Rheumatism of the heart
Rheumatism of the heart is a serious chronic disease in which an inflammatory process that begins as a result of infection of the joints, covers the heart walls and entails disorganization of the connective tissue of the heart.
Causes of rheumatism of the heart
There are several reasons for the development of this disease:
- frequent and untreated infectious diseases of the nasopharynx( tonsillitis, chronic tonsillitis, chronic pharyngitis, etc.);
- infection with beta-hemolytic group A streptococcus;
- transferred scarlet fever;
- is a hereditary factor.
Some people have a predisposition of the body in the form of hyperreaction to streptococcal infection, which not only causes rheumatic fever, but also causes its exacerbations. There is the concept of "family" rheumatism of the heart, which is caused by a prolonged stay in the streptococcal environment and unfavorable living conditions, as well as the inherited polygenic predisposition to the disease.
Symptoms of rheumatism of the heart
Symptoms of rheumatism of the heart appear, as a rule, 1 to 2 weeks after a streptococcal infection. However, in some cases, the disease can take a long time to be practically not noticeable for the patient, progressing at a slow pace.
The most common manifestations of the disease include:
- general weakness, fatigue;
- severe joint pain;
- increased sweating;
- pallor of the skin;
- nasal bleeding;
- weight loss;
- lack of appetite;
- shortness of breath;
- increased body temperature.
Special attention is paid to such a symptom for rheumatism, as pain in the heart. These pains, as a rule, are pulling, pricking and often combined with rapid heart rate.
Heart defects in rheumatism
If the treatment is not started on time, it can lead to heart disease or articular deformities. Heart disease is a defect in the structure of the heart, leading to a malfunction of its normal functioning. Rheumatic heart defects often develop with repeated rheumatic attacks.
The most common rheumatism of the heart affects the mitral valve - the lumen is narrowing, or the valve starts to flow the blood in the wrong direction. The aortic and other valvular defects are less common.
It should be borne in mind that heart defects can not give symptoms for a long time and are detected only with thorough diagnosis.
Treatment of rheumatic heart
Rheumatism of the heart requires comprehensive treatment in a hospital environment, the main principles of which are:
- Bed rest - recommended for the entire treatment period. The subsequent restoration of physical activity must be slow.
- Compliance with diet: salt refusal, restriction of liquid and carbohydrates, sufficient intake of protein, potassium-containing products( dried apricots, buckwheat porridge, potatoes, etc.).
- Medication: administration of antibiotics, anti-inflammatory and vitamin preparations. In some cases, cardiac therapy is performed.
- Sanatorium treatment - recommended during the recovery period after treatment and in the future as supporting activities.
Treatment of rheumatic heart folk remedies
Traditional medicine suggests the use of medicinal plants for the treatment of this disease. Here are a few recipes:
- A tablespoon of collection from 10 g of buckthorn bark, 40 g of birch leaves and 50 g of willow bark pour a glass of boiling water. Insist for an hour, strain and take twice a day for a glass of infusion.
- Prepare a tincture of twigs of yellow acacia with leaves, fill 30 g of raw material 200 g of vodka. Infuse in a dark place for 10 days, then strain and take 20 drops three times a day, washing down with water.
- Take on an empty stomach juice from half a lemon, diluted with half hot water.
Rheumatism: symptoms, diagnosis, treatment
Rheumatism is an inflammation of the connective tissue with a predominant localization of the process in the cardiovascular system.
The development of rheumatism is closely related to the previous acute or chronic nasopharyngeal infection caused by streptococcus, directly or indirectly, by the damaging effect of its components and toxins on the body with the development of immune inflammation.
Antistreptococcal antibodies that cross-react with the tissues of the heart( molecular disguise) are responsible for the selective damage of the heart valves and myocardium with the development of immune aseptic inflammation.
An important role is assigned to genetic factors, which is confirmed by the more frequent incidence of children from families in which one of the parents suffers from rheumatism.
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Rheumatism is characterized by a variety of manifestations and variability of the flow. As a rule, it occurs at school age, less often in preschool children and practically does not occur in children under 3 years old.
- In typical cases, the first signs of rheumatism in the form of fever, signs of intoxication( fatigue, weakness, headache), joint pain and other manifestations of the disease are detected 2-3 weeks after sore throat or pharyngitis.
- One of the earliest signs of rheumatism is pain in joints, detected in 60-100% of cases( rheumatoid arthritis).
- Rheumatoid arthritis is characterized by acute onset, involvement of large or medium joints( often knee, ankle, elbow), rapid reverse development of the process.
- Symptoms of heart disease are defined in 70-85% of cases. Complaints of a cardiac nature( pain in the heart, palpitation, dyspnea) are noted with severe cardiac disorders.
- More often, especially at the beginning of the disease, there are various asthenic manifestations( lethargy, malaise, fatigue).
To rarer symptoms of rheumatism is the annular rash and rheumatic nodules.
Annular rash( annular erythema) - pale pink soft rashes in the form of a thin annular rim that does not rise above the surface of the skin and disappear when pressed. The rash is found in 7-10% of patients with rheumatism, mainly at the peak of the disease and is usually unstable.
Subcutaneous rheumatoid nodules are rounded, dense, inactive, painless, single or multiple formations with localization in the area of large and middle joints, spinous processes of the vertebrae, in the tendons. Currently, there are rare, mainly with severe rheumatism, remaining from a few days to 1-2 months.
Abdominal pain, damage to the lungs, kidneys, liver and other organs with rheumatism is currently very rare, mainly in severe its course.
Photo: ring-shaped eczema as a sign of rheumatism
ECG often shows irregularities in the rhythm.
Radiographically( in addition to not always expressed increase in the heart), signs of a decrease in the contractile function of the myocardium, a change in the configuration of the heart are determined.
Laboratory indicators in patients with rheumatism reflect the signs of streptococcal infection, the presence of inflammatory reactions and the immunopathological process.
The active phase is determined: leukocytosis with a shift to the left, an increase in ESR, often anemia;increased serumucoid, diphenylamine reaction;disproteinemia with hypergammaglobulinemia;increase of titers of ASG, ASLO, increase in immunoglobulins( Ig) of class A, M and G;C-reactive protein( CRP), circulating immune complexes, anticardial antibodies.
Treatment of rheumatism
Treatment of rheumatism is based on the early appointment of a comprehensive therapy aimed at suppressing streptococcal infection and the activity of the inflammatory process, as well as preventing the development or progression of heart disease.
The implementation of these programs is carried out on the basis of the sequence principle:
- Stage I - inpatient treatment,
- Stage II - aftercare at a local cardio-rheumatological sanatorium,
- Stage III - dispensary observation in a polyclinic.
1. At the first stage in the hospital, the patient is prescribed medicinal treatment, correction of nutrition and therapeutic exercise, which are determined individually taking into account the characteristics of the disease and, above all, the severity of the heart.
In connection with the streptococcal nature of rheumatism, treatment is carried out with penicillin.
- Antirheumatic therapy involves one of the non-steroidal anti-inflammatory drugs( NSAIDs), which is administered alone or in combination with hormones, depending on the indications.
- Antimicrobial therapy with penicillin is carried out for 10-14 days.
- In the presence of chronic tonsillitis, with frequent exacerbations of focal infection, the duration of treatment with penicillin is increased or additionally used by another antibiotic, amoxicillin, macrolides( azithromycin, roxithromycin, clarithromycin), cefuroxime axetil, and other cephalosporins in the age-related dosage.
- NSAIDs are used for at least 1-1.5 months until the signs of activity are eliminated.
- Prednisolone in the initial dose is prescribed for 10-14 days before the effect is obtained, then the daily dose is reduced by 2.5 mg every 5-7 days under the control of clinical and laboratory indicators, in the following the drug is canceled.
- The duration of treatment with quinoline preparations for rheumatism is from several months to 1-2 years and more, depending on the course of the disease.
In hospital conditions, the elimination of chronic foci of infection, in particular, the tonsillitis surgery, carried out 2-2.5 months after the onset of the disease, in the absence of signs of activity of the process, is also carried out.
2. The main task at the II stage is to achieve complete remission and restore the functional capacity of the cardiovascular system.
The sanatorium continues the therapy begun in the hospital, treats the foci of chronic infection, implements the appropriate treatment and health regime with differentiated motor activity, therapeutic physical training, hardening procedures.
3. The III stage of complex therapy of rheumatism provides for the prevention of relapse and disease progression.
To this end, penicillin preparations of prolonged action, mainly bicillin-5, are used, the first administration of which is carried out even during inpatient treatment, and then - once in 2-4 weeks all the year round.
Regularly, 2 times a year, an outpatient examination is carried out, including laboratory and instrumental methods;appoint the necessary recreational activities, therapeutic exercise.
For rheumatism without cardiac involvement, bicillin prophylaxis is carried out for 5 years after the last attack.
In the spring-autumn period, along with the introduction of bicillin, a monthly course of NSAIDs is shown.
Prevention of rheumatism is divided into primary and secondary.
Primary prevention is aimed at preventing rheumatism and includes:
1. Enhance immunity( hardening, alternation of exercise and rest, nutrition, etc.).2. Detection and treatment of acute and chronic streptococcal infection.3. Preventive measures in children predisposed to the development of rheumatism: from families in which there are cases of rheumatism or other rheumatic diseases;often with nasopharyngeal infection;having chronic tonsillitis or who underwent an acute streptococcal infection.
Secondary prevention is aimed at preventing recurrences and progression of the disease in patients with rheumatism in conditions of dispensary observation.
Forecast for rheumatism
Currently, with timely treatment, the primary lesion of the heart ends in recovery.
The formation of valvular heart disease, more often with the development of mitral insufficiency, is determined in 15-18% of cases in the first attack, mainly in severe, prolonged or latent course of the disease.
Diagnosis by symptoms
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Rheumatism of the heart
Rheumatism of the heart is a "folk" name for one of the serious complications of chronic tonsillitis. What is the essence of this disease, how dangerous is it and can it be avoided?
Rheumatism of the heart is a "household" name for a disease known as chronic rheumatic heart disease or rheumatic heart disease. Along with other manifestations of acute rheumatic fever, this pathology poses a serious threat to the health of the patient.
- · Rheumatism of the heart in most cases is combined with the defeat of other organs - skin, nervous system, joints. This complex of manifestations is formed in a disease called acute rheumatic fever( ORL).
- · Rheumatism of the heart itself is one of the variants of the outcome of the acute respiratory disease, but its danger forces it to separate into a separate disease
- · The onset of the disease is manifested by a sudden rise in temperature 2-3 weeks after the angina. In adults, it rarely reaches febrile digits( more than 38 degrees).
- · There may be pain in the large( most often knee) joints, characterized by a tendency to migrate( that is, it hurts not in one particular place, but "here and there").Sometimes this is the only symptom.
- · Then the symptoms of heart rheumatism arise:
- · shortness of breath;
- · Neurological disorders are almost never detected in adult patients.
- · The main cause of rheumatism of the heart is the presence of a chronic foci of inflammation in the tonsils, the causative agent of which is beta-hemolytic streptococcus.
- · However, not every person who often has tonsillitis, this dangerous complication can arise. In order to start an acute rheumatic fever in the body, a combination of several factors is required:
- · the presence of a microbe;
- · certain external factors;
- · the genetic predisposition of the organism to autoimmune reactions( the microbe triggers an immune response mechanism in which the defenses of the body begin to mistakenly attack their own cells).
- · Based on one complaint, the diagnosis of rheumatism of the heart can not be set. After the doctor receives information about what is bothering the patient, he begins to examine it.
- · The first thing that is important when examining a patient is heart auscultation. It is with the help of a phonendoscope that reliable information can be obtained about the pathological process in this organ.
- · Previously, there were no organic noises arising from a sudden increase in temperature in young people - this is one of the most important criteria for diagnosing rheumatism of the heart.
- · An increase or decrease in the heart rate also indicates a pathological process.
- · Signs of heart failure( shortness of breath, the appearance of swelling) can occur with severe damage to all layers of the heart.
- · Already at this stage, with a careful analysis of all the symptoms, rheumatism of the heart is an almost indisputable diagnosis, however patients are most often referred for additional studies:
- · electrocardiography, which allows to detect and assess the degree of rhythm and conductivity disturbances;
- · phonocardiography is a kind of "advanced" version of auscultation, helping to more accurately detect extraneous noises in the heart;
- · Chest X-ray, which reveals signs of blood stagnation in the lungs and an increase in heart size;
- · two-dimensional echocardiography with Doppler technique, in which it is possible to detect abnormalities in the operation of the valve apparatus;
- · a general blood test in which an increase in the rate of erythrocyte sedimentation is detected;
- · a blood test for C-reactive protein, the growth of which is observed in any inflammation.
- · The physician's efforts in the case of rheumatism of the heart are directed to:
- · complete destruction of the pathogen;
- · With all forms of pathology, the patient is transferred to bed rest.
- · The diet should be enriched with proteins and vitamins, salt in case of severe disease is limited.
- · Beta-hemolytic streptococcus can be treated with penicillin. Phenoxymethylpenicillin and its analogs are the drugs of choice for rheumatism of the heart. If this group of drugs is intolerant, lincomycin and other antimicrobial agents may be prescribed.
- · Duplication of mild inflammation is performed with non-steroidal anti-inflammatory drugs - aspirin, diclofenac. In severe disease, the process is suppressed by corticosteroids - prednisolone.
- · Various cardiac agents, diuretics are used to combat heart failure.
- · In severe forms of heart rheumatism with damage to its valvular apparatus, a patient can undergo a surgical procedure for the plastic of the affected valve or for its prosthetics.
Complications and consequences of
- · In case of rheumatic heart disease, the lethal outcome is virtually excluded.
- · Nevertheless, pathology can cause some complications that can worsen the patient's quality of life:
- · valvular heart valve malformation;
- · stagnation in a small circle of circulation with the development of pulmonary problems;
- · chronic heart failure due to hemodynamic disorders in the heart chambers due to valvular defects.
- · Rheumatic fever can become recurrent, while carditis( inflammation of the heart) is a key manifestation of it.
- · The primary measure of prevention of rheumatism of the heart is careful suppression of activity and complete destruction of beta-hemolytic streptococcus in the foci of inflammation. For this, it follows:
- · timely treatment of dental caries;
- · carefully sanitize inflammation in the tonsils, pharynx.
- · Secondary prevention( prevention of recurrence in people who have already had an attack of rheumatic fever at least once) is to take special antibiotics from the penicillin group 1 time per month.
- · Antibiotic prophylaxis is performed:
- · for 10 years in patients whose valvular heart apparatus remained healthy;
- · for life - in patients with a defect, even if they underwent an operation to restore the affected valve or its prosthetics.
- · Rheumatism of the heart is a disease of a young age. The older the patient - the less often he has this pathology. In elderly people, heart disease has other causes, but not rheumatism.
- · All patients with heart lesions must undergo a control every six months in a rheumatologist and an echocardiogram.
- · Great physical exertion should be avoided - the amount of work must be agreed with the attending physician.
- · If any kind of fever occurs, swelling on the legs and shortness of breath, unexplained weakness should immediately consult a doctor.
Symptoms in children
- · More than half the case, the disease debuts in 2-3 weeks after the angina.
- · Suddenly, the patient rises to a fairly high temperature.
- · Simultaneously with this articular pain( most often in the knees), having a "volatile" character, that is not localized in one place, but shifting to different parts of the joint and even to other joints.
- · Almost immediately appear and manifestations of rheumatic heart disease in the form of dyspnea, palpitation, pain in the heart).
- · In the recurrence of acute rheumatic fever, usually only symptoms of carditis occur.
Rheumatism: heart and vascular problem
If joints hurt. ..
According to the established opinion, any pain in the joints is somehow connected with rheumatism. So they say: "My knees hurt, rheumatism has tortured me."With rheumatism joints really hurt. But most of all, rheumatism affects the heart and blood vessels. About that, in fact, rheumatism, in the interview to the newspaper "Expert Health" , cardiothoriatologist of the first category Yusupova Indira Khamitovna .
EZ: There is such a philistine idea that rheumatism is a disease of the musculoskeletal system, which comes with age. What is rheumatism?
- Physicians have such concepts as rheumatic fever and rheumatic heart disease. This is an autoimmune disease in which inflammation of the connective tissue occurs. Autoimmune processes are triggered by a transited angina caused by beta-hemolytic streptococcus A. Connective tissue exists everywhere, including in the vessels, in the inner shell of the heart, endocardium, valvular heart apparatus, and also in the skin and articular surfaces. There is rheumatism with heart disease, a common inflammatory reaction - fever, fever, weakness, joint pain and vasculitis - inflammation of the inner shell of the vessels. The degree of manifestation is different. Up to a stroke. Vessels are located everywhere, so vital organs are damaged, the brain, and the heart.
Inflammatory reaction in the kidneys leads to pyelonephritis. If there is a brain in the affected area, then it is chorea, large and small: involuntary movements, hyperkinesis. There can be changes on the part of the psyche, tearfulness, resentment, and involuntary movements of skeletal muscles and facial expressions. A child's disease can be perceived as wrong behavior. Everyone thinks that he imitates others, in fact it is a manifestation of the disease.
EZ: Rheumatism is a consequence of an infectious lesion?
- This is the result of an autoimmune reaction. Beta-hemolytic streptococci secretes toxins that damage the connective tissue of the organs. As a result, an autoimmune reaction develops. Its own tissue is perceived by the body as foreign and antibodies are being developed to it.
EZ: Which organs are most often affected by rheumatism?
- Heart, skin, large joints - knee, elbow, wrist.
How does rheumatism affect the heart, what exactly is changing in it? How to recognize the rheumatism of the heart? Gulbanu Suleimenova, 38 years old, Kyzylorda city
- Heart valves are affected. It manifests itself with pains, shortness of breath, palpitations. Palpitation is still the result of intoxication. If you make an ultrasound of the heart, then the prolapse of the mitral valve will be revealed, this is when the ligament becomes weak: the valve does not fully close and allows blood to flow. Over time, if the disease is not treated, mitral valve insufficiency manifests itself. In more severe cases, stenosis develops, this is when the valves become calcified, become sclerotized and stiff. There is a narrowing of the holes.
Is rheumatic heart disease treated? Svetlana Prodina, 45, Almaty, Kazakhstan
- Yes, she is being treated. Mainly antibiotics. The course of therapy - 1 month, then prevention. Non-steroidal anti-inflammatory drugs are used. Prevention is always done, once every 3 weeks, and exacerbations, of course, are treated with a minimum of 10 days or more.
How can I get rid of rheumatoid pain? Nadezhda Petrova, 48, Karaganda,
- Of course, it's difficult to get rid of the process when the process is already chronic. While the person is young enough, up to 40 years old, I believe that it is necessary to treat chronic inflammatory processes in the throat, but not with antibiotics, but also with plant preparations, with what nature gives.
Very often rheumatism affects the nervous system. Half of the strokes are caused by rheumatism. Often, the diagnosis of ischemic heart disease is actually an infection. Even if not beta-hemolytic streptococcus, but some other.
In ischemic heart disease, sclerosis of the coronary vessels occurs, a sclerotic plaque appears. Because of what it appears? Everyone says that because of a violation of fat metabolism, but we must understand that at first there was inflammation, then a scar appeared.
EZ: What is the difference between rheumatism in adults and children?
- I think that children have a more vivid clinic - a strong rheumatic fever in the initial stages. And in adults, rheumatic heart disease develops as a consequence of inflammation. In children, the immune system is still strong, so the process of resistance to the body of the disease is more pronounced. The older the person, the more hidden the processes, but each person has it differently. Some people react very brightly to any infection, while others do not get sick for a long time, and then they suffer a serious illness.
EZ: How can superfluous kilograms influence the development of rheumatism?
- The most direct way. There is a violation of metabolic processes, which contributes to the development of the disease. Therefore, you need to get rid of excess weight. Very much in this matter depends on whether the person is mobile or not.
EZ: What is the difference between rheumatoid arthritis and polyarthritis?
- Arthritis of rheumatic origin is much easier to proceed: volatile pain, no deformities, as in rheumatoid polyarthritis, during the course of the disease there is mainly an emphasis on the heart and on the vessels of the brain. Treatment, however, is the same: anti-inflammatory and antibacterial.
Among the causes of arthritis in the first place is also an infection. One reason is injury, for example, in athletes lifting weights. And with rheumatism there is no such gross damage to the joints. How can I treat swollen joints in my arms? Elena Nikiforova, 42, Kostanay
- The most important element of treatment is non-steroidal anti-inflammatory drugs. Radon natural sources also help. Sanatorium treatment can for a while remove the symptoms, some lack the effect of therapy for a year, and someone for three years. The result depends on several factors: what is the source, and what are the compensatory abilities of the organism. But it should be remembered that radon is harmful to the heart, so the bath should be taken with caution. In general, the sources must go young. For people of retirement age, this can be harmful to the health of the heart.
EZ: How to make sure that there is no rheumatism?
- It is unlikely to get rid of rheumatism. I believe that much depends on the environment. We have very bad air, because of the fumes, nasopharyngeal mucosa is burned, it becomes dry, easily vulnerable, permeable to any infection. Immunity, of course, suffers. If you live in an environmentally safe place, half of the rheumatic diseases will go by themselves. In addition, the patient should treat himself attentively, apply to a competent doctor, follow all the prescriptions carefully and regularly take preventive and curative courses. There is also a hereditary predisposition. If you have a sick mother or grandmother, then it is likely that you will also have rheumatism.
When diagnosed, doctors should always exclude rheumatism first. The problem is that until tissue damage occurs, the diagnosis is not made. Therefore, we must independently prevent the nasopharyngeal infectious diseases, be sure to monitor the state of the stomach and intestines, because this depends on the human immunity.
What physiotherapy procedures help with rheumatic pain? Serik Abdrakhmanov, 39, Astana, Kazakhstan
- Someone is helped by paraffin, he relieves pain for a while. During the illness, inflammation occurs, an autoimmune process, it must be interrupted. For this, it is necessary to take non-steroidal anti-inflammatory drugs, to conduct desensitizing therapy against allergies. And most importantly - the state of the throat. Even if you simply rinse with saline, you can get rid of half the infections and toxins.
EZ: What exactly do you recommend to gargle?
- Sea salt. It is necessary to make a very weak solution, because it dries: a glass of water contains half a teaspoon of salt. Rinse out enough once or twice a day.
EZ: What is usually done with heart disease in a neglected case?
- It all depends on which one is diagnosed with the defect. If this is decompensated stenosis of the mitral valve, then only surgery will help. If it is heart failure, rhythm disturbance, then valve prosthesis. And further - symptomatic treatment: taking drugs that prevent the formation of blood clots. And thrombi all the same will appear, because the prosthesis is a foreign body.
EZ: How can a person reliably determine if he has rheumatism or not? Is there a reliable diagnosis?
- Analyzes, of course, there are, and they are reliable, but you can not rely only on the results of analyzes. The doctor takes into account the symptoms of the disease, complaints of the patient. The fact is that the results of tests can be positive in a person who does not have rheumatism, and negative in a person who has rheumatism, and already in neglected form. That is, all blood tests, CRP, rheumatheros are not the main ones in diagnostics. The decisive criterion is the symptoms of rheumatic heart disease and polyarthritis. Another landmark is rheumatoid nodules and erythema on the skin, nodules subcutaneous.
If a person doubts if he has rheumatism or not, he should consult a trusted doctor, because the treatment process seriously affects the overall health: antibiotics destroy immunity, give an incentive for the growth of fungal microflora. Therefore, it is necessary to consult a doctor and be examined in order to dispel all doubts. Rheumatism must be treated, and the earlier, the better.