the prevention of rheumatic fever and rheumatic heart …：风湿热、风湿性心脏病预防…

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1、RheumaticFeverandRheumaticHeartDiseaseDR.ABDULGHAFFARMEMONAssociateProfessorCardiologyLUMHSHYD/JAMSHOROLearningObjectives:TounderstandthepathogenesisofacuterheumaticfeverandrheumaticheartdiseaseToappreciatetheburdenofdiseaseTorecognizethefeaturesofastreptococcalsorethroa

2、tToknowthetreatmentregimensofastreptococcalsorethroatTobeawareofsecondarypreventionmeasuresPerformanceObjectives:ExaminetheburdenofdiseasewithinowncommunitiesTimelyrecognitionofastreptococcalsorethroatwithcorrecttreatmentInstitutesecondarypreventionprogrammeJointheglobal

3、communityfightingRheumaticfeverandrheumaticheartdiseaseWhatistheincidenceofacuterheumaticfeverandrheumaticheartdisease?EpidemiologyARFisadiseaseofchildagegroup6–15yrs.ARFuncommon<5yrs.Andrecurrenceveryrareafter34yrs.Pharyngitis80%viral20%bacterial15%GABHS5%otherbact..3–3

4、%ARFIncidenceofARF:Population-basedStudiesWhatistheprevalenceofrheumaticheartdisease?Pathobiologyagenthostenviron-ment-GABHS->100subtypeofMproteinHeart-myosinHeartvalve-lamininSynovia-vimentinSkin-keratinBrain-lysoganglioside-Extentofimmuneresponsetopharyngitis-Geneticsu

5、sceptibility-PriorhistoryofRF-Overcrowding-lowsocioeconomicstatusCarapetis.Lancet2005;366:155Whatisthepathogenesisofacuterheumaticfever?ACUTERHEUMATICFEVERAutoimmuneconsequenceofinfectionwithGroupAstreptococcalinfectionResultsinageneralisedinflammatoryresponseaffectingbr

6、ains,joints,skin,subcutaneoustissuesandtheheart.ACUTERHEUMATICFEVERTheclinicalpresentationcanbevagueanddifficulttodiagnose.CurrentlythemodifiedDuckett-Jonescriteriaformthebasisofthediagnosisofthecondition.RHEUMATICHEARTDISEASERheumaticHeartDiseaseisthepermanentheartvalve

7、damageresultingfromoneormoreattacksofARF.Itisthoughtthat40-60%ofpatientswithARFwillgoontodevelopingRHD.RHEUMATICHEARTDISEASEThecommonestvalvesaffectingarethemitralandaortic,inthatorder.Howeverallfourvalvescanbeaffected.RHEUMATICHEARTDISEASESadly,RHDcangoundetectedwiththe

8、resultthatpatientspresentwithdebilitatingheartfailure.Atthisstagesurgeryistheonlypossibletreatmentoptio