2. DEFINITION
Rheumatic heart disease is the
permanent damage to the valves of
the heart caused especially by
repeated attacks of Rheumatic
fever, charactererized by changes
in the Myocardium or scarring of
heart valves that reduce the power
of the heart to pump blood
MD DANISH RIZVI
3. • Rheumatic Heart disease is a condition in
which the heart valves are damaged by
Rheumatic fever.
•
MD DANISH RIZVI
4. • Rheumatic heart disease (RHD)
is damage to one or
more heart valves that remains
after an episode of
acute rheumatic fever (ARF) is
resolved. It is caused by an
episode or recurrent episodes of
ARF, where the heart has become
inflamed.
MD DANISH RIZVI
5. • Rheumatic heart disease is a complication
of rheumatic fever in which the heart
valves are damaged. Rheumatic fever is
an inflammatory disease that begins with
strep throat. It can affect connective tissue
throughout the body, especially in the
heart, joints, brain and skin
MD DANISH RIZVI
6. …...
• Rheumatic heart disease is a
chronic condition resulting from
rheumatic fever which involves all
the layers of the heart by scarring
and deformity of the heart valves.
MD DANISH RIZVI
7. • 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.
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8. • ETIOLOGY
• PATHOGEN
• • S. Pyogenes also known as Group A
Streptococcus
• (GAS) is the causative agent in Group A
Streptococcal
• infections including Streptococcal
pharyngitis, acute
• rheuamtic fever , scatlet fever, and acute
• glomerulonephritis.
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9. • Everyday oral activities. Activities such as brushing
your
• teeth or chewing food can allow bacteria to enter your
• Bloodstream
• • An infection or other medical condition. From an
• infected area, such as a skin sore. Gum disease, a
• sexually transmitted infection.
• • Weakened immune system
• • Certain dental procedures. Some dental procedures
• that can cut your gums may allow bacteria to enter your
• bloodstream.
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10. • Upper respiratory tract infection:
• Rheumatic fever is an outcome of upper
• respiratory tract infection with group A
betahemolytic
• streptococcus
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11. • 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
MD DANISH RIZVI
12. • Environmental factors: - A greater risk of
Rheumatic fever is associated with
overcrowding, poor sanitation and other
conditions that may easily result in the
rapid transmission or multiple exposures
to strep bacteria.
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13. PATHOPHYSIOLOGY
• Delayed immune response to infection
with group A beta hemolytic streptococci
• The organism attach to the epithelial cells
of the upper respiratory tract
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14. •
• Streptococcal pharyngitis (sore throat,
fever, malaise)
•
Hyper sensitivity reaction
•
• Antibodies directed against the M proteins
of certain strains of streptococci cross
react with tissue glycoprotein in the heart,
joints, and other tissues.
•
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16. • CLINICAL
• Major manifestations
• Carditis - inflammation of the heart.
• Polyarthritis Polyarthritis is most often
caused by an auto-immune disorder such
as rheumatoid arthritis,
• Erythema marginatum
• Subcutaneous nodules
MD DANISH RIZVI
17. • Erythematic marginatum is a type
of erythema (redness of the skin or mucous
membranes )
MD DANISH RIZVI
18. • Sudden onset of sore throat, throat
reddened with exudates
• b)Swollen, tender lymph nodes at angle of
jaw
• c)Head ache and fever 101-104 degree F
•
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19. • .Warm and swollen joints(poly arthritis)
•
• 3. Chorea (irregular, jerky, involuntary,
unpredictable muscular movement. This
can occur very late in the disease for least
three months from onset of infection)
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23. • Elevated acute phase reactants:
• Blood tests. Certain blood tests may be
used to look for infection and
inflammation.
• a) Erythrocyte sedimentation rate
• b) C-reactive protein
• c) Leukocytosis
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24. • Chest X-ray to check the size of the heart
and to see if there is excess fluid in the
heart or lungs
• Echocardiogram, a non-invasive test that
uses sound waves to create a moving
image of the heart and to measure its size
and shape
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25. • Antibiotic therapy:-
• Oral penicillin 500 mg BD x 10 days OR
• A single dose of Benzathine penicillin 1.2
million
• units I/M
• Tab. Erythromycin 250 mg BD x 10
days(in case
• of penicillin allergy)
• (the patient should be started on long-
term antibiotic
• prophylaxis)
MD DANISH RIZVI
26. • Arthritis , arthralgia : Salicylates or NSAIDS
(eg: aspirin)
• 80-100 mg/kg/day in 4-5 divided doses x 3-5wks
• • Severe carditis :- Corticosteroids (
prednisolone 1-2 mg
• /kg/day ;max 60 mg x 4-6 wks, then taper20-25
mg/wk)
• • Sydenham’s Chorea :-
• ▫ Haloperidol -0.5mg/kg/day
• ▫ Carbamazepine or sodium valproate -15-20
• mg/kg/day x1-2 wks
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28. • HEART CATHETERIZATION
• In acute rheumatic heart disease, this
• procedure is not indicated.
• With chronic disease, heart
catheterization
• has been performed to evaluate mitral and
• aortic valve disease and to balloon
stenotic
• mitral valves.
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30. • Commissurotomy is an open-heart
surgery that repairs a mitral valve that is
narrowed from mitral valve stenosis.
During this surgery, a person is put on a
heart-lung bypass machine. The surgeon
removes calcium deposits and other scar
tissue from the valve leaflets.
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31. • valvotomy is the preferred treatment
for mitral valve stenosis . It is a procedure
that widens the mitral valve so that blood
flows more easily through the heart.
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32. • Mitral valve replacement is a cardiac
surgical procedure in which a patient's
diseased mitral valve is replaced by
either a mechanical or bioprosthetic valve.
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33. • Mechanical valves are made from
durable metals, carbon, ceramics and
plastics. A fabric sewing ring is used to
attach the valve to the tissues in the
patient’s heart.
•
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34. • NURSINGMANAGEMENT
• 1.Patient’s overall health and medical history
• 2. Ask the patient about symptoms of fever, sore throat or jointpain.
• 3.Ask the patient about chest pain, dyspnea, fatigue
• 4. Observe for skin lesions or rash on trunk and extremities.
• 5.Palpate for the firm, non tender movable nodules, near tendonsor
joints
• 6. Auscultate heart sounds for murmur.
• 7.Advice the client to take a well balanced, heart healthy diet, low in fat,
salt, and cholesterol
• 8. Learn to control stress by adopting new ways to relax such asdeep
breathing exercises, muscle relaxing techniques, meditation or yoga.
• 9. Get at least seven hours of sleep each night and during the day time
if patients feel tired.
•
MD DANISH RIZVI
35. 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.
MD DANISH RIZVI
36. • Interventions
• Assess the level of pain, duration,
intensity
• and frequency of pain.
• Complete bed rest and provide
comfortable
• position.
• Provide diversional therapy and
psychological
• support.
• Administer analgesics as needed
MD DANISH RIZVI
37. • 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.
MD DANISH RIZVI
38. • Interventions
• Assess the symptoms of heart failure and
• decreased cardiac output including
diminished
• quality of peripheral pulses, cool skin and
• extremities, increased respiration, increased
heart
• rate, neck vein distention and presence of
• edema.
• Assess for heart sounds.
• Monitor intake and output.
MD DANISH RIZVI
39. • 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
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40. • 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.
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41. • Nursing diagnosis
• Anxiety related to disease condition and
• heart failure
• Objectives: clients shows maximum
• reduction of anxiety.
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42. • Interventions
• Assess the clients level of anxiety.
• Clarify the doubts of the clients by using
non
• medical terms and calm, slow speech.
• Explain all activities, procedures and issues
• that involves the client.
• Explain about the disease conditions and
• prophylactic treatment.
• Provide anxiolytics as prescribed.
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