Rheumatic Heart Disease with Coronary Artery Disease and Stroke: A Case Report

Author : D.Y. Pertiwi, T.T. Dewi, I. Rakhmawati, I Sofyan , I.R. Hidayat, A.P. Ayu, D. Rostiati
Upload Date : 19-04-2018

Introduction: Rheumatic heart disease (RHD) Global Status Report 2015-17 said there was 32 million sufferers primarily in developing countries, included Indonesia. Yet, there has been no study about the incidence of RHD there. WHO 2014 said number of the death caused by Coronary Artery Disease (CAD) in Indonesia was 113,380 (9.89%). RHD with CAD is still rarely found.

Case Presentation: A 42 year old, female presented with dyspnea and fatigue. She often felt cough but she ignore her symptom. She had been diagnosed to suffer from stroke 3 years ago with sequelae and not gota routine treatment from other hospital. She denied to have hypertension and diabetes mellitus. Also, she declared to be a non-smoker and non-alcoholic.

Her BP was 110/70 mmHg and pulse 120 x/min, irregular. Systolic murmur, rhonchi and wheezing were revealed. ECG showed atrial fibrillation rapid ventricular response.

Echocardiography showed dilated left atrium (5.49 cm), right atrium and ventricle. Severe mitral stenosis with MV PHT 382/0,57 ms/cm2, anterior hypokinetic with ejection fraction 20.08%, decreased of contractility right ventricle, TAPSE 0,72. She was diagnosed to suffer from RHD, CAD with AF RVR and sequelae stroke.

Discussion: In this case, the risk factors for RHD such as low socio-economy. History of sore throat are still unknown. The risk factors for CAD patients are elderly and often eat high-fat foods. Past stroke was caused by mitral stenosis which made turbulence and progress cardioembolic.

RHD and CAD can be treated either through a bypass surgery at the same time with valve replacement, or hybrid that is catheterization and valve replacement. Which of the two therapies to be taken at precedence actually depends on the severity of illness of the patients and may be directly done both.

Conclusion: The treatment for RHD with CAD currently remains under debate.


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