It include definition ,risk factor , pathophysiology, clinical manifestations , diagnostic test and it's management

1. BSC. (H) NURSING

3. Rheumatic Heart Disease (RHD) is
a diffuse inflammatory disease
characterized by a response to
infection by Group A HEMOLYTIC
STREPTOCOCCUS (GAS) in the
tonsilopharyngeal area affecting
the heart, joints, CNS , skin and
subcutaneous tissue.

4.  RHD is a chronic condition resulting
from rheumatic fever which involves
all the layers of heart (PANCARDITIS)
and characterized by scarring and
deformity of the heart wall.

6.  ANATOMY OF HEART –
 Heart is normally located in the mid and slightly to
the left side of the thoracic cavity on the diaphram
between 3rd and 5th ribs. Weight for male is 325
grams and about 275 grams in female.
 The heart has base, apex, anterior, posterior.
It has four chambers
* RIGHT ATRIUM
* RIGHT VENTRICLE
* LEFT ATRIUM
* LEFT VENTRICLE

7.  THERE ARE FOUR VALVES-
* MITRAL VALVE
* AORTIC VALVE
* TRICUSPID VALVE
* PULMONIC VALVE
PHYSIOLOGY OF HEART
* SYSTOLE - CONTRACTION- 0.3 SEC
* DIASTOLE- RELAXATION – 0.5 SEC
* TOTAL CARDIAC CYCLE- 0.8 SEC

8.  Poor socio-economic status
 Overcrowding
 Age
 Climate and Season
 Upper Respiratory Tract Infection
 Previous History of RF
 Genetic Predisposition

10.  MAJOR MANIFESTATIONS
• Carditis
• Polyarthritis
• Chlorea
• Erythema Marginatum
• Subcutanous Nodules
 MINOR MANIFESTATIONS
• Fever related to weakness, weight loss,
malaise and anorexia
• Arthralgia

11.  A diagnosis of RHD is made after
confirming antecedent RF
 The modified Jones criteria revised in
1992 provide guideline for the
diagnosis of rheumatic fever.

12.  MAJOR MANIFSTATIONS
 MINOR MANIFESTATIONS
 LABORATORY FINDINGS
• Elevated ESR, C reactive protein and Leucocytosis
• ECG and electrocardiogram to confirm to rhythm
problems and structural changes ( prolonged
P-R interval)
 EVIDENCE OF GRP A STREPTOCOCCAL INFECTION
• Positive throat culture for streptococcus A
• Elevated or rising anti-streptococcal tighter
• Recent Scarlet Fever

14. Chest Radiography
Doppler Echocardiogram
In chronic RHD
Heart Catheterization
On ECG

15.  Positive throat culture for grp A beta hemolytic
Streptococcal
 Elevated acute phase reaction
 ESR
 C Reaction Protein
 Leukocytosis
 Prolonged P-R interval
 ASO TITER TEST
 Antistreptolysin O titer is a blood test to
measure antibodies against streptococcus
bacteria. Antibodies are proteins our bodies
produce when they detect harmful substances
such as bacteria

16. Lesions at the line of closure
Aschoff bodies
Bread and Butter Pericarditis
Antishkow cells are plump
macophages with Aschoff bodies

18.  ERADICATE INFECTION
a. Prevention and prophylaxis therapy
b. Primary prophylaxis serves as first course of
secondary prophylaxis to prevent
recurrence of RF and RHD.
c. An injection 0.6-1.2 million unites of
benzathione penicillin G intramuscularly
every 4 week is recommend.
d. Alternate drugs including PO Clindamycin in
children, PO Azithromycin or
Clarithromycin.

19. e. Administer same dosage every three week in
area where RHD is endemic
f. Pt who had fever without wall damage donot
need endocarditis prophylaxis
g. Continue prophylaxis in high risk pt.
 MAXIMISE CARDIAC OUTPUT
a. Corticosteroid are used if heart failure evident
b. If heart failure develops treatment included ACE
inhibitors, beta blockers and diuretics is
effective
 PROMOTE COMFORT

20. a. When heart failure persists or worsens then
surgery can be life saving.
b. 40% of pt subsequently develop mitral
stenosis as adults.
c. CUMMISUROTOMY- can be done to widen
valves
d. Due to high rates of recurrent symptoms
after annuloplasty or other repair processes,
valve replacement appears to be the
preferred surgical option.

22.  NSG DIAGNOSIS- pain related to inflammatory
response to the joints.
OBJECTIVES- the client verbalises increased
comfort as evidenced by reports of increased
comfort, expression of joint pain reduction
 DIAGNOSIS- decrease cardiac output related
to valve dysfunction
OBJECTIVES- client’s cardiac output as
evidenced by regular cardiac rhythm, blood
pressure & urine output within normal limits

23.  DIAGNOSIS- knowledge deficit related to
disease condition and long-term treatment
OBJECTIVE-pt gains adequate knowledge as
evidenced by explaining disease condition,
recognized need for medication,
understanding treatment

24.  ABSTRACT
RHD remains disease of international importance,
yet little has been published about disease
progression. It provides a well-established
method of estimating rate of transition between
disease between disease stress and can be used
to evaluate the cost of effectiveness of potential
interventions .
METHODS AND RESULTS
Northern territory RHD register was used to
identify all indigenous residents diagnosed with
RHD between the age of 5 and 24 years in the
time period of 1999-2012.

25.  16.2% pt with severe RHD were diagnosed
 50% had valve surgery by two years
 10% were dead within 6 years of diagnosis
 11.4% were progressed to severe HD
 CONCLUSIONS
 Interventions must focus on earlier detection
and treatment.
 This model can be used to predict the effect
of different interventions and their associated
cost.

26.  ABSTRACT
 RHD is a chronic condition with an infectious
etiology causing high disease burden in low
income setting. Affected individual are young and
associated morbidity is high however our HD is
relatively neglected due to other heart diseases
 METHODS AND RESULTS
In the narrative review we describe how RHD care
can be informed and integrated with other
models of care developed for non priority non
communicable disease and high burden
communicable disease.

27.  Examining the four level preparation model (
primary to tertiary prevention )suggest
prevention of RHD can leverage of existing
tuberculosis control efforts, given shared risk
factors.
 Success in coronary heart disease control
provide inspiration for similar bold initiatives
for RHD.
 Strengthening system to true integration of
services can improve RHD programs.

29. CONCLUSION
 Strengthening of system through integrated
(linkages with other well performing and
resource services in conjunction with policies to
adopt the CCM framework for the secondary and
tertiary prevention of RHD in settings with limited
resources, has the potential to significantly
reduce the further burden of RHD. Globally more
research is required to provide evidence based
recommendation for the policy and service
design.

30.  Name- Ram
 Age -8 years
 Sex – Male
 He comes in emergency ward due to intense joint
pain with his parents
Chief questions to ask
Duration, intensity and time period of pain
Is it migratory?
Does pain occurs in one joint only or it occurs in
multiple joints ?

31.  It is very important to correctly diagnose the
patient because if over diagnosed it can
cause socioeconomic problems and if under
diagnosed then it can cause heart diseases in
adult.
 Treatment-
Antibiotic therapy should be used with patient
suffering from RHD

32.  Introduction
 Definition
 Anatomy and physiology
 Physiology
 Clinical Manifestations
 Laboratory Findings
 Diagnostic Evaluation
 Imaging Studies
 Histological Findings
 Medical Management
 Surgical Management
 Nursing Management
 Research Studies

33.  Black JM, Hawks JH, Medical Surgical Nursing
8th edition volume 2 Elsevier pg 1396-1401
 https://www.slideshare.net/miel9156/rheum
atic-heart-disease-3264045
 Lewis, Heitkemper, Dirksen O’ Brian Bucher
medical surgical nursing 7th edition New Delhi
at pg 875-880
 https://en:wikipedia.org/wiki/Rheumatic-
fever