Rheumatic heart disease is a condition where the heart valves are permanently damaged by rheumatic fever, which can result from untreated strep throat infections. It is characterized by inflammation and scarring of the heart valves. Risk factors include poverty, overcrowding, a history of rheumatic fever, and strep throat infections. Symptoms include heart valve problems, joint pain, and heart failure. Treatment involves antibiotics to prevent future strep infections, medications for heart failure, and potentially heart valve surgery. Complications can include heart failure, bacterial endocarditis, and ruptured heart valves.

1. Mrs.Melba Sahaya Sweety.D
GIMSAR

2. INTRODUCTION
• Rheumatic heart disease is a
condition where the heart valves
have been permanently damaged
by rheumatic fever. The heart
valve damage may start shortly
after untreated or under-treated
streptococcal infection such as
strep throat or scarlet fever. An
immune response causes an
inflammatory condition in the
body. This can result in ongoing
valve damage.

3. • Rheumatic heart disease is a
chronic condition resulting from
rheumatic fever which involves all
the layers of the heart (i.e.
pancarditis) and is characterized
by scarring and deformity of the
heart valves.
DEFINITION

4. DEFINITION
• It is an inflammatory
disease characterized
by a delayed
response to an
infection by Group
‘A’ Beta hemolytic
streptococci (GAS) in
the
tonsillopharyngeal
area. (BlackJ M)
• It is a chronic
inflammatory disease
process resulting
from a delayed
(Months to Years)
sequel of rheumatic
fever, causing
scaring and deformity
of the heart valves.
(Coronarycarenursingtextbook)

5. INCIDENCE
• Rheumatic fever is principally a disease
of childhood, with a median age of 10
years, although it also occurs in adults
(20% of cases).
• Rheumatic fever occurs in equal
numbers in males and females, but the
prognosis is worse for females than for
males.

6. INCIDENCE
• The disease is seen more commonly in poor
socio-economic strata of the society living in
damp and overcrowded place.
• IN INDIA • RHD is prevalent in range of 5-
7/1000 in 5-15 age groups.
• About 1 million cases of RHD

7. ETIOLOGY
Group A beta-hemolytic
streptococcus. Rheumatic fever

8. RISK FACTORS
• Poor socio-economic
status: People who are
poor and belongs to low
socio-economic
conditions are prone to
get Rheumatic heart
disease.

9. RISK FACTORS
• Over-crowding:
People who are living
in a slum or damp
area are more prone
to get Rheumatic
heart disease.

10. RISK FACTORS
• Age: It
appears most
commonly in
children between
the age of 5 to 15
years.

11. RISK FACTORS
• Climate and
season: It
occurs more in
the rainy season
and in the cold
climate.

12. RISK FACTORS
• Upper respiratory tract
infection: Rheumatic
fever is an outcome of
upper respiratory tract
infection with group A
beta- hemolytic
streptococcus.

13. RISK FACTORS
• Previous history of
Rheumatic fever:
The client with
previous history of
Rheumatic fever are at
high risk to develop
Rheumatic heart
disease.

14. RISK FACTORS
• Genetic
predisposition:
Rheumatic heart
disease shows
familiar tendency.

16. CLINICAL MANIFESTATION
• Major manifestations
Carditis
Polyarthritis
Chorea
Erythema Marginatum
Subcutaneous nodules

17. CLINICAL MANIFESTATION
CARDITIS POLYARTHRITIS

18. CLINICAL MANIFESTATION
CHOREA
ERYTHEMA
MARGINATUM

19. CLINICAL MANIFESTATION
SUBCUTANEOUS NODULES

20. CLINICAL MANIFESTATION
• Minor manifestations include:
Fever
• Weakness
Malaise
• Weight loss and Anorexia
Arthralgia

21. DIAGNOSTIC EVALUATION
• History Collection :
• Previous history of Rheumatic Fever
• About Risk Factors
• Strep Throat
• Physical Examination:
• Major criteria

22. DIAGNOSTIC EVALUATION
• Blood Test:
• WBC count and ESR
is elevated
• C- reactive protein is
positive.
• Cardiac enzymes
levels may increase in
severe carditis.

23. DIAGNOSTIC EVALUATION
• Anti streptolysin-
O titser is elevated
95% of patients
with in 2 months
onset.

24. DIAGNOSTIC EVALUATION
• Throatcultures
continue to
presence of
GABS; however
they usually occur
in small numbers.
Isolating them is
difficult.

25. DIAGNOSTIC EVALUATION
• ECG reveals
no diagnostic
changes, but
20% of patient
show a
prolonged PR
interval.

26. DIAGNOSTIC EVALUATION
• Chest Xray –
Cardiomegaly –
Sign of
pulmonary
venous
congestion •

27. DIAGNOSTIC EVALUATION
• ECHO 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.

28. MEDICAL MANAGEMENT
• GOAL :
1. Eradicate infection
• Preventive and prophylactic therapy
is indicated after rheumatic fever
and acute rheumatic heart disease to
prevent further damage to valves.

29. MEDICAL MANAGEMENT
• Primary prophylaxis
An injection of 0.6-1.2
million units of
benzathine penicillin G
intramuscularly every 4
weeks is the
recommended regimen
for secondary prophylaxis
for most US patients.

30. MEDICAL MANAGEMENT
• Administer the same dosage every 3 weeks
in areas where rheumatic fever is endemic,
in patients with residual carditis, and in
high-risk patients.
• Continue antibiotic prophylaxis indefinitely
for patients at high risk (eg, health care
workers, teachers, day care workers) for
recurrent GABHS infection.
• Patients with rheumatic fever with carditis
and valve disease should receive antibiotics
for at least 10 years or until age 40 years.

31. MEDICAL MANAGEMENT
• Alternate drugs recommended by
the American Heart Association for
these patients include PO
clindamycin (20 mg/kg in children,
600 mg in adults) and PO
azithromycin or clarithromycin (15
mg/kg in children, 500 mg in
adults).

32. MEDICAL MANAGEMENT
2. Maximize cardiac output
• Corticosteroids are used to treat
carditis, especially if heart failure is
evident.
• If heart failure develops, treatment,
including ACE inhibitors, beta
blockers and diuretics, is effective.

33. SURGICAL
MANAGEMENT
• When heart failure persists or worsens
after aggressive medical therapy for
acute rheumatic heart disease, surgery
to decrease valve insufficiency may be
life-saving.
• Forty percent of patients with acute
rheumatic heart disease subsequently
develop mitral stenosis as adults.

34. SURGICAL
MANAGEMENT
• commissurotomy
surgical incision
or digital
disruption of the
components of a
commissure to
increase the size
of the opening.

35. SURGICAL
MANAGEMENT
• In patients with critical stenosis,
• mitral valvulotomy
• valvuloplasty, or valvoplasty and consists of
making one or more incisions at the edges of
the commissure formed between the two or
three valve leaflets, which relieves the
constriction of valvular stenosis

36. SURGICAL
MANAGEMENT
• Percutaneous
balloon
valvuloplasty,

37. SURGICAL
MANAGEMENT
• Mitral valve replacement may
be indicated.

38. COMPLICATON
Heart failure. This can occur from either a
severely narrowed or leaking heart valve.

39. COMPLICATON
• Bacterial endocarditis. This is an infection of
the inner lining of the heart. It may occur
when rheumatic fever has damaged the
heart valves

40. COMPLICATON
• Ruptured heart valve. This is a medical
emergency. It must be treated with surgery to
replace or fix the heart valve

41. COMPLICATON
• Valvular heart diseases

42. NURSING DIAGNOSIS
• Chronic Pain related to inflammatory response in
the joints as manifested by verbalization and facial
expression.
• Decreased cardiac output related to valve
dysfunction or HF as manifested by Weakness.
• Activity intolerance related to arthralagia secondary
to joint pain as evidenced by observation, fatigue.
• Knowledge deficit related to disease condition and
long term treatment as evidenced by asking more
questions.
• Anxiety related to disease condition and heart
failure as manifested by facial grimace , discomfort

43. • Chronic Pain related to inflammatory
response in the joints as manifested by
verbalization and facial expression. .
• 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.

44. Chronic Pain related to inflammatory response
in the joints as manifested by verbalization and
facial expression.
• 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.

45. • Decreased cardiac output
related to valve dysfunction or
HF as manifested by Weakness .
• Objectives: client increases cardiac
output as evidenced by regular
cardiac rhythm, heart rate, blood
pressure, respiration and urine
output within normal limit.

46. Decreased cardiac output related to valve
dysfunction or HF as manifested by Weakness .
• 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.
• Provide bed rest.
• Administration of cardiac glycosides as
prescribed.

47. Knowledge deficit related to
disease condition and long term
treatment as evidenced by asking
more questions.
• Objectives: Patient gains adequate
knowledge as evidenced by explaining
disease condition, recognizing need for
medication, understanding treatment.

48. Knowledge deficit related to disease
condition and long term treatment as
evidenced by asking more questions.
• 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.

49. • Anxiety related to disease
condition and heart failure as
manifested by facial grimace ,
discomfort
• Objectives:
clients shows maximum reduction of
anxiety.

50. Anxiety related to disease condition and
heart failure as manifested by facial
grimace , discomfort
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.