Rheumatic Heart Disease Overview

Rheumatic Heart Disease (RHD)

• Inflammatory response from rheumatic fever damages heart valves permanently.
• Rheumatic fever is an acute, inflammatory disease affecting multiple systems, often triggered by group A streptococcal pharyngitis.
• Chronic, progressive damage to heart valves remains after acute rheumatic fever.
• Heart inflammation, valve stretching/scarring, and disrupted blood flow are key issues.
• Often first diagnosed during or shortly after pregnancy.

Pathophysiology

• Rheumatic fever and recurrent streptococcal infections can trigger cross-immune responses.
• Autoimmunity is implicated in this process.
• Rheumatic inflammation affecting cardiac tissue, including the valve leaflets, can occur.
• Fibrous thickening, valve stenosis, and regurgitation can result from this inflammation.

Assessment and Risk Factors

• Full history and physical examination are crucial.
• Risk factors include reduced left ventricle systolic function, severe valve stenosis, history of heart failure, symptomatic previous valve disease, high poverty/limited access to care.
• Symptoms include chest pain, heart palpitations, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, edema, and syncope.

Complications During Pregnancy

• Mitral valve stenosis, cardiac arrhythmias, and heart failure can be complication of RHD.
• Special management is recommended during pregnancy, often at a specialized referral center that includes specialized cardiology and intensive care.
• Pregnant women with RHD need careful monitoring and management by a cardiologist and obstetrician.

Gestational Diabetes Mellitus (GDM)

• Characterized by higher-than-expected blood sugars during pregnancy.
• Glucose intolerance arises, and insulin and blood glucose level regulation struggles initially during pregnancy.
• Associated with risk factors such as obesity, history of large babies, history of unexplained fetal/perinatal loss, and family history of diabetes.
• Pregnant women with GDM require close monitoring and tailored management including diet, exercise, monitoring, and medication if necessary.

Substance Abuse

• Substance abuse involves using illegal or inappropriate legal drugs to temporarily change mood or avoid reality.
• This often progresses to behavioral/psychological dependence.
• Common substances abused include alcohol, illicit drugs (heroin, cocaine, marijuana, hallucinogens, and inhalants), and potentially other controlled medications.
• Misuse can damage developing fetuses, cause premature birth, low birth weights, and other birth defects.
• Maternal risks associated with substance use during pregnancy include miscarriage, stillbirth, and increased risk of other complications.

HIV/AIDS

• Human Immunodeficiency Virus (HIV) weakens the immune system, increasing risk for infections.
• Affects T-cells (lymphocytes), leading to a compromised immune system.
• Acquired Immune Deficiency Syndrome (AIDS) develops from HIV.
• Characterized by a deficiency of CD4+ cells, leading to increased susceptibility to opportunistic infections.
• Diagnosed progressively based on medical tests & the extent of immune system damage.
• Progression to AIDS is indicated by certain diseases.
• Several opportunistic infections are common with weakened immune systems.
• Treatment often involves antiretroviral therapy (ART).

Rh Sensitization

• Rh incompatibility arises when a pregnant woman is Rh negative and the fetus is Rh positive.
• Maternal antibodies can attack fetal red blood cells, leading to severe complications for the fetus.
• Prevention involves administering RhoGAM to prevent antibody formation.
• Routine prenatal screening and testing to manage pregnancy complications associated with antibodies.

Anemia in Pregnancy

• Anemia is low red blood cell count, impacting oxygen delivery.
• Iron-deficiency anemia (IDA) is common and caused by iron insufficiency.
• Folate and vitamin B12 deficiencies can also cause anemia.
• Increased blood volume related to pregnancy and dietary needs necessitates iron and vitamin supplementation for a healthy pregnancy.
• Anemia in pregnancy can result in serious complications in both mother and baby.