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.
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RheumaticHeart 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