RATHEESH R.L
RHEUMATIC HEART
DISEASE

RHEUMATIC FEVER
 A non-contagious acute fever marked by
inflammation and pain in the joints. It chiefly affects
young people and is caused by a streptococcal
infection.

 The term "rheumatic heart disease" refers to the chronic
heart valve damage that can occur after a person has had an
episode of acute rheumatic fever. This valve damage can
eventually lead to heart failure.

RHD in India
 Prevalence: 5/1000 population of 5-15 age
group
 1 million RHD cases in India

 Rheumatic heart disease describes a group of short-term
(acute) and long-term (chronic) heart disorders that can
occur as a result of rheumatic fever.
 One common result of rheumatic fever is heart
valve damage. Every part of the heart, including the
outer sac (the pericardium), the inner lining (the
endocardium) and the valves may be damaged by
inflammation caused by acute rheumatic fever.

ETIOLOGY
 Rheumatic heart disease is a
chronic heart condition caused by rheumatic fever that
can be prevented and controlled. Rheumatic fever
is caused by a preceding group A streptococcal (strep)
infection.
 Treating streptococcal throat with antibiotics can
prevent rheumatic fever.

RISK FACTORS
Factors that may increase the risk of rheumatic fever include:
 Family history (genes)
 Type of strep bacteria Certain strains of strep bacteria are more
likely to contribute to rheumatic fever than are other strains.
 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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PATHOPHYSIOLOGY

 RHD often involves damage to the heart valves.
Typically, the damaged heart valve cannot open or
shut properly. This interferes with the proper flow of
blood through the heart. Without treatment, the
damaged valve may continue to deteriorate.

 Rheumatic fever results in rheumatic heart
disease and involves;
 Valve stenosis. This condition is a narrowing of the valve,
which results in decreased blood flow.
 Valve regurgitation. This condition is a leak in the valve,
which allows blood to flow in the wrong direction.
 Damage to heart muscle. The inflammation associated with
rheumatic fever can weaken the heart muscle, resulting in poor
pumping function.
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 Damage to the mitral valve, other heart valves or
other heart tissues can cause problems with the heart
later in life. Resulting conditions may include:
---Atrial fibrillation, an irregular beating of the upper
chambers of the heart (atria)
---Heart failure, an inability of the heart to pump
enough blood to the body

SYMPTOMS OF RHD
 Chest pain
 Heart palpitations
 Breathlessness on exertion .
 Breathing problems when lying down.
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 paroxysmal nocturnal dyspnoea
 Swelling (oedema)
 Fainting (syncope)
 Stroke
 Fever associated with infection of damaged heart valves.

DIAGNOSIS
Diagnosis may include:
 History collection
 Physical examination – while a heart murmur may suggest
RHD, many patients with RHD do not have a murmur
 Medical history – including evidence of past ARF or strep
infection
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 Chest x-ray – to check for enlargement of the heart or fluid on
the lungs
 Electrocardiogram (ECG) – to check if the chambers of the
heart have enlarged or if there is an abnormal heart rhythm
(arrhythmia)
 Echocardiogram – to check the heart valves for any damage or
infection and assessing if there is heart failure. This is the most
useful test for finding out if RHD is present.

TREATMENT
Treatment depends on the severity of rheumatic heart
disease, but may include:
 Hospital admission to treat heart failure
 Antibiotics for infection (especially of the heart valves)
 Blood-thinning medicine to prevent stroke or thin
blood for replacement valves
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 Balloons inserted through a vein to open up stuck valves
(VALVULOPLASTY)
 Heart valve surgery to repair or replace damaged heart
valves.

NURSING MANAGEMENT
 Assess the general condition of the patient.
 Assess the onset, duration and other characters of
pain.
 Assess the respiratory pattern of the patient.
 Monitor vital signs frequently.
 Assess for any peripheral cyanosis.
 Check the peripheral pulses of the patient.

 Monitor arterial blood frequently.
 Administer oxygen as per order.
 Incubate the patient if necessary.
 Provide psychological support for the patient and
family.
 Provide medicines on proper time.

NURSING DIAGNOSIS
 Decreased cardiac output related to impaired
cardiac valve functions as evidenced by peripheral
cyanosis.
 Impaired breathing pattern related inadequate
cardiac function as evidenced by breathing
difficulty.

 Imbalanced nutrition less than body requirement
related to breathlessness as evidenced by weight
loss
 Disturbed sleep pattern related to shortness of
breath as evidenced by presence of dark circles
around the eyes.

 Activity intolerance related to decreased cardiac
activity and laboured respirations as evidenced by
difficulty in performing activities of daily living.
 Fear and anxiety related to intensive care
environment as evidenced by fearful facial
expression

Thank uuuuuuu……………….
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