Muhammad Rizki Darmawan Mustakim


Rheumatic heart disease (RHD) caused by the Streptococcus β hemoliticus type A bacteria, which can cause rheumatic fever and may lead to complications such as congestive heart failure. Heart failure is a clinical syndrome caused by abnormal structure or function of the heart, where the heart can not pump blood to meet the metabolic needs of the network. A boy, 13 years old, with a chief complaint of shortness of breath which intensified since 2 days before hospital admission. Previosly, Shortness of breath had been felt for 3 weeks. The patient also complained of swollen on both legs and both eyelids, swollen stomach, and cough with dark
red blood pleghm. On physical examination, blood pressure, pulse, and temperature was normal, respiratory 34 x/min. In the face,
was found a second lid edema, nostril breath, and central cyanosis. In the neck, the jugular venous pressure was normal. In the pulmonary was found smooth wet ronkhi (+) in both lung bases. The ictus cordis was visible and palpable in the left anterior axillary linea and as high as the 5th inter costal space, palpable thrill. Left heart border was dilated and murmurs (+) at grade 4/6 in mitral, tricuspid, and aortic valves. The abdomen was convex and found tenderness in the right upper quadrant, and palpable liver. The
superior extremities were found finger clubbing on both sides, whereas the inferior extremities were found pretibial edema. Laboratory results showed leukocytosis, increased SGOT, hypoalbuminemia, CRP (+) and ASTO (+). On the EKG obtained prolonged PR interval and the echocardiographic examination found mitral, tricuspid, and aortic valves insufficiency. Patient was diagnosed with congestive heart failure et causa rheumatic heart disease. The pharmacotherapy was furosemide 40 mg/12 hours, captopril 2 x 12,5 mg, and digoxin 1 x 0.125 mg. The heart failure in this patient is caused by rheumatic heart disease which is established by using Jones criteria. The results of treatment in this patient showed mprovement after evaluation during treatment. [J Agromed Unila 2014; 1(2):119-125]
Keywords: child, congestive heart failure, rheumatic fever, rheumatic heart disease

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