RHEUMATIC HEART

DISEASE
INTRODUCTION

Rheumatic fever is a diffuse inflammatory

disease characterized by a delayed response
to an infection by group A beta-hemolytic
streptococci (GAS) in the tonsilopharyngeal
area, affecting the heart, joints, central
nervous system, skin and subcutaneous
tissues.
It is thought that 40-60% of patients with ARF
will go on to developing RHD.
DEFINITION

Rheumatic heart disease is a chronic

condition resulting from rheumatic fever which
involves all the layers of the heart (i.e.
pancarditis) and is characterized by scarring
and deformity of the heart valves.
The commonest valves affecting are the mitral
and aortic, in that order. However all four
valves can be affected.
ETIOLOGY
Group A beta-hemolytic streptococcus.
Rheumatic fever
RISK FACTORS

Poor socio-economic status: People who

are poor and belongs to low socio-economic
conditions are prone to get Rheumatic heart
disease.
Over-crowding: People who are living in a
slum or damp area are more prone to get
Rheumatic heart disease.
Age: It appears most commonly in children
between the age of 5 to 15 years.
RISK FACTORS(contd…)

Climate and season: It occurs more in the

rainy season and in the cold climate.

Upper respiratory tract infection:

Rheumatic fever is an outcome of upper
respiratory tract infection with group Abeta-
hemolytic streptococcus.
RISK FACTORS(contd…)

Previous history of Rheumatic fever: The

client with previous history of Rheumatic fever
are at high risk to develop Rheumatic heart
disease.

Genetic predisposition: Rheumatic heart

disease shows familier tendancy.
PATHOPHYSIOLOGY
Causative agent (Group A
Beta-hemolytic streptococci)

Untreated Strep throat

Rheumatic fever
All layers of the heart and the
mitral valve become inflamed

Vegetation forms

Valvular regurgitations and

stenosis

Heart failure
JONES CRITERIA IS USED
FOR THE DIAGNOSIS
 2 major or
1 major and 2 minor
Revised Jones
Criterion
 Carditis
• Involves the endocardium, myocardiumand
pericardium to varying degrees
• Incidence declines with increasing age - ranging
from 90% at 3 years to around 30% in
adolescence.
• It manifest as
– Breathlessness - heart failure or pericardial effusion
– Palpitations or chest pain - pericarditis or pancarditis
– Other features include tachycardia, cardiac
enlargement
and new or changed cardiac murmurs.
– Aortic regurgitation - 50% of cases but the tricuspid
and pulmonary valves are rarely involved.
– Conduction defects
 Arthritis
• Most common and
early manifestation
• Acute painful asymmetric
and migratory
inflammation of the large
joints
• Typically affects the
knees, ankles, elbows
and wrists.
• Pain
characteristically
responds to aspirin
 Skin lesions
• Erythema marginatum
– occurs in < 5% of patients
– lesions start as red macules
(blotches)
that fade in the
centre
– but remain red at the edges
– occur mainly on the trunk and
proximal extremities but not the
face
• Subcutaneous nodules
– occur in 5–7% of patients
– Small (0.5–2.0 cm), firm and
painless
– Best felt over extensor surfaces of
bone or tendons
– typically appear more than 3 weeks
after - help to confirm rather than
SUBCUTANEOUS
NODULES
ERYTHEMA
MARGINATUM
 Sydenham’s chorea
(St Vitus dance)
• Late neurological manifestation
• Appears at least 3 months after
the episode of ARF
• all the other signs may
have disappeared.
• Occurs in up to 1/3rd of cases
and is more common in females
• Emotional breakdown or changes
may
be the first feature.
• Typically followed by purposeless
involuntary choreiform movements
of the hands, feet or face.
• Speech may be explosive and
halting.
• Spontaneous recovery usually
occurs
within a few months
 Investigations
• ESRand CRP:monitoring progress of
the disease
• Positive throat swab cultures are obtained
in only 10–25% of case.
• Echocardiography
– Mitral regurgitation with dilatation of the
mitral annulus
– Prolapse of the anterior mitral leaflet
– May also show aortic regurgitation and
pericardial effusion
Investigations

CXR: cardiomegaly due

to carditis
 SURGICAL
MANAGEMENT
Cummisurotomy can be done to widen the
valve.
In patients with critical stenosis mitral valve
replacement may be indicated.
NURSING MANAGEMENT
Nursing diagnosis
Pain related to inflammatory response in
the joints.

Objectives: The client verbalizes increased

comfort as evidenced by reports of reduced
discomfort, expression of joint pain reduction,
relaxed body posture and a calm facial
expression.
Nursing diagnosis
Decreased cardiac output related to valve
dysfunction or HF.

Objectives: client increases cardiac output as

evidenced by regular cardiac rhythm, heart
rate, blood pressure, respiration and urine
output within normal limit.
Nursing diagnosis
Knowledge deficit related to disease condition
and long term treatment.

Objectives: Patient gains adequate

knowledge as evidenced by explaining
disease condition, recognizing need for
medication, understanding treatment.
Intervention
Assess the clients level of knowledge.
Assess the client’s ability to learn.
Explain about disease condition and about
prophylactic treatment of antibiotics.
Clarify the clients doubt clearly.
Nursing diagnosis
Anxiety related to disease condition and
heart failure

Objectives: clients shows maximum

reduction of anxiety.
BIBLIOGRAPHY
Black JM, Hawks JH. Medical surgical nursing. 8th
ed.vol-2. Elsevier; p.1396-1401
Lewis, Heitkemper, Dirksen O’Brien, Bucher. Medical
surgical nursing.7th ed.New Delhi.Elsevier;p. 875-82
URL:https://en.wikipedia.org/wiki/Rheumatic_fever
URL:http://www.slideshare.net/miel9156/rheumatic-
heart-disease-3264045
URL:http://www.powershow.com/view/3d4797-
MWI0M/Rheumatic_heart_disease_RHD_powerpoint
_ppt_presentation
URL:http://gmch.gov.in/estudy/e%20lectures/Patholog
y/cvs5%20RF.pdf
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