Pregnancy Complications Diagnosis
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Questions and Answers

What is a significant symptom experienced by Mrs. Dewi?

  • Vaginal bleeding
  • Shortness of breath on minor exertion (correct)
  • Severe ankle pain
  • Severe headaches

    • What is Mrs. Dewi's past medical history?

  • Diabetes and hypertension
  • Previously healthy and active (correct)
  • Rheumatic fever
  • Cardiovascular disease

    • Why was Mrs. Dewi's husband unable to return immediately?

  • He was on a medical emergency
  • He was on a long-distance drive
  • He was on a business trip
  • He was outstation on duty (correct)

    • What is Mrs. Dewi's occupation?

    <p>Housewife</p> Signup and view all the answers

    What is a probable diagnosis for Mrs. Dewi's condition?

    <p>Valvular heart disease</p> Signup and view all the answers

    What is a potential complication for Mrs. Dewi?

    <p>Cardiac complications</p> Signup and view all the answers

    What is a significant symptom of Mrs. Dewi's condition?

    <p>Coughing up pink frothy sputum</p> Signup and view all the answers

    How many previous babies has Mrs. Dewi had?

    <p>4</p> Signup and view all the answers

    What is a possible complication of Mrs. Dewi's condition for the fetus?

    <p>All of the above</p> Signup and view all the answers

    What is a risk factor for Mrs. Dewi's condition?

    <p>Multiparity</p> Signup and view all the answers

    What is a possible treatment option for Mrs. Dewi's condition?

    <p>All of the above</p> Signup and view all the answers

    What is a potential family history impact of Mrs. Dewi's condition?

    <p>Her children may be at risk of heart disease</p> Signup and view all the answers

    Which of the following is NOT a major criterion for the diagnosis of rheumatic fever?

    <p>Fever</p> Signup and view all the answers

    What is the most common age group affected by rheumatic fever?

    <p>5-14 years old</p> Signup and view all the answers

    What is the most common complication of rheumatic heart disease?

    <p>All of the above</p> Signup and view all the answers

    What is the primary cause of rheumatic heart disease?

    <p>Autoimmune reaction to Group A beta-hemolytic streptococcus</p> Signup and view all the answers

    What is the main diagnostic tool for detecting signs of rheumatic heart disease before symptoms appear?

    <p>Echocardiography</p> Signup and view all the answers

    What is the name of the test that detects the presence of Group A beta-hemolytic streptococcus?

    <p>Antistreptolysin O titre</p> Signup and view all the answers

    What is the characteristic feature of the mitral valve in chronic rheumatic heart disease?

    <p>All of the above</p> Signup and view all the answers

    What is the percentage of attacks that occur in adults?

    <p>20%</p> Signup and view all the answers

    Study Notes

    Case Presentation

    • 35-year-old Indian housewife, Mrs. Dewi, is 24 weeks pregnant and experiencing shortness of breath, fatigue, and bilateral ankle swelling over the past few weeks.
    • She felt her heart racing, severe shortness of breath, and coughed up pink frothy sputum on the day of admission to the hospital.

    Medical History

    • No known medical illness prior to pregnancy
    • History of sore throats as a child, but no specific history of rheumatic fever
    • Four previous pregnancies with no complications

    Rheumatic Heart Disease

    Pathophysiology

    • Caused by autoimmune reaction to Group A beta-hemolytic streptococcus (streptococcus pyogenes) resulting in valvular damage
    • Characterized by repeated inflammation with fibrinous repair
    • Cardinal anatomic changes of the valve: leaflet thickening, commisural fusion, and shortening and thickening of tendinous cords

    Signs and Symptoms

    • Migratory polyarthritis of the large joints
    • Pancarditis
    • Subcutaneous nodules
    • Erythema marginatum of the skin (non-itchy)
    • Sydenham chorea (neurologic disorder with involuntary rapid, purposeless movements)
    • Fever
    • Multiple painful joints
    • Heart involvement in half of the cases, usually in people between 5-14 years old

    Diagnosis

    • Auscultation – S1 snap
    • Echocardiography (more sensitive) to detect signs of rheumatic heart disease before obvious symptoms
    • Elevated antistreptolysin O titre or anti-DNase B to test for presence of GAS
    • Signs of preceding streptococcal infection: scarlet fever, raised ASOT or other streptococcal antibody titre, positive throat culture
    • Revised Jones criteria: diagnosis made when 2 major criteria, or one major criterion plus 2 minor criteria are present along with evidence of streptococcal infection

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    Description

    A pregnant woman experiencing shortness of breath, fatigue, and ankle swelling. Identify the underlying condition and recommend a course of action.

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