1. Rheumatic Heart Disease
Inflammatory heart disorder

2. 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)

3. 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

4. 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.

5. 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.

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

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

8. 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)

9. 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

10. 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

11. 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

12. 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

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