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Acute Joint Rheumatism May Cause "Aortic Stenosis and Insufficiency"!

Updated: Jun 2, 2022



☑️ Acute joint rheumatism, rheumatic fever, fibrous thickening of the aortic valve and later retraction of the valve,



☑️ In cases where the hole between the two ventricles is adjacent or close to the VSD aortic valve,



☑️ Tearing of any leaflet of the aortic valve is among the most common causes of chest trauma (traffic accident, fall, etc.).



ACUTE JOINT rheumatism:

acute rheumatoid arthritis (AER); It is a rheumatic disease that affects the heart, joints, nervous system and skin. Although AER can be seen at any age, it is more common between the ages of 5-15 years.

Symptoms in AER appear 2-4 weeks after streptococcal throat infections. AER symptoms occur after very few streptococcal throat infections.



SYMPTOMS OF ACUTE JOINT rheumatism:

- Joint swelling and pain (ankles, elbows, knees, wrists)

- Chest pain and respiratory distress

- Tiredness

- carditis

- Involuntary movements of the face and hands (chorea) occur in 1% of patients.

- Skin rashes (rarely)

- Subcutaneous nodules (rarely)



CAUSES OF ACUTE JOINT rheumatism:

The exact cause of AER is unknown. Only a fraction of people with streptococcal throat infections develop AER. Again, some of these patients have joint involvement, and some have cardiac involvement.

The disease is probably caused by the immune system's inability to distinguish between bacterial products and heart valves and heart muscle and joints.



Causes of Aortic Stenosis

Aortic stenosis can occur in 3 ways; Under the lid, at the lid level and above the lid, it is largely dependent on the lid in the adult. Stenosis due to the aortic valve is divided into two; rheumatic and non-rheumatic. While rheumatic aortic stenosis constitutes 30-40% of patients in western countries, this rate is higher in our country. Due to rheumatism, the aortic valve thickens and becomes inflamed, and over time, the valve deteriorates and the three normally mobile leaflets adhere to each other and calcification occurs, making it similar to a piece of stone. Rheumatic aortic stenosis often causes disease of the mitral heart valve, but its clinical significance may be different. Non-rheumatic aortic stenosis is in two forms; It is 'Congenital' and 'Degenerative'. Congenital aortic stenosis is more common. Bicuspid aortic stenosis is the most common. Normally, the aortic valve has 3 leaflets, while the aortic valve has 2 leaflets. 1 or 2 out of every 100 people in the community are born with a bicuspid aortic valve. These bicuspid valves may deteriorate over time or may show a completely normal course. Disruption of this valve may result in aortic stenosis, aortic regurgitation (leakage), or both (stenosis and leak). Sometimes, a picture of microbial infection in the heart valve, which we call endocarditis, may occur on this valve floor. Calcific aortic stenosis occurs with calcification of the congenital bicuspid valve. With the progression of calcification, the occurrence of significant aortic stenosis usually occurs between the ages of 50 and 60. Degenerative type aortic stenosis is also named as atheriosclerotic, idiopathic calcific and senile. It has a normal three-leaf cover. Calcification develops due to atherosclerosis (hardening of the arteries). Significant aortic stenosis develops in the 60s-70s and 80s.



Cause of Aortic Insufficiency

The most common cause is acute joint rheumatism. Rheumatic fever causes fibrous thickening of the aortic valve and then aortic regurgitation by retracting the valve. The second most common is infective endocarditis (on the basis of the bicuspid or normal valve). Infective endocarditis is microbial infection of the heart valve. Again, in cases where the hole between the congenital two ventricles (VSD: Ventricular Septal Defect) is adjacent or close to the aortic valve, aortic failure may occur over time. Aortic insufficiency may occur with the rupture of any leaflet of the aortic valve in chest traumas (traffic accident, fall, etc.). Apart from these, other causes of aortic insufficiency; myxamatous degeneration, rheumatoid arthritis and systemic lupus erythromatosis can cause aortic insufficiency. Aortic regurgitation occurs in Marfan Syndrome, which causes enlargement of the aorta (in arteriosclerotic or syphilitic aortic aneurysm with a similar mechanism), in annuloaortic ectasia where there is enlargement due to weak aortic valve circumference, with or without Marfan Syndrome. Again, aortic insufficiency may occur in aortic dissection, which creates a tear between the layers of the aortic vessel. Various rheumatic and systemic diseases (Rheumatoid Arthritis, Reiter's Syndrome, Psoriasis, Takayasu's Disease) can cause aortic insufficiency by involving the aortic valve.

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