RHEUMATIC HEART DISEASE.

2. DEFINITION OF RHEUMATIC HEART DISEASE:-
It is an acute, recurrent inflammatory disease that causes damage
to the heart as a sequel to group A beta- haemolytic
streptococcal infection, particularly the valves, resulting in
valves leakage and obstruction. There are associated
compensatory changes in the size of heart’s chambers and the
thickness of chamber walls.

3. ETIOLOGY:-
 It is a squeal to group A beta – haemolytic
streptococcal infection that occurs in about
3% of untreated infection.

4.  Age: It appears most commonly in
children between the ages of 5 to 15
years.

5.  Poor socio-economic status: People
who are poor and belongs to low
socio-economic conditions are prone
to get rheumatic heart disease.

6. Over-crowding: people who are living
are living in a slum or damp areas are
more prone to get rheumatic disease.

7.  Climate and season: It occurs more in
the rainy season and in the cold climate

8.  Upper respiratory tract infection:
rheumatic fever is an outcome of
upper respiratory tract infection.

9. PATHOPHYSIOLOGY:-
Due to causative agent (group A streptococcal infection)
Connective tissue of the heart, blood vessels, joints and
subcutaneous tissues can be affected.
There is tissue necrosis occurs (surrounded by immune
cells)

10. Heart valves are affected, resulting in valve
leakage and narrowing
Thickness of chamber walls occur
All layers of heart are swelled (carditis)
Impaired cardiac function, rheumatic
fever will occur (if infection is more than 3
weeks)

11. CLINICAL MANIFESTATIONS
 Sudden onset of sore throat
 Swollen, tender lymph nodes
 Headache and fever 101o to 104o F
 Abdominal pain
 Warm and swollen joints (polyarthritis)
 Heart murmurs
 History of previous rheumatic fever or
rheumatic heart disease.

13. DIAGNOSTIC EVALUATION:-
 Throat culture – streptococcal organisms

14.  Elevated complete blood count, E.S.R

15.  Echocardiogram – to confirm rhythm
problems and structural changes( prolonged
PR interval or heart block

16.  Chest X-ray shows enlarged heart

17.  Heart cathetherization- with chronic
disease, heart catheterization has been
performed to evaluate mitral and aortic
valve disease and to ballon stenotic mitral
valves.

19. COMPLICATIONS:-
 Valvular heart disease:- when heart
valves that normally move blood
efficiently through the heart
chambers not fully open or fully
closed, perfusion of heart and distal
tissues is impaired and heart muscle
is strained
 Cardiomyopathy:- it is a include sub
acute or chronic disorders of the
myocardium.

20.  Heart failure:- it is physiologic state in
which the heart cannot pump enough
blood to meet the metabolic needs of
the body (determined as oxygen
consumption).

22. MANAGEMENT
 MEDICAL MANAGEMENT:-
 Eradication infection
 Antimicrobial therapy: - killing microorganisms,
or suppressing their multiplication or growth. Eg:
tetracycline (penicillin)
 Maximize cardiac output
 Corticosteroids are used to treat carditis,
especially if heart failure is evident.
.

23. CONT…
 If heart failure develops, treatment, include
ACE inhibitors, beta blockers and diuretics
is effective.
 NSAIDs: - Salicylates:- it inhibit the
synthesis of prostaglandin and other
mediators in the process of inflammation

24.  Promote comfort
 Client with arthritic manifestation obtain
relief with salicylates.
 Bes rest is usually prescribed to reduce
cardiac effort until evidence of inflammation
has subsided

25. SURGICAL MANGEMENT
 When heart failure persists or worsens after
aggressive heart disease, surgery to decrease
valve insufficiency may be life saving
 In acute rheumatic heart disease,
cummisurotomy can be done to widen the
valve.

26. CONT..
 In patients with critical stenosis, mitral
valvulotomy, percutaneous ballon
valvuloplasty, mitral valve replacement
may be indicated