Rheumatic fever heart disease

Outlined by the Department of cluster B A hemolytic streptococcus caused recurring non-suppurative inflammation, can occur in all parts of the body collagen organizations, especially the heart and joints most features. After the acute attack, if spread to the heart will lead to significant heart valve damage, as rheumatic valvular heart disease. The disease occurs mainly in winter and spring, cold, damp and crowded conditions, age of 5 ~ in over 15 years, Recurrence more after the initial three-five years. ① cardiac examination generally increased with temperature disproportionate tachycardia, heart sounds apex of the first decline in diastolic Benma law. II apex above the level of the high systolic murmur whole term and may have a soft, The low-key short-diastolic murmur (Carey-Coombs murmur); ② the end of the lung may appear small wetlands rales signs such as heart failure; ③ Some pericardial friction sound, accompanied by pleural friction sound; ④ joints red, swelling, restricted activities; ⑤ minority patients in the trunk or limbs can be seen on the inside skin erythema pink ring, Central pale; in the extensor joints, particularly elbow, knee and wrist joints, chest or occipital areas. lumbar vertebrae and other departments can see two-5mm size of the subcutaneous nodules, no tenderness, and skin adhesion, Mobile; ⑥ children can be seen hand-foot-Unconscious uncoordinated movements, gestures, such as chorea performance; ⑦ outside the heart of rheumatoid performance : have pleurisy, pneumonia, peritonitis, nephritis, vasculitis, encephalopathy performance. In recent years annular erythema, skin nodules, chorea rare. Clinical manifestations carditis, multiple migratory arthritis, skin annular erythema, nodules and other chorea. Prior to the onset of a three-week, half of patients with acute tonsillitis, pharyngitis, and other upper respiratory tract infection or scarlet fever history. Diagnostic ask whether patients with "flu", fever, fatigue, skin rash, family living environment; Availability palpitations, chest tightness, chest pain; availability of large joints ache, was migrans. ① auxiliary Streptococcus positive throat culture; ② Antistreptolysin O (ASO) ≥ 500u or anti-DNase "200,000 u / L, erythrocyte sedimentation rate (ESR) faster, C-reactive protein (CRP) positive; blood may show mild anemia, leukocytes and neutrophils increased proportion; ③ electrocardiogram (ECG) : atrioventricular block, extra, AF, Sinus tachycardia, P-R interval prolongation, ST-T changes : myocardial injury ST segment depression, acute pericarditis Camponotus arise downward ST segment elevation; ④ X-ray : a big heart. Pericardial effusion was flask heart can change; ⑤ B - (UCG) : Visibility ventricular enlargement, to reduce the rate of myocardial beat, pericardial cavity can be seen on dark area; ⑥ isotope myocardial tomography (ECT) : myocardial was piebald changes, ventricular enlargement. Typical diagnostic criteria above (mainly) manifestations have two or one, if coupled with the past suffered from rheumatic fever or rheumatic heart disease. arthritis, fever, faster ESR, CRP positive, leukocytosis, P-R interval prolongation, ST-T changes Q-T extended or arrhythmias were two, highly suspicious of acute rheumatic fever. When both ASO and anti-DNase increased recently suffered from scarlet fever, A throat culture found many positive Streptococcus cluster can be diagnosed. The three checks rheumatoid judgment : When ASO increased ESR and CRP and negative, it indicates a streptococcus infection, or recovery of rheumatic fever; When ESR, CRP increased, but normal ASO, and consider any other infection; If the three were positive, Rheumatoid is suggested; Rheumatic fever with right heart failure at the ESR can be normal, but still positive CRP; If the three were negative, were mostly ruled out active rheumatic fever, but does not do so. Chronic rheumatic valvular heart disease, the diagnosis of rheumatoid activities should watch over one of the following : mild anemia, Sinus tachycardia, joint pain, increased ASO and / or ESR, CRP increased. The changing nature of the original noise, or the emergence of new pathologic murmur. The newly emerged no obvious incentive to increase the heart or heart failure. Intractable heart failure, digitalis poisoning easy preparation. Emerging serious arrhythmia. ESR normal heart failure, congestive heart failure or corrected after surgery may exclude other causes of elevated ESR. For valve bioprosthesis or balloon angioplasty after a two-year also appeared more obvious valve stenosis. Rheumatic fever appeared outside the heart performance. Diagnostic Antirheumatic illness after treatment significantly improved. Differential diagnosis should be noted with infective endocarditis, viral myocarditis, rheumatoid arthritis, Poncet syndrome, acute suppurative arthritis, post-streptococcal infection, connective tissue disease identification. Treatment of rheumatic fever cardiac involvement should absolutely bed rest and hospitalization. Antibiotics kill Streptococcus election, the high sensitivity of antibiotics, such as penicillin 4000000 8000000 u ~ u, VD, a / d, 10 ~ 14 consecutive days, then 800,000 u, im, 2 / d. When ASO normal, long-acting formulations with benzyl - penicillin 1.2 million u, im, a / d, shared five years, Application to children 16 years of age; Salicylic acid formulations : Choice aspirin, adult 4 ~ 6g / d, Pediatric 100 ~ 150mg/kg body weight, three-four times immediately after a meal served to alleviate gastrointestinal symptoms, necessary services aluminum hydroxide gel. Even serve three-six months, reduction to 2g / d, to a sustained; Adrenal cortical hormones : Hyperthermia may arise when the pine Hydrocortisone 100 mg +100 ml liquid, VD, a / d, temperature control after the switch to 30-40mg of prednisone, a / morning, oral, two weeks after the reductions, every three days by 2.5 mg, up to 5 mg, 1 / 23, with eight consecutive weeks after withdrawal. When complete control of rheumatoid activities, myocarditis patients still have two weeks to rest before gradually increasing the volume of activities.