Rheumatic heart disease (RHD) is a serious condition resulting from damage to the heart valves due to rheumatic fever, which is caused by an infection with group A beta-hemolytic streptococcus bacteria. The document outlines the incidence, types, risk factors, symptoms, diagnosis, and treatment options for RHD, emphasizing the importance of early management to prevent complications. It also details nursing care and interventions for patients affected by this disease.

1. Rheumatic Heart Disease
Prepared by : Arpana Bhusal
BNS

2. CONTENT
 Introduction
 Definition
 Incidence
 Type
 Risk factors
 Causes
 Pathophysiology
 Sign and symptoms
 Diagnosis

3. Cont
 Treatment
 Medical management
 Nursing management
 Complication
 Reference

4. Introduction
 Rheumatic fever is an inflammatory disease that can
develop when strep throat or scarlet fever isn't properly
treated , it can caused rheumatic heart disease . Strep throat
and scarlet fever are caused by an infection with group A
beta hemolytic streptococcus bacteria.

5. Definition
 Rheumatic heart disease (RHD) is a life-threatening heart
condition which results from damage to heart valves caused
by one or several episodes of rheumatic fever, an
autoimmune inflammatory reaction to infection with
streptococcal bacteria (streptococcal pharyngitis or strep
throat).

6.  Rheumatic heart disease is caused by damage to the heart
valves and heart muscle from the inflammation and scarring
caused by rheumatic fever.
 Rheumatic heart disease involve permanent damage to the
heart, including damaged heart valves and heart failure.

7. Types Of Rheumatic Heart
Disease
1. Acute Rheumatic Heart Disease:
Acute rheumatic disease usually occur after the course of
acute rheumatic fever, any condition in with unspecified
type of heart involvement ,rheumatic carditis
2. Chronic rheumatic heart disease :
In chronic rheumatic heart disease, valve are particularly
damage due to chronic inflammation, most commonly
mitral and aortic valve .

8. Incidence
Worldwide 33.4 million people have rheumatic heart disease
and that 300,000-500,000 new cases of rheumatic fever
(approximately 60% of whom will develop rheumatic heart
disease) occur annually, with 230,000 deaths resulting from its
complications.

9. Risk factors
Factors that can increase the risk of rheumatic fever
include:
 Poor socio economic status ; people who are poor and
belong to low socio economic condition are prone to get
RHD.
 Over crowding ; people who are living in a slum areas
are more prone to get RHD
 Age ; It appears most commonly in children between the
age of 5-15 years .

10. Cont.
 Climate and season; It occurs more in the
rainy season and in the cold climate.
 Upper Respiratory tract infection ;
Rheumatic fever is an outcome of upper
respiratory tract infection with group A beta
hemolytic streptococcus .
 Previous history of rheumatic fever
 Genetic predisposition

11. Causes
 Group A beta hemolytic streptococcus which causes
rheumatic fever

12. Pathophysiology

13. Sign And Symptoms
Major manifestation include;
 Carditis
 Polyarthritis
 Chorea
 Erythema marginatum
 Subcutaneous nodules

14. Chorea

15. Erythema marginatum

16. subcutaneous nodules and
destructive polyarthriti

17.  Minor manifestation are as follows:
• Polyarthralgia
• Fever exceeding 38.5°C
• Elevated ESR (>60 mm/hr.) or CRP level (>3 mg/L)
• Prolonged PR interval

18. Cont.
Symptoms of heart valve damage that is
associated with rheumatic heart disease may
include:
 chest pain or discomfort
 shortness of breath
 swelling of the stomach, hands or feet
 fatigue
 Rapid or irregular heart beat

19. cont ..
 jerky uncontrollable body movements called
‘chorea’
 painless nodules under the skin near joints
and/or a rash consisting of pink rings
 heart murmur

20. Diagnostic Evaluation
 Blood cultures
 Antibody titer tests used include ASO test, antistreptococcal
DNase B (ADB) test, and the antistreptococcal hyaluronidase
(AH) test
 erythrocyte sedimentation rate (ESR), and C-reactive protein
levels (CRP)

21. Radiological examination:
 Chest X-ray; cardiomegaly pulmonary congestion
 Electrocardiogram; prolong P-R interval
 Cardiac MRI, Echocardiogram (echo)

22. Primary Prophylaxis
 Amoxicillin
• 50 mg per kg (maximum, 1 g) orally once daily for 10
days
 Penicillin G benzathine-
• Patients weighing 27 kg (60 lb.) or less: 600,000 units
IM once
• Patients weighing more than 27 kg: 1,200,000 units IM
once

23. cont. ..
 Penicillin V potassium
• Patients weighing 27 kg or less: 250 mg orally 2 or 3 times
daily for 10 days
• Patients weighing more than 27 kg: 500 mg orally 2 or 3
times daily for 10 days

24. cont. ..
For patients allergic to penicillin
 Azithromycin -12 mg per kg (maximum, 500 mg) orally
once daily for 5 days
 Clarithromycin - 15 mg per kg orally per day, divided into 2
doses (maximum, 250 mg twice daily), for 10 days
 Clindamycin -20 mg per kg orally per day (maximum, 1.8 g
per day), divided into 3 doses, for 10 day

25. Secondary prophylaxis
 Penicillin G benzathine -=
• Patients weighing 27 kg (60 lb.) or less: 600,000 units IM
every 4 weeks†
• Patients weighing more than 27 kg: 1,200,000 units IM
every 4 weeks†
 Penicillin V potassium - 250 mg orally twice daily

26. cont. ..
 Sulfadiazine
• Patients weighing 27 kg or less: 0.5 g orally once daily
• Patients weighing more than 27 kg: 1 g orally once daily
 Macrolide or azalide antibiotic (for patients allergic to
penicillin and sulfadiazine)

27. Treatment Modalities
 Heart failure management
 Valve repair
 Valve replacement
 Anticoagulation management

28. cont. ..
Promote comfort
 Client with arthritic manifestation obtain relief with
salicylates .
 Bed rest usually prescribed to reduce cardiac effort until
evidence of inflammation has subsided

29. cont. ..
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 .

30. Nursing management
Assessment
 History of family and medical history i.e. present and past
illness
 Assessment of cardiac function, nutritional status,
discomfort level, sleep disturbance,
 Monitor vital sign .
 Assessment of presence of pain, presence of skin lesion.

31. Nursing diagnosis
 Acute Pain related to inflammation evidenced by verbal
description of pain, edema , redness .
 Hyperthermia related to Illness or inflammatory disease
evidenced by increase body temperature above normal
range, hot, flushed skin.
 Activity intolerance related to decrease cardiac output as
evidence by prolong bed rest.
 Reduce cardiac output related to valve stenosis .
 Risk for infection related to recurrence chronic disease.

32. Nursing intervention
1. Pain and comfort management
 Administer analgesic to relief pain
 Provide cold / hot compress to relief pain
 Provide quite and calm environment.
 Maintain bed rest during the acute stage of disease.
 Elevate involved extremities above heart level
 Encourage the use of nonpharmacologic interventions such
as relaxation, distraction
 Offering support to reduce anxiety.

33. Cont..
2. Management of hyperthermia
 Assess temperature, heart rate, and blood pressure
frequently.
 Remove excess cloths and cover
 Provide sponge bath
 Administer antipyretic drugs
 Encourage fluid intake , keep in cool environment.

34. Cont..
3. Patient will participate in physical activity as
tolerated.
 Monitor vital signs before and during activities.
 Encourage self-care and gradually increasing activities
as allowed and tolerated

35. Cont.….
 Provide for rest periods, uninterrupted sleep, and
adequate nutritional intake.
 Provide assistance as needed. Suggest use of a shower
chair, sitting while brushing hair or teeth, and other
energy-saving measures.

36. Cont..
4. Prevent infection:
 Apply infection prevention measures such as hand
washing, linen changes and sterility during
procedures.
 Encourage short stay to prevent nosocomial infections
 Maintain skin and mucosal integrity:

37. Cont..
5. Prevent complication
 Check vital sign and record it carefully.
 Carefully monitor intake output.
 Closely monitor sign for cardiac tamponade.

38. 6. Nutrition
 Ensure high protein, high carbohydrate,
 low sodium diet to meet adequate nutrition.
 serve attractive meals that stimulate appetite

39. Complication
 Valve stenosis
 Valve regurgitation
 Damage to the heart muscle
 Heart failure
 Arrhythmia
 Endocarditis

41. Reference
 MandalG.N.,“Text book of adult nursing” Makalu
publication house (P) Ltd, Dili bazar, Kathmandu
 R.N. Wilma J. phipps “Shafer’s Medical Surgical
Nursing”B.I. Publications PVT LTD, New Delhi
 Datta BN, (1992). “Text book of Pathology” 2nd edition,
Jaypee brothers (p). Ltd, New Delhi
 Mosby,( 2009 ),Medical surgical Nursing (5th edition)
 https://www.mayoclinic.org/diseases-conditions/heart-
attack/diagnosis-treatment/drc-20373112. aug. 2021