RHEUMATIC HEART

DISEASE
 Rheumatic Heart Disease
 Rheumatic Fever
 Epidemiology

—2 – 3 % of people with untreated Group A beta-

hemolytic streptococcal infection.
—470,000 new cases and 233,000 deaths each year.

—Mostly in developing countries, among

indigenous groups.
—over 15 million people are estimated to have
rheumatic heart disease.
—In the US and other developed countries the
incidence is low (hygiene and routine antibiotic
use)
 Predisposing Factors

—AGE – 90% occur between the ages of 5 – 15

y.o.
- Also the AGED, severe cardiac disability and
death.
—SOCIOECONOMIC FACTORS – slum, city
dweller more than the farmer.
— GENETICS – may appear to develop in
household members.
 Etiology
—Exact cause remains uncertain!
- bacteria do not grow within the heart and joints.

—2 Theories:

—The body undergoes anallergic response to invading streptococci.

—The host develop an autoimmune response in which streptococcal
antibodies attack the host tissue.

—Basis of the theories:

1. RF develops following an URTI by streptococci

2. The devl’p of RF is between 1 - 5weeks, with an average of 18 days.

The time our body needs to sensitized an organism and undergo immune
response.

3. Since only 2 -3 % devl’p RF after strep. throat, it has been

hypothesized that these people have a greater immunological reaction.
 Assessment

—Almost always follows a streptococcal infection of the nasopharynx.

Did you experience sore throat lately? How often?

Signs and Symptom

 1.Polyarthritis – prominent finding; last hours to days

 2.Carditis – common manifestation

 3.Relapsing fever – 38o C and episode of normal temp.

 4.Subcutaneous nodules – small, painless firm

 nodules (knees, knuckles, and elbows); usually in

 children; only in first week.

 5.Erythema Marginatum – crescent shape lesion with

 clear centers “chicken-wire rash”

 6.Abdominal pain – may be related to liver

 engorgement

 7.Sydenham’s chorea – “St. Vitus’ dance”; late stages,

 usually in girls; Involuntary grimacing and jerky,

 purposeless movements.

 8.Malaise, weakness, weight loss, and anorexia – As a

 result of fever, pain, and the general debilitation

Diagnostic Measures

—There is no single diagnostic feature identifies rheumatic fever.

JONES CRITERIA

- gauges the probability of the presence of rheumatic fever in an individual.

Premise:


1. Diagnosis requires two major manifestation

2. One major manifestation and two minor manifestation

 —Major criteria

Joints
O [imagine heart-shaped O] (carditis)
N: Nodules
Erythema marginatum
Sydenham’s chorea (St. Vitus' dance)

C: Carditis
A: Arthritis
N: Nodules
C: Chorea
ER:ERythema Marginatum
 —Minor criteria

Fever
Arthralgia

Laboratory abnormalities: increased ESR, increased C reactive Protein,

leukocytosis
Electrocardiogram abnormalities: a prolonged PR interval
Evidence of Group A Strep infection: elevated or rising
Antistreptolysin O titre, or DNAase, though by the time clinical illness
begins, cultures for the streptococci bacterium will be negative.

Previous rheumatic fever or inactive heart disease

Other signs and symptoms

Abdominal Pain
Nosebleeds
Medical Intervention
—Control and alleviate infecting streptococci if still
present.
—Protect the heart against the damaging effects
of carditis.
—Relieve joint pain, fever, and other symptoms.

—Typical intervention:

1. Chemotherapy with penicillin, salicylates, and

steriods
2. Bed rest
3. Proper diet
 Pharmacologic Intervention
—PENICILLIN – for 10 days ff. the onset of rheumatic
fever.
—ERYTHROMYCIN – if allergic to penicillin
—Prophylactic doses of same med is given to prevent
further attacks
—Monthly injections of Longacting Penicillin must be
given for a period of 5 years in patients having one attack of
Rheumatic fever
—SALICYLATES – to control fever and to relieve joint
pain.
—Aspirin – give with food to reduce gastric irritation
—STERIODS – relieve inflammatory symptoms; prevent
further scarring of tissue and may prevent development of
sequelae such as Mitral stenosis
—CARDIAC GLYCOSIDES (‘digitalis’) and DIURETICS
 Nursing Management

NURSING ASSESSMENT

* Cardiac function

* Tolerance to activity and feelings towards restriction

* Support Systems

* Coping Strategies

* Nutritional Status

* Level of Discomfort

* Knowledge with RF
 Nursing Dx and Interaction


—Alteration in Comfort
—Activity Intolerance – Bed rest (reduces strain
on the heart and reduces metabolic needs)

* Temp is normal without salicylates

* Resting pulse (adults) <100>

 Prognosis and Complication

—With antibiotic therapy, the prognosis is

generally good. (only 1 – 2 % die from initial
attack; acute myocarditis)
—Laboratory and clinical signs subsides within
one to two months following therapy.
—Some develop residual heart damage:

MITRAL REGURGITATION and/or STENOSIS

AORTIC REGURGITATION