Rheumatic Heart Disease.pptx

1. RHEUMATIC HEART DISEASE
PRESENTED BY:
V.RAMYA,
TUTOR.

2. OUTLINE
 Introduction
 Epidemiological Triad
 Agent Factors
 Host factors
 Environmental Factors
 Clinical manifestations
 Prevention and Control
 Benzathine Benzyl Pencillin
 Health Promotion

3. Rheumatic heart disease

4. INTRODUCTION
 Rheumatic heart fever is caused by group A beta
haemolytic streptococci affecting connective tissues
particularly of heart & joints.
Rheumatic heart fever leads to Rheumatic heart disease.
This is a problem of all part of world.
 Rheumatic heart disease accounts for 12-65 percent of
hospital admissions related to cardiovascular diseases.
During 1994, about 12 million people suffered from RF &
RHD.

5. group A beta haemolytic streptococci

6. Epidemiological TrIad
Agent (Group A Beta hemolytic streptococci)
Host (5-30 years)
Environment (Over crowding, poor housing conditions
Inadequate health services)

7. Agent Factors
The causative agent of Rheumatic fever and
Rheumatic heart disease is group A BETA
haemolytic streptococci.
The serotype M type 5 is associated with
Rheumatic fever.

8. Host factors
 Rheumatic fever and Rheumatic heart disease is a
disease of childhood and adolescents
i.e.. between 5 to 15 years of age.
Rheumatic fever and Rheumatic heart disease
affects both the sexes equally.
 The high risk groups are slum dwellers, people
living in barracks.

9. Environmental Factors
The environmental factors which lead to Rheumatic fever
and Rheumatic heart disease are: -
Poverty
Overcrowding
Poor housing conditions
 Inadequate health services
Unawareness of disease
 Inadequate health care experts.

10. Clinical Manifestations
Fever
 Sweating
 Polyarthritis
 Carditis
Subcutaneous nodules
 Tachycardia

11. Cardiac murmur
Pericarditis
 Chorea
Abnormal jerky purposeless
movements of arms, legs and body.
Skin rashes.

12. Diagnosis
Diagnosis is made on the basis of 4
Clinical manifestations minor and major.
 Evidence of Beta haemolytical
streptococci.
 Laboratory diagnosis.

13. Prevention and Control
Early diagnosis and treatment
Early diagnosis can be made and complications
can be prevented by appropriate treatment at its
earliest possible.
WHO has revised the criteria for diagnosis of RF
in 2002-2003, the criteria given is as below

14. Diagnostic criteria
Diagnostic criteria for primary episode
of Rheumatic fever –
Two major or one major and two minor
clinical manifestations.
Evidence of preceding group A
streptococcal infection

15. Major Clinical Manifestations
Carditis
 Polyarthritis
 Chorea
Erythema marginatum
Subcutaneous nodules

16. Minor Clinical Manifestations
Fever,
Polyarthritis

17. Laboratory
Elevated ESR or leukocyte.
Supporting evidence of a preceding streptococcal
infection within 45 days.
 ECG - Prolonged P-R interval
 ASO- Elevated or Rising ASO
 Throat Culture - Positive for Beta haemolytic
streptococci

18. Diagnostic criteria
 Diagnostic criteria for Recurrent attack of Rheumatic fever with
rheumatic heart disease - Two minor manifestation
 And an evidence of group A BETA haemolytical streptococcal
infection.
 On identifying all patients with streptococcal infection, the patients
should be treated with pencillin .
 The patients should be identified having streptococci by throat swab
culture.
 If positive, then should be treated with benzathine benzyl pencillin.

19. Benzathine Benzyl Pencillin
Treatment for those having throat culture positive
Benzathine Benzyl Pencillin - 1.2 million units
I/M, a single dose for adults or oral pencillin G for
10 days.
600,000 units I/M for children.
 Erythromycin - Erythromycin is used for those
having allergy to pencillin.

20. Benzathine Benzyl Pencillin
Treatment for those patients having Rheumatic fever –
Benzathine Benzyl Pencillin - 1.2 million units I/M at an
interval of 3 weeks and it should be continued until the
child is at least five years or until child reaches 18 years,
whichever is later.
 In case, patients with carditis, after the last attack of
Rheumatic fever, it should be continued till 10 years or at
least 25 years of age whichever is longer.

21. Health Promotion
Health should be promoted by giving health
education regarding the rheumatic fever,
Rheumatic heart disease and also about its
prevention and control.
This will help the people to understand about
taking medical & non medical measures for
prevention & control of rheumatic heart disease.

22. Survey
Survey should be carried out on individuals between 6-14
years of group at 5 year intervals.
Surveys should be carried out to know the incidence,
prevalence disease.
By this, evaluation of the programmes can be done.
All this creates an awareness regarding whether the
treatment is adequately provided and cases are taking it
appropriately or not.

23. Non medical measures
Non medical measures should be adopted to prevent or
control the rheumatic fever and Rheumatic heart disease.
These are :
Improving living conditions.
 Improving socio-economic status.
 Breaking the poverty-disease poverty cycle.
 Raising standard of living

24. BIBLIOGRAPHY
 Neelam Kumari A Textbook of Community Health Nursing - I
,2011 Edition , Published by Pee Vee ( Regd .), Page
reffered to 581- 584.
 https://www.slideshare.net/NeeluAryal/rheumatic-heart-disease-
78763324
 https://www.slideshare.net/AbhayRajpoot3/rheumatic-heart-disease-
226069122
 https://www.slideshare.net/EstherMaryMathew/rheumatic-heart-
disease-89497407