I. Rheumatic
Acute Rheumatic Fever:
It is a febrile disease that often affects the heart and joints, causing permanent damage to the heart and leading to consequences that may lead to surgery. . Findings:
1. Fire,
2. Migratory pain, swelling, redness and warmth in the joints;
3. Symptoms such as inflammation in the heart, damage to the heart valves, heart failure, resulting weakness, fatigue, palpitations.
4. Involuntary movements such as various tics in arms, legs and face.
5. Non-itchy rashes like waves on the skin.
Although its other effects are insignificant and temporary, its effect on the heart valves is the most dangerous and can cause lifelong permanent malfunctions.
Etiology (Cause):
Bacteria called Beta hemolytic streptococcus, which grows in the throat and causes angina, may be the cause of rheumatic fever. However, not everyone who grows this bacteria in their throat will get rheumatic fever. However, 1-2% of patients with angina develop rheumatic fever. Some constitutional characteristics that may vary from person to person also play a role in the development of the disease. Some people can be carriers and have streptococcus in their throat without being sick. These types of patients are called carriers and if there are no signs of inflammation, treatment is not necessary.
The disease is not contagious. However, bacteria called streptococcus, which cause rheumatic fever and throat inflammation, are contagious.
Although there is no definitive evidence about genetic transmission (heredity), it can be seen more frequently in some families.
Diagnosis:
Mostly children between the ages of 5-15 get this disease. It is very rare outside these ages. Since the possibility of recurrence is common in children who have previously had rheumatism, they can also be caught again over the age of 15. For this reason, a person who has had rheumatism once must be protected with depot penicillin.
Streptococcus growth in the throat does not mean rheumatism. Only some of the patients (about 3-5%) whose strep throat is not well treated and who are prone to this disease suffer from rheumatism.
Common but wrong among the public Another well-known issue is the ASO value. Elevated ASO indicates that a streptococcal infection has been experienced only in the last few months. It is useful if there are symptoms of rheumatism. A high ASO alone without other symptoms does not mean anything. But unfortunately, many patients can be diagnosed with rheumatism and given unnecessary treatments just because the ASO level is high, without looking at other symptoms and valuable laboratory findings.
Should every leg pain in children be suspicious of Rheumatic Fever?
Leg pain is common, especially in children who do sports or are very active, when they come home in the evening. Pain, especially in the calf or behind the knee, is harmless and can be relieved by rest or massage. If there is pain at night along with fever and it is not gone in the morning, if there is difficulty in moving, if there are any symptoms such as swelling, redness and warmth in the joint, rheumatism should be considered.
Does Rheumatic Fever cause valve rheumatism?
No, rheumatic fever can affect not only the joints but also the heart. Or even if it only affects the joints for the first time, if it recurs, it can also affect the heart. For this reason, preventing the recurrence of the disease is much easier and more effortless than treating it, as it can prevent heart failure.
What is Rheumatism of the Heart?
It is the dysfunction seen in the valves and heart due to the damage caused by rheumatism in the heart and valves. For example, in people suffering from rheumatism, at first, the valves fail to close properly, that is, blood leakage, but after many years, symptoms of valve thickness and stenosis begin. In fact, in some patients, symptoms of cardiac rheumatism may appear in middle age due to very mild rheumatism in childhood. This is called silent rheumatism of the heart.
Can one get Rheumatic Fever more than once?
Yes, the probability of getting this disease again is quite high. In fact, those who are caught once have a much higher chance of being caught again than those who are never caught. For this reason, these patients must be depilated every 3 weeks against the risk of recurrence. It should be protected by taking penicillin. Because each recurrence of rheumatism causes more and more damage to the valves of the heart, and the valves may even need to be replaced with surgery. This is an expensive and serious surgery. Even the best artificial valve never works as well as one's own valve. After valve replacement, it is necessary to constantly use medication to protect the valve from germs and to prevent clots from forming in the valve. Therefore it is best; Early diagnosis, good treatment and prevention of recurrences.
How Can Rheumatic Fever Recurrence Be Prevented?
1. Depot penicillin injections (such as penadur and depocillin) should be administered regularly every 3 weeks.
2. If there are symptoms of throat inflammation such as fever, sore throat, difficulty in swallowing, you should be taken to a pediatrician immediately and the inflammation should be treated.
3. If there are signs of recurrence of rheumatism, your doctor should be consulted immediately.
4. The necessary checks should never be interrupted. The purpose of the checks is to notice the changes early and take precautions.
Within a few weeks following the fever and sore throat, pain in the joints, swelling, redness, headache, nausea, vomiting, weakness, easy fatigue. Symptoms such as shortness of breath and palpitations may be observed. When one or more of these are observed, the possibility of rheumatism recurrence should be investigated.
Follow-up:
According to the severity of the valve problem in patients with heart rheumatism, 6- A check-up is required every 12 months, or every 1-2 years if you only have rheumatism.
TREATMENT:
Bed Rest:
Sick and tired The work of the heart is reduced by rest, allowing it to heal more quickly and without damage. In cases of severe heart inflammation, at the beginning of the disease, the child must meet even his food and toilet needs in his bed or be carried to the toilet. As the disease improves, you can gradually return to normal daily movements according to your doctor's recommendations. During bed rest, pillows should be placed under the patient's head and back if there is shortness of breath. Resting longer than recommended is also undesirable.
U Long-Acting Penicillins:
They prevent the recurrence of rheumatic fever by preventing the bacteria that cause rheumatic fever from growing in the throat. Although it can sometimes be done every 4 weeks, it is better to have it done every 3 weeks. Because the effectiveness of the drug decreases in the 4th week, its protective effect also decreases. Therefore, in order not to leave anything to chance, having long-acting penicillin administered every 3 weeks provides more guaranteed protection. The period of using depot penicillin is up to the age of 20 for patients who have only had joint rheumatism or mild heart rheumatism but whose valves have fully recovered. It is recommended that patients who have had cardiac rheumatism and have permanent damage to the valves use depot penicillin for life.
CAUTION: If symptoms such as skin redness, red rashes, itching, swelling occur after taking penicillin, immediately go to the nearest hospital. You should go to a doctor. In case of rare but serious allergic problems such as anaphylaxis, you should have depot penicillin administered in a hospital with a fully-equipped emergency unit and wait there for about 30 minutes after the procedure, in case you develop an allergy.
Aspirin:
Although Aspirin is an old medicine, it is still indispensable for many diseases and rheumatism. However, it is necessary to be careful when using it, be aware of its side effects and be careful. It can irritate the stomach and cause pain, burning and sourness in the stomach. Therefore, it is more appropriate to take it on a full stomach. If it still causes complaints, it can be taken with milk or antacid drugs such as Talcid and Rennie when necessary.
CAUTION!.. Tinnitus, nausea, vomiting, headache, bruises in places on the body. In case of black poop or bleeding from anywhere (such as nosebleed), the medication should be discontinued and the doctor should be informed. If you develop chickenpox while using aspirin or come into contact with someone who has chickenpox, the medicine should be stopped immediately and the doctor should be informed.
Cortisone:
It is the most effective medicine for heart rheumatism. While taking the medication, facial swelling, weight gain, increased appetite, cracked skin, and increased body hair may occur. These types of effects will disappear when the drug is stopped. Also Cortisone can cause blood pressure to rise because it causes salt and water retention in the body. To prevent this, as little salt as possible should be eaten while taking cortisone. (It can be eaten with normal salt after cortisone is completely stopped.) It should be taken on a full stomach, even with some milk, as it may cause pain, burning and sourness in the stomach. Cortisone should never be stopped suddenly. When discontinued, it should be tapered according to your doctor's recommendation. Sudden interruptions are very harmful.
II. Infectious
Myocarditis (Inflammation of the myocardium muscle layer)
It is inflammation and necrosis of myocardin due to various factors. Acute and chronic Coxsackie B virus myocarditis is a typical example (accounting for 50%).
Diagnosis:
Depending on age, whether it is acute or chronic, and the immune response of the person, conditions ranging from asymptomatic to chronic myocarditis + dilated cardiomyopathy can be seen. While it progresses very slowly and rapidly in newborns, diagnosis is made only when cardiomyopathy develops in infants and toddlers.
In a newborn with Coxsackie B:
Fever, tachycardia, Gallop rhythm, cyanosis, ashen skin (a sign of shock), respiratory distress, severe heart failure and hepatomegaly are present. On examination, heart sounds are deep, there are signs of acidosis, and a mitral regurgitation murmur can be heard at the apex.
Older Child / Adult with Coxsackie B:
Fever, Palpitations, There are chest pain, signs of influenza infection, gallop rhythm, dysrhythmia, signs of heart failure, and signs of mitral and tricuspid regurgitation. Tele and ECG findings are the same.
Diagnosis:
Sedimentation is high, heart enzymes (SGOT, CK MB band, LDH) and Coxsackievirus IgM are high, and especially Coxsackievirus IgM is high for 5-10 years. can stay. Diagnosis is supported by heart enlargement, valve insufficiency and contraction defect of the heart muscle in echocardiographic examinations. Definitive diagnosis is made by endomyocardial biopsy (removing a piece of the heart muscle).
Treatment:
Bed rest, oxygen, monitoring (sudden death may occur), drugs that strengthen the contraction of the heart muscle, diuretics. , fluid/salt restriction is required. If there is arrhythmia, antiarrhythmic / (rhythm regulating drugs)&n
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