Rheumatic heart disease (RHD) is damage to one or more

heart valves that remains after an episode of acute

rheumatic fever (ARF) is resolved. The heart valves can
remain stretched and/or scarred, and normal blood flow
through damaged valves is interrupted. Blood may flow
backward through stretched valves that do not close
properly, or may be blocked due to scarred valves not
opening properly. When the heart is damaged in this way,
the heart valves are unable to function adequately, and
heart surgery may be required.
 Mitral valve is affected in over 90% of cases of RHD
Mitral regurgitation most commonly found in children & adolescents
Mitral stenosis represents longer term chronic disease, commonly in adults
Most common complication of mitral stenosis is atrial fibrillation
Aortic valve next most commonly affected
Often occurs with disease of the mitral valve.
Stenosis tends to develop as a long term complication of aortic regurgitation
Tricuspid and pulmonary valves are much less commonly affected
Usually affected in very severe RHD when all valves are affected
 Causative Rheumatic
agent: GABS Fever
Untreated
Step throat

RHD Inflammation
of valve
 Fever.
Swelling
Jerky movement (Chorea)
Stomach pains.
Joint inflammation including swelling, tenderness, and redness over multiple
joints. The joints affected are usually the larger joints in the knees or ankles. The
inflammation moves from one joint to another over several days.
Small nodules or hard, round bumps under the skin.
Rash (a pink rash with odd edges that is usually seen on the trunk of the body or
arms and legs). (Erythema Marginatum)
DIAGNOSIS:
Needs 2 major
1 major and 2 minor
Throat cultures
 Antibiotics:
Benzanthine PenicillinG (3-4
weeks)
Anti-inflammatory:
aspirin or naproxen (Naprosyn)
Anticonvulsant medications.
Percutaneous balloon mitral
valvuloplasty using the Inoue
balloon, initially described in
1984, [19] appears to produce good
results and has been extensively
used in countries with a high
incidence of rheumatic fever.
Mitral valve replacement
Monitor vital signs such as: blood pressure, apical pulse and peripheral pulse.
Encourage the patient to stress management techniques
(quiet environment, meditation).
Maintain bed rest until the results of laboratory and clinical status of patients improved
Monitor temperature
Monitor heart sounds
Position client in fowlers position to promote lung expansion
 Decreased cardiac output related to the disturbances on the closure of the mitral
valve.

Ineffective Tissue perfusion related to a decrease in peripheral blood circulation.

Activity intolerance related to the swelling and pain in the joints, muscle weakness,
decreased cardiac output (imbalance between myocardial oxygen supply and
needs).
 PRIMARY PREVENTION :
Penicillin treatment, no vaccine

SECONDARY PREVENTION:
Penicillin

THERTIARY PREVENTION:
Medical treatment for cardiac failure
Cardiac surgery