PRACTICE TEACHING RHD Rheumatoid heart .

Practice Teaching on Rheumatoid Heart disease

1. PRACTICE TEACHING ON RHEUMATIC HEART DISEASE PRESENTED TO: MISS. MANASWI DEBBARMA ASSIT. PROF OF TCN PRESENTED BY: PRINCE DEY M.SC 2 ND SEMESTER

2. INTRODUCTION: Rheumatic fever is an inflammatory disease of the heart potentially involving all layers (endocardium, myocardium, and pericardium ) of the heart. Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves.

3. DEFINITION: Acute rheumatic fever is an inflammatory disease resulting from an auto immune reaction to infection with group A streptococci. It affects the heart, joint , central nervous system and subcutaneous tissue . cardiac valvular damage , may persist after the other feature have disappeared.

4. ETIOLOGY: Streptococcus pyogenes cause infection of the throat Congenital valve disease. Acquired valve disease. Endocarditis. Changes in the valves of the heart. Mitral valve prolapsed .

5. RISK FACTORS: socio economic status Over crowding Age Climate Upper respiratory tract infection: rheumatic fever is an outcome of upper respiratory tract infection with group A beta haemolytic streptococci . Previous history of rheumatic fever Genetic predisposition: it shows familiar tendency.

6. ANATOMY

7. PHYSIOLOGY

8. PATHOPHYSIOLOGY:

9. CLINICAL MANIFESTATION: Major findings: Carditis Mono or polyarthritis Chorea Erythema marginatum Subcutaneous nodules

10. DIAGNOSTIC EVALUATION: History collection and physical examination Doppler- echocardiogram: identify and quantitates valve insufficiency and ventricular dysfunction. And it used to track the progression of valve stenosis and may help determine the time for surgical intervention. Chest – X ray: may shows an enlarged heart if HF is present. Heart catheterization:

11. COMPLICATION: A complication that can result from ARF is chronic rheumatic carditis. It results from changes in valvular structure that may occur months to years after an episode of ARF. Rheumatic endocarditis can result in fibrous tissue growth in valve leaflets and chordae tendineae with scarring and contractures. The mitral valve is most frequently involved. Other valves that may be affected are the aortic and t tricuspid valves.

12. MEDICAL MANAGEMENT: Preventive and prophylactic therapy is indicated after rheumatic fever and acute rheumatic heart disease to prevent further damage to valves. Primary prophylaxis also serves as the first course of secondary prophylaxis . An injection 0.6- 1.2 million units of benzathine penicillin G intramuscularly every 4 weeks I the recommended regimen for secondary prophylaxis. Low sodium intake , diuretics If the patients is in arterial fibrillation use digoxin + low dose betablockers

13. SURGICAL MANAGEMENT: Pacemaker implantation: a pacemaker is a small device that monitor heart beat and sends electric signals to stimulate heart to beat at a specific rate. If only sends signals, if heart beat slows below a particular level. Valve replacement: due to high rates of recurrent symptoms after annuloplasty or other repair procedure this procedure appear to be preferred surgical option. Valve replacement: patient with critical stenosis , mitral valvulotomy or valve replacement may be indicated. Commissurotomy can be done to widen the valve .

14. NURSING DIAGNOSIS: Activity intolerance related to arthralgia secondary to joint pain, pain from pericarditis, and HF. Decreased cardiac output related to valve dysfunction or HF. Ineffective therapeutic regimen management related to lack of knowledge concerning the need for long-term prophylactic antibiotic therapy and possible disease sequelae.

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