RheumaticRheumatic Heart DiseaseHeart Disease

Inflammatory heart disorderInflammatory heart disorder

Rheumatic heart diseaseRheumatic heart disease

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

Etiology and Etiology and PathophysiologyPathophysiology• Antibiotics, especially PCN, helped with Antibiotics, especially PCN, helped with

the decline in rheumatic fever. the decline in rheumatic fever.

• Ineffective treatment of infection results Ineffective treatment of infection results in delayed reaction and inflammation of in delayed reaction and inflammation of the cardiac tissues and CNS, joints, skin, the cardiac tissues and CNS, joints, skin, and subcutaneous tissueand subcutaneous tissue. .

• 90% are between 5 and 15 years of age90% are between 5 and 15 years of age

Etiology and Pathophysiology Etiology and Pathophysiology (cont.)(cont.)

• Onset is usually suddenOnset is usually sudden

• Often occurs after 1 to 5 symptom-Often occurs after 1 to 5 symptom-free weeks after recovery from free weeks after recovery from pharyngitis or scarlet fever.pharyngitis or scarlet fever.

• Often goes undiagnosed and Often goes undiagnosed and untreated which could lead to untreated which could lead to valvular heart disease years later.valvular heart disease years later.

Etiology and PathophysiologyEtiology and Pathophysiology(Cont.)(Cont.)

• Can effect the pericardium, myocardium, Can effect the pericardium, myocardium, and endocardium. and endocardium.

• Develops small areas of necrosis, which Develops small areas of necrosis, which heal, leaving scar tissue. heal, leaving scar tissue.

• Aschoff’s nodules (vegetative growth) Aschoff’s nodules (vegetative growth) make the valves fibrous and incompetent. make the valves fibrous and incompetent.

• Valves become thickened and deformed Valves become thickened and deformed leading to valvular stenosis & insufficiency leading to valvular stenosis & insufficiency which can cause Valvular Heart disease.which can cause Valvular Heart disease.

Clinical ManifestationsClinical Manifestations

• FeverFever

• Increased pulseIncreased pulse

• EpistaxisEpistaxis

• AnemiaAnemia

• Joint involvementJoint involvement

• Nodules on joints and subcutaneous tissueNodules on joints and subcutaneous tissue

• CarditisCarditis

AssessmentAssessment

•Subjective:Subjective:

• Polyarthritis (joint pain)Polyarthritis (joint pain)

• Abdominal painAbdominal pain

• LethargyLethargy

• FatigueFatigue

AssessmentAssessment• Objective:Objective:

• Small erythematous circles and wavy lines Small erythematous circles and wavy lines on the trunk and abdomen (appear and on the trunk and abdomen (appear and disappear rapidly)disappear rapidly)

• If Sydenham’s chorea (St. Vitus’ dance, If Sydenham’s chorea (St. Vitus’ dance, disorder of CNS) is present, involuntary, disorder of CNS) is present, involuntary, purposeless movement of the muscles purposeless movement of the muscles may occur. may occur.

• Heart murmurs (carditis w/valve Heart murmurs (carditis w/valve involvement)involvement)

Diagnostic TestsDiagnostic Tests

• ECHO – determines valve and myocardium ECHO – determines valve and myocardium damagedamage

• ECG – dysrhythmiasECG – dysrhythmias

• Cardiac murmurs or friction rubCardiac murmurs or friction rub

• Elevated sedimentation rate and leukocyte Elevated sedimentation rate and leukocyte countcount

• Serum antibodies against the strepSerum antibodies against the strep

• C-reactive protein is abnormally highC-reactive protein is abnormally high

Medical ManagementMedical Management

• Preventative measuresPreventative measures

• Rapid treatment for pharyngitis with Rapid treatment for pharyngitis with prolonged antibiotic therapy (PCN prolonged antibiotic therapy (PCN pref)pref)

• Periods of bed restPeriods of bed rest

• Carditis present, ambulation is Carditis present, ambulation is postponed until HF is controlledpostponed until HF is controlled

• Symptomatic care and treatmentSymptomatic care and treatment

Medical Management Medical Management (Cont.)(Cont.)• NSAID’s for joint pain and NSAID’s for joint pain and

inflammationinflammation• Application of gentle heatApplication of gentle heat• Well-balanced diet, high-volume fluid Well-balanced diet, high-volume fluid

intake, with supplemental Vitamin B intake, with supplemental Vitamin B and Vitamin Cand Vitamin C

• Some patients, surgical Some patients, surgical commissurotomy or valve commissurotomy or valve replacement is necessaryreplacement is necessary

Nursing Interventions & Nursing Interventions & Patient TeachingPatient Teaching• Bed rest during initial attackBed rest during initial attack• Proper positioningProper positioning• Schedule of daily events for childSchedule of daily events for child• Patient and family teachingPatient and family teaching• Prophylactic antibioticsProphylactic antibiotics• Patients w/history of rheumatic fever or evidence Patients w/history of rheumatic fever or evidence

of rheumatic heart disease should take PCN daily of rheumatic heart disease should take PCN daily po, or monthly injectionpo, or monthly injection

• Patients with deformed heart valves should use Patients with deformed heart valves should use prophylactic antibiotics before surgery or dental prophylactic antibiotics before surgery or dental proceduresprocedures

PrognosisPrognosis

• Depends upon involvement of the Depends upon involvement of the heartheart

• Carditis can result in a serious heart Carditis can result in a serious heart diseasedisease

• Valvular heart disease may resultValvular heart disease may result