Rheumatic Heart Disease Inflammatory heart disorder

Rheumatic heart disease A result of rheumatic fever, predominantly results from a delayed childhood reaction to inadequately treated childhood pharyngeal or upper respiratory tract infection (strep)

Etiology and Pathophysiology Antibiotics, especially PCN, helped with the decline in rheumatic fever. Ineffective treatment of infection results in delayed reaction and inflammation of the cardiac tissues and CNS, joints, skin, and subcutaneous tissue. 90% are between 5 and 15 years of age

Etiology and Pathophysiology (cont.) Onset is usually sudden Often occurs after 1 to 5 symptom-free weeks after recovery from pharyngitis or scarlet fever. Often goes undiagnosed and untreated which could lead to valvular heart disease years later.

Etiology and Pathophysiology (Cont.) Can effect the pericardium, myocardium, and endocardium. Develops small areas of necrosis, which heal, leaving scar tissue. Aschoff’s nodules (vegetative growth) make the valves fibrous and incompetent. Valves become thickened and deformed leading to valvular stenosis & insufficiency which can cause Valvular Heart disease.

Clinical Manifestations Fever Increased pulse Epistaxis Anemia Joint involvement Nodules on joints and subcutaneous tissue Carditis

Assessment Subjective: Polyarthritis (joint pain) Abdominal pain Lethargy Fatigue

Assessment Objective: Small erythematous circles and wavy lines on the trunk and abdomen (appear and disappear rapidly) If Sydenham’s chorea (St. Vitus’ dance, disorder of CNS) is present, involuntary, purposeless movement of the muscles may occur. Heart murmurs (carditis w/valve involvement)

Diagnostic Tests ECHO – determines valve and myocardium damage ECG – dysrhythmias Cardiac murmurs or friction rub Elevated sedimentation rate and leukocyte count Serum antibodies against the strep C-reactive protein is abnormally high

Medical Management Preventative measures Rapid treatment for pharyngitis with prolonged antibiotic therapy (PCN pref) Periods of bed rest Carditis present, ambulation is postponed until HF is controlled Symptomatic care and treatment

Medical Management (Cont.) NSAID’s for joint pain and inflammation Application of gentle heat Well-balanced diet, high-volume fluid intake, with supplemental Vitamin B and Vitamin C Some patients, surgical commissurotomy or valve replacement is necessary

Nursing Interventions & Patient Teaching Bed rest during initial attack Proper positioning Schedule of daily events for child Patient and family teaching Prophylactic antibiotics Patients w/history of rheumatic fever or evidence of rheumatic heart disease should take PCN daily po, or monthly injection Patients with deformed heart valves should use prophylactic antibiotics before surgery or dental procedures

Prognosis Depends upon involvement of the heart Carditis can result in a serious heart disease Valvular heart disease may result