Disease Information for Rheumatic heart disease

Rheumatic heart disease refers to long term valvular disease [usually MS and AS] not specifically myocarditis or rheumatic fever, or bacterial endocarditis, although they may occur: Mitral stenosis: in temperate climates, a symptom-free period of 10 to 20 yr may follow recovery from rheumatic fever; symptoms of MS usually begin between ages 30 and 40; In tropical or subtropical countries, progression is swifter, often occurring in childhood; The first symptoms of MS are usually exertional dyspnea or fatigue; Frank pulmonary edema occurs with sudden elevations of left atrial pressure (eg, when uncontrolled atrial fibrillation produces too rapid a ventricular rate as an added insult to the loss of atrial contraction); Hemoptysis due to rupture of small pulmonary vessels and pulmonary edema is likely to occur with the increased blood volume in pregnancy; Emboli can occur in up to 15% of patients and are usually associated with atrial fibrillation but can occur in sinus rhythm; Left vocal cord paralysis (Ortner"s syndrome) can cause huskiness due to paralysis of the left recurrent laryngeal nerve, which is compressed when a dilated left atrium presses it against a dilated pulmonary artery; Significant MS is often found in patients with minimal or no symptoms; Lack of symptoms may, however, be due to subconscious modification of lifestyle; A plum-colored malar flush (mitral facies) is seen only with low CO and severe pulmonary hypertension; Left parasternal sustained movement may be significant (grade 2 to 4) due to RV hypertrophy and dilation or to a normal RV held against the sternum by a large left atrium; The S1 at the apex and the S2 may be palpable; -----------------------------------Aortic Stenosis: The classic triad of symptoms is syncope, angina, and dyspnea on exertion; If syncope occurs on exertion, it is considered to be due to fixed CO (inability to increase CO on exertion) and represents severe AS; Syncope may, however, be due to ventricular fibrillation unrelated to exertion

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