Rheumatic Heart Diseases

Dwi Kustriyanti
STIKes Karya Husada Semarang
Topik kita hari ini

• Definisi dan diagnosis

• Patofisiologi
• Pendekatan pengkajian pencegahan
diagnosis dan management RHD
Anatomi Jantung
Kelainan Katub Jantung
 What is
rheumatic heart disease?
 Overview of RHD
• RHD merupakan suatu penyakit sistemik
terjadi setelah infeksi Streptococcus beta
hemolyticus group A (pada saluran
pernafasan bagian atas
• Disebabkan oleh episode berulang dr
Acute Rheumatic Fever dimana jantung
sudah meradang
• Kerusakan katub (Mitral dan aorta)
What is RHD?
Example age timeline (years)

5 10 13 15 16

Membutuhkan
Heart
Heart failure medications.
mulai Biasanya, perlu
berkembang. operasi katub.
Katup bocor: Pasien mgk
ruang jantung mengalami
melar. Blocked gejala spt sesak
valves: otot napas.
Katub rusak jantung kerja
and berparut. keras
Mgk memompa
menyebabkan darah
kebocoran,
ARF blockage, or
episodes keduanya.
membuat
katub
inflamasi.
 Further RHD progress
Example age timeline (years)

16 21 21 28 30

Katub yg
berparut atau
Terlalu banyak dioperasi
warfarin rawan td
menyebabkan infeksi
Jika haemorrhage.,
menggunakan (endocarditis).
bahkan stroke. Ini bisa fatal.
katub metal, or Ini jg bisa fatal.
jantung
Next surgical menjadi
step may be fibrillasi, maka
valve pasien perlu
replacement. warfarin
First treatment
surgical
step may
be valve
repair
 Which valves are affected?
Katub Mitral terpengaruh >90% dr kasus RHD
Mitral regurgitasi sering ditemukan pada anak &remaja
Mitral stenosis menunjukkan chronic disease berkelanjutan, biasanya
pada dewasa
Mayoritas komplikasi mitral stenosis biasanya atrial fibrillasi

Katub Aortic selanjutnya yg terpengaruh

Sering muncul dengan penyakit katub mitral.
Stenosis cenderung berkembang sebagai komplikas jangka panjang
dari aortic regurgitasi

Tricuspid and pulmonary valves biasanya paling sedikit

terpengaruh
Biasanya terpengaruh pd RHD berat jika semua katub rusak
 Signs and symptoms
• Symptoms of RHD may not develop for many years
– A murmur but no symptoms suggests mild or moderate disease
Patients may not realize they need medical help; may think symptoms
are normal
– Symptoms usually suggest more severe disease
• Symptoms tergantung type and keparahan penyakit, ex;.
– Sesak napas saat aktifitas atau berbaring
– Bangun malam merasa sesak
– Kelelahan
– Pembengkakan kaik(peripheral oedema)
– Palpitasi jika atrial fibrillasi atau masalah ritme lain
• Sudden onset of symptoms may occur
– New ARF episode with carditis
– pregnancy / labour
– rupture of valve cord
 Pathofisology
of rheumatic heart disease
PATHOPHYSIOLOGY

• 0.3-3% kasus, infeksi menyebabkan

rheumatic fever bbrp minggu setelah sore
throat teratasi.
• Organisme menyebar mll cairan oral atau
sal pernapasan.
• Pasien tetap terinfeksi selama bbrp
minggu setelah resolusi gejala pharyngitis
& menjadi reservoir yg dpt menginfeksi
orang lain.
• Group A Streptococcus adl gram-positive coccus
yang berkoloni di kulit & oropharynx. organism ini
mgk menyebabkan suppurative disease, spt
pharyngitis, impetigo, cellulitis, myositis,
pneumonia, and puerperal sepsis.
• Juga berhubungan dg nonsuppurative disease, spt
rheumatic fever dan acute poststreptococcal
glomerulonephritis.
• Group A streptococci mengurai racun cytolytic
streptolysins S and O.
• Streptolysin O menginduksi titer antibody jd tinggi
sebagai tanda infeksi streptococcal dan ini mrp
nonsuppurative complications
• Rheumatic fever berkembang pd anak & remaja
diikuti pharyngitis dengan group A beta-
hemolytic Streptococcus
• Organisms menyerang sel epithelial dr saluran
pernapasan atas & memproduksi batterai
enzymesyang merusak & menginvasi jaringan.
• Setelah masa intubasi 2-4 hari, organisme yg
menyerang menyebabkan respon acute
inflammasi dengan 3-5 hari sore throat, fever,
malaise, headache, peningkatan jumlah
leukocyte
 Acute rheumatic heart disease menyebabkan
pancarditis characterized spt endocarditis,
myocarditis, and pericarditis.
 Endocarditis dimanifestasikan sbg valve
insufficiency.
 The mitral valve sering terjadi sekitar (65-70%
of patients), and the aortic valve is second in
frequency (25%).
 The tricuspid valve is deformed in only 10% of
patients and is almost always associated with
mitral and aortic lesions.
 The pulmonary valve is rarely affected.
 Diagnosis
of rheumatic heart disease
Diagnosis of RHD – key principles

• History and examination are still very

important!
• Access to echocardiography
• Access to specialist opinion
How is RHD diagnosed?

• Using echocardiography
(ultrasound of heart)
• Required for
– anyone who has had ARF
– anyone in high risk group with a murmur even if they never had
known ARF
– for investigation of breathlessness etc
• RHD needs to be detected early, before symptoms start
• Listening to the heart with the stethoscope is not accurate
– RHD can be present even when you can’t hear a murmur
 Pengkajian yang dibutuhkan

• Electrocardiogram (ECG)
– To check rhythm, evidence of hypertrophy etc
 Pengkajian yang dibutuhkan

• Chest X-ray (CXR)

– To check heart size
– To identify cardiac failure (pulmonary congestion)
 Pengkajian yang dibutuhkan

• Echocardiography
– Identifikasi kerusakan katub jantung
– Mengukur tingkat keparahan penyakit
– monitor progress
• Assign severity grade
Classification Criteria

Priority 1 – SEVERE Severe valve disease on echo

Or
Moderate disease on echo with symptoms
Or
Valve repair or replacement
Priority 2 – MODERATE Moderate valve lesion on echo without symptoms
Priority 3 – MILD Mild valvular lesion or ARF without RHD
 Acute valvulitis

Acute valvulitis
Chronic RHD
Diagnosis of acute valvulitis
Diagnosis of chronic RHD
Valve appearance in RHD
 Management
of rheumatic heart disease
CARE PLANNING
 Ten-point management plan

1. Register with RHD program

2. Establish or continue secondary prophylaxis
3. Disease education and self-management support
4. Regular clinical review and echocardiogram
5. Regular dental care
6. Management of cardiac symptoms
7. Infective endocarditis prevention
8. Family planning
9. Well-planned surgery
10. Management of pregnancy
Basic care plan for Priority 3 (Mild) RHD
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