Primary rheumatic heart disease

As noted, the primary rheumatic heart disease is observed in acute, sub-acute, protracted and latent variants of flow rheumatism, while the last two are usually determines the clinical picture of the disease. With the exception of rare cases of acute rheumatism, when dominated by the effects of arthritis or horei in children.
Expressed carditis usually found in acute and subacute during rheumatism. The clinic expressed carditis defines a diffuse inflammatory defeat one, two or all three of the shells of the heart (pancarditis). Primary rheumatic heart disease usually lacks subjective symptoms of involvement in the rheumatic process heart, but often marked shortness of breath with the movements, heart rate, and in the presence of pericarditis is characterized by pain. An objective examination found tachycardia, not corresponding to the reaction temperature, more rarely aetiology, moderate hypotension, percutere is defined by a distinct increase in the left or in both sides of the borders of the heart. Auscultation and FCG reveal the sometimes considerable muting tone, and on the FCG define mitigation and / or deformation of the first tone, the emergence of systolic (high frequency), less mediatormessage noise at the apex of the heart, pathological III and IV colours with the emergence protohistorical and presistolic rhythms gallop. Of particular diagnostic value has the appearance protohistorical aortic noise, noise, pericardial friction, x-ray and ECG symptoms of pericardial effusion.
Characteristic expressed carditis on the EKG is violation of the functions of excitability, slowing AV conduction, the lengthening of the electric systole, a violation of the processes of depolarization, change atrial complex. According to polycardiography, clearly violated the contractile function of the heart.
As indicated earlier, clinical, radiological, electricity and phonocardiographic signs of inflammatory disorders of the myocardium in patients with severe carditis not only distinct, but moving in the background Antirheumatic therapy.
Here is the observation sharply pronounced primary carditis.

Patient R., 19 years old, was admitted to the clinic of the Institute of rheumatism AMS of the USSR 1 /XII 1975 with complaints of acute pains in the knee and ankle joints, weakness. Sick with 26/XI, when after the transferred in late October of angina and subsequent cooling an acute pain and swelling in the knee, ankle joints, accompanied by fever. Objectively when entering a state of moderate severity. The body temperature of 38.5°N Position in bed enforced because of the expressed pain, swelling of the knee and ankle joints. Cardiac complaints does not show. Pulse 100 beats per minute, rhythmic, satisfactory filling. Blood pressure 110/70 mm RT. senior Percutere is determined by moderate increases in heart borders left and right. Muffled heart sounds, III tone at Botkin, accent and splitting II tone of the pulmonary artery. The top soft systolic murmur, self more intensive systolic murmur in the pulmonary artery. The data of x-ray examination: heart increased in all directions, the spherical form, retrocediendo and retrosternal space moderately narrowed; contrastirovania the esophagus has a rectilinear direction; ripple Ochsen. ECG-rhythm 80 per minute, PQ 0,24 with, QRS 0,09 C. the Vertical position of the electrical axis of heart, AV blockade of I degree, the violation vnutribruchinno conductivity. FCG: the colours reduced amplitude, especially I; weak systolic murmur at the top. At all points summation registers tone. The accent of II tone of the pulmonary artery.
Blood tests for admission: Нb 99 g/l, L. 9,8·103 in 1 mm; ESR 59 mm/h; total protein 69 g/l, globulins: A2= 15,7%; u=22,3%; fibrinogen 8.6 g/l, hexose 1.6 g/l, seromucoid 0,435 g/l, With RB + +, SLA 313 units, VDR 500 units, ASC 1200 units, streptococcal antigen 1 :20. Urine analysis - protein once 0.375 g/l (fever proteinuria).
Treatment: prednisolone 25 mg / day with a gradual reduction of the dose (in the course of 630 mg), acetylsalicylic acid 3 g / day; penicillin 1 500 000 IU a day for 10 days.
Body temperature dropped to normal on day 2, the General condition improved quickly, but arthritis completely disappeared only to the 10-th day, and arthralgia, myalgia was nearly 6 weeks. The 10-th day from the start of treatment clearly increased the sonorous tones, disappeared tachycardia and summation gallop rhythm, milder and shorter became systolic murmur. ECG interval P-Q declined to 0.19 C. When an x-ray examination detected a reduction in the size of heart. In the blood - normalization of parameters of inflammatory activity. Remained elevated VDR (330 units) and ASC (800 units), streptococcal antigen 1 :20. Issued 28/1, the 65-th day from the beginning of the disease, in satisfactory condition.
Diagnosis: rheumatism primary, active phase (III activity), polyarthritis, myocarditis (pronounced); But.
During his stay in the hospital during the clinical picture is dominated symptoms of myocarditis, clearly obnarujivaetsya dynamic clinical, radiological, electricity and phonocardiographic research.

  • Moderate rheumatic heart disease