Rheumatic hear disease is a life thretening condition which results damage to heart valves caused by inflammatory reaction of streptococcal bacterias

1. RHEUMATIC FEVER
By: Mr. Ganesh V. Naik
Lecturer
KLES Institute of nursing
Sciences Ankola

2. DEFINITION
Rheumatic heart fever is an immunological
disorder initiated by Group A beta hemolytic
streptococcus. It is a systemic inflammatory
disease of childhood that can involve the
heart, joints, central nervous system, skin and
connective tissues.

3. INCIDENCE
Rheumatic fever develops 2-3 weeks
after streptococcal infection
Rheumatic fever occurs in equal numbers in
males and females, but the prognosis is
worse for females than for males.
It appears in children between the ages of 6
to 15years.

4. ETIOLOGY
Group A beta-hemolytic streptococcus.
Genetic

5. RISK FACTORS
Poor socio-economic status: People who
are poor and belongs to low socio-economic
conditions are prone to get Rheumatic heart
disease.
Over-crowding: People who are living in a
slum are more prone to get Rheumatic
heart disease.
Age: It appears most commonly in children
between the age of 5 to 15 years.

6. RISK FACTORS(contd…)
Climate and season: It occurs more in the
rainy season and in the cold climate.
Upper respiratory tract infection:
Rheumatic fever is an outcome of upper
respiratory tract infection with group Abeta-
hemolytic streptococcus.

7. RISK FACTORS(contd…)
Previous history of Rheumatic fever: The
client with previous history of Rheumatic fever
are at high risk to develop Rheumatic heart
disease.
Genetic predisposition: Rheumatic heart
disease shows familier tendancy.

8. PATHOPHYSIOLOGY
Causative agent (Group A
Beta-hemolytic streptococci)
Untreated Strep throat
Rheumatic fever

9. All layers of the heart and the
mitral valve become inflamed
Vegetation forms
Valvular regurgitations and
stenosis
Heart failure

10. CLINICAL
MANIFESTATIONS
Major manifestations
Carditis:Pancarditis involving pericardium,
myocardium and endocardium.
Polyarthritis:Inflammation of large joint, usually
starting in legs.
Sydneham’s choea:It consists of a series of
rapid movements without purpose occuring on
face and arms, weakness.
Erythema marginatum:Reddish rash begins on
the trunk spreads over body.
Subcutaneous nodules:can be present in bony
prominences like elbow, wrist, knees

11. Polyarthritis

12. Sydneham’s choea

13. MAJOR
MANIFESTATIONS(contd…)
Erythema marginatum

14. MAJOR
MANIFESTATIONS(contd…)
Subcutaneous nodules

15. Minor manifestations include:
Fever associated with weakness, malaise,
weight loss and anorexia
Arthralgia:Joint pain without swelling

16. DIAGNOSTIC EVALUATIONS
History Collection
The modified Jones criteria (revised in 1992)
provide guidelines for the diagnosis of
rheumatic fever.

17. JONES CRITERIA
2 major or
1 major and 2 minor
Jones’ criteria for the diagnosis of
Rheumatic fever
Major manifestations
Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules

18. Minor manifestations
a) Clinical findings
Previous rheumatic fever or rheumatic heart
disease.
Arthralgia
Fever associated with weakness, malaise,
weight loss and anorexia

19. b) Laboratory findings
Elevated ESR, C-reactive protein and
Leukocytosis
c) Evidence of Group A
streptococcal infection
Positive throat culture for strep A

20. Chest roentgenography :
Cardiomegaly, pulmonary congestion, and
other findings consistent with heart failure
may be seen on chest radiography.

21. Doppler-echocardiogram
In acute rheumatic heart disease, Doppler-
echocardiography identifies and quantitates
valve insufficiency and ventricular dysfunction.

22. ON ECG
It detect bradycardia ,atrial flutter, atrial
fibrillation .

23. Management: Medical Management
Administer antiinflammatory drugs like
corticosteroids or aspirin. Aspirin
100mg/kg/day
Ibuprofen is given for pain relief
Antibiotics for infection like penicillin,
erythromycin
Bed rest is recommended during acute phase
of disease.

24. Cummisurotomy can be done to widen the
valve.
Surgical management

25. In patients with critical stenosis, mitral
valvulotomy, percutaneous balloon
valvuloplasty, or mitral valve replacement
may be indicated.

26. NURSING MANAGEMENT

27. Pain related to inflammatory response in the
joints.
Interventions
Assess the level of pain, duration, intensity
and frequency of pain.
Complete bed rest and provide comfortable
position.
Provide diversional therapy and psychological
support.
Administer analgesics as needed.

28. Decreased cardiac output related to valve
dysfunction or HF.
Interventions
Assess the symptoms of heart failure
Assess for heart sounds.
Monitor intake and output.
Provide bed rest.
Administration of cardiac glycosides
as prescribed.

29. Knowledge deficit related to disease condition
and long term treatment.
Intervention
Assess the clients level of knowledge.
Assess the client’s ability to learn.
Explain about disease condition and about
prophylactic treatment of antibiotics.
Clarify the clients doubt clearly

30. Anxiety related to disease condition and
heart failure
Interventions
Assess the clients level of anxiety.
Clarify the doubts of the clients .
Explain all activities, procedures and
issues that involves the client.
Explain about the disease conditions
and prophylactic treatment.

31. THANK YOU