Rheumatic Heart Disease

Submitted by:Calvento, Jamie Lyn G.

A315(JRU)

I. Identification

• A systemic inflammatory disease of childhood, acute rheumatic fever develops after infection of the upper respiratory tract with Group A Beta- Hemolytic streptococci.

• Rheumatic fever principally involves the heart, joints, CNS (Central Nervous System), skin, subcutaneous tissues.

• The term Rheumatic heart disease refers to the cardiac involvement develops to 50% of patients and may affect the endocardium, myocardium or pericardium. It may later affect the heart valves, causing chronic valvular disease.

• The extent of damage to the heart depends on where the disorder strikes.

EndocarditisCauses valve leaflet, swelling, erosion along the lines of leaflet closure and blood, platelet and fibrin deposits, which form beadlike vegetation.

• A narrowed or stenotic valve requires the heart to pump harder, which can strain the heart and reduce blood flow to the body.

• A regurgitant (incompetent, insufficient, or leaky) valve does not close completely, letting blood move backward through the valve.

II. Causative Factors

• GABS (Group A Beta- Hemolytic Streptococci)

• Rheumatic fever

III. Risk Factors

• 5-15 years old• Family history of RF• Low socioeconomic status (poverty,

poor hygiene, medical deprivation)• Untreated strepthroat

IV. PathophysiologyCausative agent

Group A Beta-hemolytic streptococci

Untreated strep throat

Rheumatic fever

All layers of the heart and the mitral valve become inflammed

Vegetation forms

Valvular Regurgitation and stenosis

Heart Failure

V. Signs and Symptoms• Poly arthritis-

sharp, sudden pain starts over sternum and radiates to neck, shoulders, back and arms.

• Erythema marginatum- a non- pruritic, muscular, transient rash.

• Subcutaneous nodules- a firm, movable, nontender and about 3 mm-2 cm in diameter.

• Transient chorea- involuntary grimace and an inability to use skeletal muscles in a coordinated manner.

• Heart murmur• CHF

VI. Laboratory and Diagnostic Test

•There is no diagnostic studies are specific for rheumatic heart disease, but the following can support the diagnosis:

• WBC count and ESR is elevated• C- reactive protein is positive.• Cardiac enzmes levels may increase in severe

carditis.• Anti streptolysin- O titser is elevated 95% of

patients with in 2 months onset.• Throat cultures continue to presence of GABS;

however they usually occur in small numbers. Isolating them is difficult.

• ECG reveals no diagnostic changes, but 20% of patient show a prolonged PR interval.

• Echocardiography helps evaluate valvular damage, chamber size, ventricular function and the presence of a pericardial effusion.

• Cardiac catheter evaluates valvular damage and left ventricular function in severe cardiac dysfunction.

Nursing Diagnosis

• Acute Pain related to migratory inflammation of the joints.

• Activity Intolerance related to joint pain.• Hyperthermia related to inflammatory

process

Nursing Intervention

• Acute Pain related to migratory inflammation of the joints.-Provide adequate rest periods. To prevent fatigue.-Suggest parent be present during procedures. To comfort child

• Activity Intolerance related to joint pain.– Check vital signs before and immediately after

activity Orthostatic hypotension can occur with activity because of compromised cardiac pumping function.

• Hyperthermia related to inflammatory process– Administer medication as indicated, to treat the

underlying cause, such as antibiotics (for infection).

– Provide supplemental oxygen to offset increased oxygen demand.

– Administer replacement fluids and electrolytes to support circulating volume and tissue perfusion.

Treatment

• Severe mitral or aortic valve dysfunction that causes persistent heart failure requires corrective surgery such as:

• Commissurotomy• Valvuloplasty• Valve replacement

Commissurotomy

Valvuloplasty

Valve Replacement