Rheumatic heart disease

Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever. The heart valve damage may start shortly after untreated or under-treated streptococcal infection such as strep throat or scarlet fever.

1. “ RHEUMATIC HEART DISEASE ” MR. ABHAY RAJPOOT MSc. NURSING FINAL YEAR

2. 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. DEFINITION:

3. 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 . INCIDENCE:

4. Since rheumatic fever is caused by a communicable disease, the risk factors include: Unhygienic living conditions Overcrowding Reduced access to medical care RISK FACTORS:

5. 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. ETIOLOGY:

6. 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 CLINICAL MANIFESTATIONS:

7. 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. DIAGNOSTIC EVALUATION

8. Carditis Polyarthritis Subcutaneous Nodules Chorea Erythema Marginatum Major criteria:

9. Fever Pain in multiple joints Laboratory evidence of infection with increased ESR or white blood cell count ECG shows a prolonged P-R interval Minor Criteria:

10. Cardiomegaly Infective endocarditis Stroke COMPLICATIONS:

11. 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 allergic to penicillin are given erythromycin. PREVENTION:

12. Antibiotic therapy- example – penicillin Blood thinning agents- example – Aspirin Diuretics – example - Lasix Corticosteroids- example - Dexamethasone Beta blockers- example - atenolol Analgesics – example - Ibrufen Bed rest MEDICAL MANAGEMENT:

13. Valvuloplasty SURGICAL MANAGEMENT

14. Valve replacement

15. 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 NURSING MANAGEMENT

16. A cross-sectional study was conducted from 9 August to 24 December 2011 involving 2019 pupils, aged between 5 and 18 years selected from the 16 ‘ daaras ’ of the Academic Inspectorate ( Inspection d'Académie ) of the city of Dakar and its suburbs. About 60.1% of the pupils were men and the mean age was 9.7±3.3 years. 10 cases of definite RHD were detected, prevalence being 4.96 per 1000 (95% CI 2.4 to 9.1). This prevalence was five times higher with echocardiographic screening compared with clinical screening. 23 cases (11.4 per 1000) of borderline forms were detected. RESEARCH STUDY

17. SUMMARY

18. 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. CONCLUSION

19. Peri -operative nursing care for Valve replacement ASSIGNMENT

20. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Thirteenth edition, 2013, Elsevier publications page no.769-795. http://www.heartandstroke.ca/heart/conditions/rheumatic-heart-disease https://www.chw.org/medical-care/hermaheart/conditions/rheumatic-heart-disease https://www.webmd.com/heart-disease/heart-failure/qa/what-is-rheumatic-heart-disease https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588 BIBLIOGRAPHY