly damaging to people. When inhaled second-hand smoke for more than 30 minutes, the risk of heart disease is 26% higher than the average person. So please don't smoke, and don't be around the smokers.
Mental factors (10%):
Excessive mental stress is one of the most common causes of rheumatic heart disease. A stressful friend needs to meditate for 20 minutes every day, or do something that he feels relaxed, thus reducing his inner anxiety.
Resistance decreased (28%):
The reproduction of ordinary bacteria and the resistance of the human body are in a delicate balance. When the resistance is strong, no adverse symptoms will occur. When the cold, cold, fatigue and other factors lead to the decline of the body's resistance, the streptococci at this time is in an active period, from latent to proliferating, and many toxic substances in the human body.
Prevention
Rheumatic heart disease prevention
1. Taking medicine: It is necessary to take some medicines on time in the early postoperative period, mainly anticoagulants and cardiac diuretics. Replacing the biological valve requires taking low-intensity anticoagulant therapy for aspirin in the first half of the year, and replacing the mechanical valve requires taking anticoagulant drugs for life.
2. Lifestyle: Pay attention to maintaining good living habits, staying up late and avoiding fatigue.
3. Prevention of infection: usually exercise properly, enhance physical fitness, prevent cold and other respiratory inflammation, if you have periodontitis, ulceration, urinary tract infection. You should seek medical advice promptly, and take the initiative to explain to the doctor that you have undergone heart valve surgery and accurately provide your current medication.
4. Seek medical treatment: Once you are not feeling well, you should take medication under the guidance of a doctor. Do not use drugs such as cold medicines and antibiotics.
Complication
Rheumatic heart disease complications Complications arrhythmia infective endocarditis heart failure
Common complications
Patients with rheumatic heart disease are prone to respiratory infections, which show a decrease in resistance and are prone to cold symptoms. Mainly on the basis of pulmonary congestion, it is easy to combine bacterial infection and aggravate heart failure. At the same time, patients with rheumatic heart disease may experience exertional flusteredness, shortness of breath, decreased physical tolerance, and a significant impact on quality of life. At the same time, there are the following major hazards:
1. Arrhythmia: that is, we often say "heart beat", the most common is heart tingling (atrial fibrillation), atrial fibrillation is the most common arrhythmia in rheumatic heart disease, the incidence rate is more than 50%, sometimes the first illness, It can also be the cause of the first dyspnea episode or the beginning of limited physical activity. Atrial fibrillation can lead to poor heart function, making the patient feel uncomfortable. The most important thing is that it may cause thrombosis in the atria.
2. Thromboembolism: A large left atrium with atrial fibrillation can easily lead to thrombosis, and thrombus shedding can cause embolism. Cerebral embolism can be aphasia; limb embolism causes ischemia and necrosis of the limb; deep vein thrombosis leads to pulmonary embolism.
3. Infective endocarditis: occurs in the early stage of valvular disease, bacteria attached to the surface of the valve leaflets, aggregated to form neoplasms, infected bacteria common streptococci, staphylococcus, enterococci and so on. Once infective endocarditis occurs, heart failure can be aggravated. At the same time, the neoplasms fall off and cause embolism
4. Heart failure: It is the main cause of death in rheumatic heart disease for late complications, accounting for 50-70%. Mainly manifested as cardiogenic dyscrasia, multiple organ dysfunction.
Symptom
Symptoms of rheumatic heart disease Common symptoms Heart aortic regurgitation palpitations Heart rhythm hops chops rupture end sitting ventricle tachycardia tired after chest pain appetite loss heart rate reserve reduction pulse
Clinically, according to the degree of progression of the disease, the main main performances are as follows:
1. After the activity, palpitations, shortness of breath, and even breathing difficulties, sitting breathing, not lying flat at night;
2. After a slight activity or fatigue, coughing, coughing and bloodshot, it is easy to catch a cold;
3. Loss of appetite, that is to say, eating for a period of time is not good, gastrointestinal bleeding may not be well digested, and stomach swelling. Reduced urine output, lower extremity edema, abdominal distension, ascites, liver and splenomegaly;
4. Most patients have two eyes and the lips are purple-red, that is, "mitral valve face";
5. The palpitations are often caused by atrial fibrillation or arrhythmia. Rapid atrial fibrillation causes the patient to feel uncomfortable, even breathing or making it worse, thus prompting the patient to seek medical treatment. Atrial fibrillation is also the main cause of atrial hemorrhage and even stroke.
6. Chest pain, chest pain caused by simple valvular disease is generally not effective with nitroglycerin.
Examine
Rheumatic heart disease examination
Auxiliary inspection
1. Doppler echocardiography: As a non-invasive method, it has been one of the main methods for evaluating each valvular lesion. It can not only measure the size of the heart chamber, ventricular function, but also measure the transvalvular pressure difference, the valve opening area, and the pulmonary artery. Indicators such as pressure.
2. X-ray examination: you can understand the heart size and lung changes.
3. Electrocardiogram: can determine the patient's heart rhythm, with or without myocardial ischemia, whether combined with atrial fibrillation.
4. Cardiovascular angiography: For some patients older than 45 years old, ECG suggests myocardial ischemia, and cardiovascular angiography can determine whether there is coronary artery disease.
Diagnosis
Diagnosis and diagnosis of rheumatic heart disease
Diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.
Disease diagnosis
Diagnosis of rheumatic valvular heart disease is easier based on the patient's medical history, clinical manifestations, signs, and echocardiography.
Differential diagnosis
Mainly infective endocarditis, valvular lesions caused by congenital dysplasia and senile valvular heart disease.
