Rheumatic chorea

Rheumatic chorea is a syndrome characterized by choreic movements, muscle weakness and emotional instability. It is one type of diseases of cardio vascular system. The aetiology are pharyngeal infection by group A streptococci, chorea is a delayed manifestation of rheumatic fever ,it is more common in females , in the age group 5-15 years, when no pervious rheumatic manifestations are noted, the term pure chorea is used. Some clinical features of this disease are mild form will appear like increased fidgetinesses and may be difficult to diagnose. Three signs which helpful in mild cases are 1.‘Milkmaid’s grip’ is due to inability to maintain muscles contraction. When the patient is asked to squeeze the examiner’s fingers, a squeezing and relaxing motion occurs, which is described as milkmaid’s grip, 2.’Bags of worm appearance’ is asynchronous contractions of the lingual muscles, 3.’Jack in the box sign’ –when patient is asked to keep the tongue protruded out, it retracts involuntarily .Well-established cases are easy to diagnose. Facial chorea results in frequent blinking and slurring of speech. These movements subside in sleep and get worsened with emotional disturbances, and during voluntary movements. Some management to follow is complete mental and physical rest and rheumatic fever prophylaxis.

Pulmonary Oedema

Pulmonary oedema is defines as a rapid transudation of fluid out of the pulmonary capillaries into the interstitial spaces, alveoli and bronchioles, beyond the capacity of the drainage system of the lungs. It is one type of diseases of the cardio vascular system. The two different types are cardiogenic and non-cardiogenic .Cardiogenic pulmonary oedema is transudation of fluid, macromolecules and red blood cells from the pulmonary capillaries into initially the intrestitium and later alveoli and bronchioles. Various factors which operate in the development of pulmonary oedema can be summarized as follows: Elevated pulmonary capillary pressure favoring transduction of fluid, Widening of the pulmonary endothelial intercellular junctions, allowing passage of fluid, macromolecules and red blood cells into the intrestitium, Disruption of the intercellular junctions between the alveolar lining cells ,allowing fluid , macromolecules and red blood cells to enter the alveoli. Some clinical features of acute pulmonary oedema are Severe dysponea and orthopnoea, cough which is initially dry, but later with copious, pinkish frothy expectoration, cold bluish extremities, bilateral scattered rhonchi, signs of underlying heart disease, tachypnonea etc. The following treatment should be taken to prevent this disease they are monitoring the intra-arterial pressure and pulmonary vascular pressures, correcting of precipitating causes like infection or arrhythmias.

Primary pulmonary hypertension

Primary pulmonary hypertension is defined as an intrinsic, idiopathic, obstructive disease of the small pulmonary arteries and arterioles. The aetiology is unknown. However pregnancy, oral contraceptives and familial occurrence are noteworthy .Primary pulmonary hypertension is more common in females. The mean patient age is 20-30 years. Death commonly occurs within 5 years of the onset of symptoms. Clinically dysponea, weakness, fatigue, exercise included syncope and chest pain in an otherwise healthy, young, acyanotic woman with no heart disease or cardiac murmurs suggest primary pulmonary hypertension. . Sudden death is common and physical signs are the same as that for pulmonary hypertension. Some managements of this disease are 1.Restrict physical activities, 2.Careful use of diuretics in patients with right ventricular failure and functional tricuspid regurgitation; 3.Calcium channel blockers may alleviate pulmonary vaso-constriction and prolong life in about 20% cases. Unfortunately, there is no way to predict which patient will respond to oral vasodilators; 4. Epoprostenol is a potent short acting vasodilator. Continuous intravenous infusion of this agent has been shown to prolong life, 5.Endothelin receptor and antagonists and selective phosphodiesterase-5 inhibitors are under trial; 6. Maintaining an International Normalized Ratio is recommended and ultimate answer is lung transplantation.

Polymyalgaia rheumatica

Polymyalgaia rheumatica is a descriptive term for an aching syndrome usually seen in the elderly patients, with an elevated ESR that cannot be attributed to more defined rheumatic, infectious or neoplastic disorders. This disease is one type diseases of the connective tissues, bones and joints. It is more common in females than males. Some clinical features for these diseases are 1.Proximal myalgias are characteristic. There is chronic, symmetric, proximal muscle aching and stiffness usually involving shoulder and pelvic girdles and neck. But muscles may be tender on palpation; 2. Constitutional symptoms like malaise, fatigue, anorexia, weight loss, fever and night sweats may be present; 3.Neuropsychiatric manifestations are frequent, particularly depression; 4.About 30-50% of these patients have associated temporal arteritis. Apart from this some investigations are made such as Elevated ESR more than 50mm/hour and normocytic normochromic anaemia, Tests for rheumatoid factor and antinuclear antibodies may be positive, temporal artery biopsy may show evidence of giant cell arteritis and Muscle enzymes are characteristically normal. Some special treatments are available for these kinds of diseases. Best treatment is Prednisolone given at dose of 10-15 mg per day is rapidly effective, Prompt and dramatic clinical response is considered by some to be an absolute criterion for diagnosis.