3. DEFINITION:
Rheumatic heart disease is an acute,
recurrent inflammatory disease and a sequela to
group A beta-haemolytic streptococcal
infection, which damages the heart particularly
the valves.
4. ETIOLOGY:
Streptococcal infections
Gram-positive non motile spherical
bacteria occurring in chains
Many pathogenic species are haemolytic
Most common subtypes are 1,3,5
5. PATHOPHYSIOLOGY:
Streptococcal infection
Cross immune response between host and streptococcal
antigens(antigenic mimicry)
Abnormal reaction- auto immunity disease
Rheumatic pancarditis and endocarditis in valves
Erosion of valve leaflets
Fibrous thickening and thickened valves
Stenosis and regurgitation
10. Sydenham’s chorea- neurological disorder with
rapid, involuntary, purposeless, non-repetitive
movements and unable to use skeletal muscles in
a co-ordinated manner.
11.
12. DIAGNOSTIC CRITERIA:
WBC count and ESR is elevated
C- reactive protein is positive.
Cardiac enzymes levels may increase in severe
carditis.
Anti streptolysin- O titer is elevated 95% of patients
with in 2 months onset.
Throat cultures shows presence of GABS; however
they usually occur rarely at the time of presentation
ECG reveals no diagnostic changes, but 20% of
patient show a prolonged PR interval.
18. MEDICAL MANAGEMENT:
1) Eradicate infection
Sore throat should be swabbed and cultured
Give Penicillin (If culture is not possible a sore throat
can be treated with Benzathine Benzyl Penicillin)
Dose: One IM inj.,1.2 miilion units(adults), 0.6 million
units (children)
Or Oral Penicillin V, 500mg BD for 10 days
Erythromycin, 250 mg QID for 10 days (In case of allergy
to Penicillin)
19. 2) Maximize cardiac output:
Corticosteroids are used to treat carditis specially if
heart faliure is evident (e.g. PREDNISOLONE)
Cardiac glycosides (e.g. DIGOXIN)
Diuretics
3) Promote comfort-: Salicylates (e.g. ASPIRIN)
20. Throat swab culture
ASO titre
Physical examination
Auscultation(murmur)
Electrocardiography
Echocardiography
Pressure tracings of the left atrium
X-RAY
21. Secondary Prevention/ prophylaxis:
Prevention of recurrences of RF
• RF without carditis- One IM Penicillin inj at 3
weeks interval (For atleast 5 years or till the child
reaches 18 years whichever is later)
• For carditis without valvular disease- 10 years
treatment after the last attack or till 25 years of
age
• For more severe cases-lifelong treatment
23. NURSING MANAGEMENT:
Encourage good nutrition.
Maintain good hygiene.
Adequate rest.
To seek treatment immediately should sore
throat occur.
Support patients in long-term antibiotic
therapy to prevent relapse (5 years for most
adults).
24. NURSING DIAGNOSIS
&INTERVENTIONS:
Acute Pain related to migratory inflammation of the joints
Provide adequate rest periods to prevent fatigue
Suggest parent be present during procedures
Activity Intolerance related to joint pain
Check vital signs before and immediately after activity,
Orthostatic hypotension can occur with activity because of
compromised cardiac pumping function
Hyperthermia related to inflammatory process
Administer medication as indicated, to treat the underlying
cause, such as antibiotics (for infection)
Administer replacement fluids and electrolytes to support
circulating volume and tissue perfusion
25. PROGNOSIS:
Rheumatic fever can recur whenever the individual experience
new GABH streptococcal infection, if not on prophylactic
medicines
Good prognosis for older age group & if no carditis during the
initial attack
Bad prognosis for younger children & those with carditis with
valvar lesions
26. Patients should attend clinic for rapid treatment of skin sores
and throat infections
Patients should bathe daily
Patients with severe disease should attend if they develop
worsening breathelessness
Avoid dirt & infections
Patients with dyspnea should reduce physical activity
Restrict sodium
Patients can take oral diuretics
