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Rheumatic Heart Disease


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  • 1. Rheumatic Heart Disease Submitted by: Calvento, Jamie Lyn G. A315(JRU)
  • 2.  
  • 3. I. Identification
    • A systemic inflammatory disease of childhood, acute rheumatic fever develops after infection of the upper respiratory tract with Group A Beta- Hemolytic streptococci.
  • 4.
    • Rheumatic fever principally involves the heart, joints, CNS (Central Nervous System), skin, subcutaneous tissues.
    • The term Rheumatic heart disease refers to the cardiac involvement develops to 50% of patients and may affect the endocardium, myocardium or pericardium. It may later affect the heart valves, causing chronic valvular disease.
    • The extent of damage to the heart depends on where the disorder strikes.
  • 5.
      • Endocarditis
      • Causes valve leaflet, swelling, erosion along the lines of leaflet closure and blood, platelet and fibrin deposits, which form beadlike vegetation.
  • 6.  
  • 7.
    • A narrowed or stenotic valve requires the heart to pump harder, which can strain the heart and reduce blood flow to the body.
    • A regurgitant (incompetent, insufficient, or leaky) valve does not close completely, letting blood move backward through the valve.
  • 8. II. Causative Factors
    • GABS (Group A Beta- Hemolytic Streptococci)
    • Rheumatic fever
  • 9. III. Risk Factors
    • 5-15 years old
    • Family history of RF
    • Low socioeconomic status (poverty, poor hygiene, medical deprivation)
    • Untreated strepthroat
  • 10. IV. Pathophysiology Causative agent Group A Beta-hemolytic streptococci Untreated strep throat Rheumatic fever All layers of the heart and the mitral valve become inflammed Vegetation forms Valvular Regurgitation and stenosis Heart Failure
  • 11.  
  • 12. V. Signs and Symptoms
    • Poly arthritis- sharp, sudden pain starts over sternum and radiates to neck, shoulders, back and arms.
    • Erythema marginatum- a non- pruritic, muscular, transient rash.
    • Subcutaneous nodules- a firm, movable, nontender and about 3 mm-2 cm in diameter.
    • Transient chorea- involuntary grimace and an inability to use skeletal muscles in a coordinated manner.
    • Heart murmur
    • CHF
  • 13. VI. Laboratory and Diagnostic Test
    • There is no diagnostic studies are specific for rheumatic heart disease, but the following can support the diagnosis:
  • 14.
    • WBC count and ESR is elevated
    • C- reactive protein is positive.
    • Cardiac enzmes levels may increase in severe carditis.
    • Anti streptolysin- O titser is elevated 95% of patients with in 2 months onset.
    • Throat cultures continue to presence of GABS; however they usually occur in small numbers. Isolating them is difficult.
    • ECG reveals no diagnostic changes, but 20% of patient show a prolonged PR interval.
  • 15.
    • Echocardiography helps evaluate valvular damage, chamber size, ventricular function and the presence of a pericardial effusion.
    • Cardiac catheter evaluates valvular damage and left ventricular function in severe cardiac dysfunction.
  • 16. Nursing Diagnosis
    • Acute Pain related to migratory inflammation of the joints.
    • Activity Intolerance related to joint pain.
    • Hyperthermia related to inflammatory process
  • 17. Nursing Intervention
    • Acute Pain related to migratory inflammation of the joints.
    • -Provide adequate rest periods. To prevent fatigue.
    • - Suggest parent be present during procedures . To comfort child
    • Activity Intolerance related to joint pain.
      • Check vital signs before and immediately after activity Orthostatic hypotension can occur with activity because of compromised cardiac pumping function.
  • 18.
    • Hyperthermia related to inflammatory process
      • Administer medication as indicated, to treat the underlying cause , such as antibiotics (for infection).
      • Provide supplemental oxygen to offset increased oxygen demand.
      • Administer replacement fluids and electrolytes to support circulating volume and tissue perfusion.
  • 19. Treatment
    • Severe mitral or aortic valve dysfunction that causes persistent heart failure requires corrective surgery such as:
    • Commissurotomy
    • Valvuloplasty
    • Valve replacement
  • 20. Commissurotomy
  • 21. Valvuloplasty
  • 22. Valve Replacement
  • 23.  
  • 24.