2. DEFINITION
Damage to the heart, especially to the valves, as
a result of rheumatic fever, characterized by
inflammation of the myocardium or scarring and
malfunction of the heart valves.
3. INCIDENCE
The mean age of the patients was 27.5 years (range 11–65) with a male
predominance (62.8%). Infective endocarditis was secondary to
rheumatic valvular disease in 63% of patients and 29.9% of patients had
primary infective endocarditis.
Mortality was 28.7%, mostly related to refractory heart failure.
5. ETIOLOGY
Rheumatic heart disease is caused by rheumatic
fever, a complication from untreated strep throat,
which is caused by Group A beta haemolytic
Streptococcus (GAS, or S. pyogenes) bacteria.
6. CLINICAL MANIFESTATIONS
Chest pain
Getting tired easily
Palpitations
Breathlessness on exertion or while lying down.
Swelling of the feet
Fainting
Fever if the damaged heart valves get infected
7. DIAGNOSTIC EVALUATION
Rheumatic heart disease is diagnosed if a person
meets the
criteria for rheumatic fever and the heart is affected.
Guidelines
for clinical diagnosis of acute rheumatic fever were
originally suggested by Dr. Jones and later revised by
American Heart
Association and the WHO. These are called as JONES
criteria
9. MINOR CRITERIA
Fever
Pain in multiple joints
Laboratory evidence of infection with increased
ESR or white blood cell count
ECG shows a prolonged P-R interval
11. PREVENTION
Rheumatic heart disease can be prevented by early diagnosis and
treatment of strep sore throat and rheumatic fever with penicillin.
Once a patient has suffered from rheumatic fever, the patient is
prescribed long acting benzathine penicillin every 2-4 weeks to
prevent a repeated attack. Those
Those allergic to penicillin are given erythromycin
12. MEDICAL MANAGEMENT
Antibiotic therapy- example – penicillin
Blood thinning agents- example – Aspirin
Diuretics –example - Lasix
Corticosteroids- example - Dexamethasone
Beta blockers- example - atenolol
Analgesics –example - Ibuprofen
Bed rest
15. NURSING DIAGNOSIS
Impaired gas exchange related to decreased blood flow as
evidenced by breathlessness
Acute pain related to disease condition as evidenced by patient
verbalization
Impaired physical mobility related to weakness as evidenced by
patient is unable to perform daily activity.
Imbalanced nutrition less than body requirement related to less
intake of food as evidenced by weight loss
16. NURSING MANAGEMENT
Administer appropriate antibiotics and monitoring for
effectiveness and side effects.
Manage inflammation and symptoms with anti-
inflammatory medications.
Monitor and manage cardiac complications.
Educate patients and families on adherence to
antibiotic prophylaxis and recognizing symptoms.
17. CONCLUSION
Rheumatic Fever (RF) is still the most common cause of
acquired heart disease in many developing countries as in
Egypt, India and South America The precise pathogenetic
mechanism(s) of rheumatic fever and rheumatic heart
disease have never been defined. It has been hypothesized
that on exposure to group A streptococci during infection,
'antigenic mimicry' leads to autoimmune-like reaction
within the human host and results in valvulitis, ultimately
leading to rheumatic valvular heart disease.
