Rheumatic Heart Disease

1
Rheumatic Heart Disease

• Inflammatory heart disorder

2
Rheumatic heart disease

• A result of rheumatic fever, predominantly
  results from a delayed childhood reaction to
  inadequately treated childhood pharyngeal or
  upper respiratory tract infection (strep)

3
Etiology and Pathophysiology

• Antibiotics, especially PCN, helped with the
  decline in rheumatic fever.
• Ineffective treatment of infection results in
  delayed reaction and inflammation of the cardiac
  tissues and CNS, joints, skin, and subcutaneous
  tissue.
• 90 are between 5 and 15 years of age

4
Etiology and Pathophysiology (cont.)

• Onset is usually sudden
• Often occurs after 1 to 5 symptom-free weeks
  after recovery from pharyngitis or scarlet fever.
• Often goes undiagnosed and untreated which could
  lead to valvular heart disease years later.

5
Etiology and Pathophysiology(Cont.)

• Can effect the pericardium, myocardium, and
  endocardium.
• Develops small areas of necrosis, which heal,
  leaving scar tissue.
• Aschoffs nodules (vegetative growth) make the
  valves fibrous and incompetent.
• Valves become thickened and deformed leading to
  valvular stenosis insufficiency which can cause
  Valvular Heart disease.

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Clinical Manifestations

• Fever
• Increased pulse
• Epistaxis
• Anemia
• Joint involvement
• Nodules on joints and subcutaneous tissue
• Carditis

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Assessment

• Subjective
• Polyarthritis (joint pain)
• Abdominal pain
• Lethargy
• Fatigue

8
Assessment

• Objective
• Small erythematous circles and wavy lines on the
  trunk and abdomen (appear and disappear rapidly)
• If Sydenhams chorea (St. Vitus dance, disorder
  of CNS) is present, involuntary, purposeless
  movement of the muscles may occur.
• Heart murmurs (carditis w/valve involvement)

9
Diagnostic Tests

• ECHO determines valve and myocardium damage
• ECG dysrhythmias
• Cardiac murmurs or friction rub
• Elevated sedimentation rate and leukocyte count
• Serum antibodies against the strep
• C-reactive protein is abnormally high

10
Medical Management

• Preventative measures
• Rapid treatment for pharyngitis with prolonged
  antibiotic therapy (PCN pref)
• Periods of bed rest
• Carditis present, ambulation is postponed until
  HF is controlled
• Symptomatic care and treatment

11
Medical Management (Cont.)

• NSAIDs for joint pain and inflammation
• Application of gentle heat
• Well-balanced diet, high-volume fluid intake,
  with supplemental Vitamin B and Vitamin C
• Some patients, surgical commissurotomy or valve
  replacement is necessary

12
Nursing Interventions Patient Teaching

• Bed rest during initial attack
• Proper positioning
• Schedule of daily events for child
• Patient and family teaching
• Prophylactic antibiotics
• Patients w/history of rheumatic fever or evidence
  of rheumatic heart disease should take PCN daily
  po, or monthly injection
• Patients with deformed heart valves should use
  prophylactic antibiotics before surgery or dental
  procedures

13
Prognosis

• Depends upon involvement of the heart
• Carditis can result in a serious heart disease
• Valvular heart disease may result