PENYAKIT JANTUNG

REMATIK
DR.dr.Prambudi Rukmono, SpAK
FK Malahayati
Unversitas Malahayati
 PENDAHULUAN

• Masalah kesehatan utama pada anak dan dewasa muda di

negara berkembang
• Tahun 1994,
• 12 juta pts. Rheumatic Fever dan Rheumatic Heart Disease di
seluruh dunia
• 3 juta pts CHF memerlukan perawatan rumah sakit
• Sebagian besar pasien CHF karena rheuma , 5–10 tahun
kemudian memerlukan cardiac valve surgery
• Angka mortalitas RHD :
• 0.5 per 100 000 populasi di Denmark
• 1.8 per 100 000 populasi di Amerika
• 7.6 per 100 000 populasi di Asia Tenggara.
• 8.2 per 100 000 populasi di China
WHO Expert Consultation, Geneva,2004
 EPIDEMIOLOGI

• umur : 5 – 15 tahun
• Sex : Tak ada predileksi
• Gen : Pernah dilaporkan ada hubungan dengan
II HLA antigens ( kulit hitam : DR2,
kulit putih DR4 in whites, Asia : DQW2)
• Environmental : poor living condition,
overcrowded

1. Report of a WHO Expert Consultation Geneva 10 October – 1 November 2001.World Health Organization. Geneva 2004.
2. Fuster V, Alexander RW, O’Rourke RA. Acute Rheumatic Fever in Hurst the Heart 10th ed. New York: Mc GrawHill. 2001.
3. Calleja HB, Guzman SV,eds. Rheumatic Fever And Rheumatic Heart Disease. Phillipine Foundation for the prevention and
Control of Rheumatic Fever/Rheumatic Heart Disease. Manila. 2001.
 PATOGENESIS
PATOGENESIS
Struktur group A beta hemolytic streptococcus

Capsule

Cell wall

Protein antigens

Group carbohydrate

Peptidoglycan

Cyto.membrane

Cytoplasm

induces antibody response in victim which result in autoimmune

damage to heart (pancarditis), sub cutaneous tissue, tendons,
joints & basal ganglia of brain.
 Demam Rematik

Definisi : reaksi peradangan

yang disebabkan oleh kuman
betha streptococcus
hemoliticus, meliputi berbagai
organ ( antara lain jantung,
persendian, sistem saraf
pusat,kulit dan jaringan
subcutan.

1. Fuster V, Alexander RW, O’Rourke RA. Acute Rheumatic Fever in Hurst the
Heart 10th ed.
2. Calleja HB, Guzman SV,eds. Rheumatic Fever And Rheumatic Heart Disease.
The aetiopathogenic events occurring during the development of carditis
 DIAGNOSIS DEMAM REMATIK

Report of a WHO Expert Consultation Geneva 10 October – 1 November 2001.

World Health Organization. Geneva 2004
Report of a WHO Expert Consultation Geneva 10 October – 1 November 2001.
World Health Organization. Geneva 2004
 Jones Criteria (Revised) for Guidance in the
Diagnosis of Rheumatic Fever*
Major Manifestation Minor Supporting Evidence
Manifestations of Streptococal Infection
Carditis Clinical Laboratory
Polyarthritis Previous Acute phase
Chorea rheumatic reactants: Increased Titer of Anti-
Erythema Marginatum fever or Erythrocyte Streptococcal Antibodies ASO
Subcutaneous Nodules rheumatic sedimentation (anti-streptolysin O),
heart disease rate, others
Arthralgia C-reactive Positive Throat Culture
Fever protein, for Group A Streptococcus
leukocytosis Recent Scarlet Fever
Prolonged P-
R interval

*The presence of two major criteria, or of one major and two minor criteria, indicates
a high probability of acute rheumatic fever, if supported by evidence of Group A
streptococcal nfection.

Recommendations of the American Heart Association

STEP I: Primary Prevention of Rheumatic Fever
(Treatment of Streptococcal Tonsillopharyngitis)
Agent Dose Mode Duration
Benzathine penicillin G 600 000 U for patients Intramuscular Once
27 kg (60 lb)
1 200 000 U for patients >27 kg
or
Penicillin V Children: 250 mg 2-3 times daily Oral 10 d
(phenoxymethyl penicillin) Adolescents and adults:
500 mg 2-3 times daily
For individuals allergic to penicillin
Erythromycin: 20-40 mg/kg/d 2-4 times daily Oral 10 d
Estolate (maximum 1 g/d)

or
Ethylsuccinate 40 mg/kg/d 2-4 times daily Oral 10 d
(maximum 1 g/d)
Recommendations of American Heart Association
Step II: Anti inflammatory treatment
Clinical condition Drugs
Arthritis only Aspirin 75-100
mg/kg/day,give as 4
divided doses for 6
weeks
(Attain a blood level 20-
30 mg/dl)
Carditis Prednisolone 2-2.5
mg/kg/day, give as two
divided doses for 2
weeks
Taper over 2 weeks &
while tapering add
Aspirin 75 mg/kg/day
for 2 weeks.
Continue aspirin alone
100 mg/kg/day for
another 4 weeks
3.Step III: Supportive management &
management of complications

• Bed rest
• Treatment of congestive cardiac failure:
-digitalis,diuretics
• Treatment of chorea:
-diazepam or haloperidol
• Rest to joints & supportive splinting
Duration of Secondary Rheumatic Fever
Prophylaxis
Category
Rheumatic fever with carditis and
residual heart disease
(persistent valvar disease*)
Duration
At least 10 y since last
episode and at least until
age 40 y, sometimes lifelong
prophylaxis

Rheumatic fever with carditis 10 y or well into adulthood,

but no residual heart disease whichever is longer
(no valvar disease*)

Rheumatic fever without carditis 5 y or until age 21 y,

whichever is longer

*Clinical or echocardiographic
Recommendations of evidence.
American Heart Association