SEMINAR

ON
RHEUMATIC HEART
DISEASES

SUBMITTED TO: SUBMITTED BY:

Mrs. Sudha Madam Mrs. P.Goda Devi

Lecturer. MSc (N) 2nd year.

.Govt.College of Nursing
Govt. College of Nursing

SBMITTED ON
 RHEUMATIC HEART DISEASE
INTRODUCTION

Rheumatic heart disease describe a group of short term (acute) and long term (chronic) heart disorders
that can occur as a result of rheumatic fever one common results of rheumatic fever is heart valve
damage.

Every part of the heart, including the outer sac the pericardium, the inner lining endocardium and the
valves may be damaged by inflammation caused by acute rheumatic fever. It usually occurs in
children between the ages of 5-15 years.

RHEMATIC FEVER

Definition:-

Rheumatic heart disease is chronic condition resulting from rheumatic fever which involves all the
layers of the heart (e.g. pancarditis) and is the characterized by scarring and deformity of the heart
valves.

 The coommonest valves affected all the mitral and aortic, in that order. However all 4 valves can
be affected.
 Infections are named for the layers of the heart involved in the infectious process: ineffective
endocarditis (endocardium)., myocarditis (myocardium), and pericarditis ( pericardium).

Causes:-

Streptococus pyogenes cause infection of the throat.

Congenital valve disease.
Acquired valve disease.
Endocardities.
Changes in the valves of the heart.
Mitral valve prolapsed (MVP).

Risk factors of Rheumatic fever:-

 Family history: some people may carry a gene or genes that make them more likely to
develop rheumatic fever. Types
of step bacteria: Certain stains of strep bacteria are more likely to contribute rheumatic
fever.
 Environmental factors: Present in developing countries, such as over crowding.
  Poor hygiene.
 Lower socio economic status.
 Malnutrition.
 Dental caries.
 Previous dental surgeries.

Pathophysiology:-

Infection due to group A- beta hemolytic streptococci.

Immune response to streptococcal antigen.

Antigen binds in heart (brain, muscle, synovial joint)

Inflammatory response.

Rheumatic pancardities & endocardities in valves.

Fibrous thickening & thickened valves.

Acute swelling of heart tissue.

Joint pain.

Heart failure.

Swelling valve & valve dysfunction.

Complications of Rheumatic fever:-

 Congestive cardiac failure.

 Recurrence of rheumatic fever.
 Spontaneous bacterial endocarditis.
 Valve stenosis. This condition is a narrowing of the valve, which results in decreased blood
flow.
 Valve regurgitation.
 Damage to heart muscle.
 Damage to mitral valve.
 Atrial fibrillation.
 Heart failure.

Signs & Symptoms of Rheumatic fever:-

Pink or red skin rash.

Red, swollen, inflamed joints.
Abdominal pain.
Heart problems (cardiac) which may not have symptoms, or may results in shortness of
breath & chest pain.
Joint swelling( making in the knee, elbows, ankles, and wrists).
Joint swelling; redness.
 Fever- acute, may last 12 weeks or longer, recurs
 Polyarthritis- occurs in 90% cases,longer joints affected more common.
 Cardities-valves and all layers involved, manifested by tachycardia, murmurs,
enlargement, pericarditis, heart failure, first degree AV block in ECG.
 Nodules-small, painless below skin.
 Brain involvement-abnormal jerky movements arms, legs and the body.
 Skin involvement- various skin rashes.

Diagnostic evaluations:-

History collection.
Physical examination.
Throat culture.
X- ary, ECG
.2D Echo (Ecocardiography).
Cardiac cathetrization.
Blood test: ESR, WBC, CRP.

Medical management:-

 Penicillin prophylaxis for rheumatic fever.

  Prophylaxis for ineffective endocarditis.
 Low sodium intake, diuretics.
 If patient is in Atrial fibrillation use digoxin +low dose B-blocker.
 Anticogulation for at least 1 year for patients who suffered thromboembolism and
permanently to those with AF.

Surgical management:-

Pacemaker Implantation: A pacemaker is a small device that monitor heart beat and sends
electrical signals to stimulate heart to beat at a specific rate. If only sends signals, if heart beat
slows below a particular level.

Nursing management:-

 Assess for a abnormal heart and lung sounds.

 Assess mental status and level of consciousness.
 Assess patients skin temperature and peripheral pulse.
 Administer cardiac glycoside agents. Encourage periods of rest and assist with all
activities.
 Assist the patient in assuming a high fowlers potion. Instruct patient to get adequate bed
rest and sleep.
 The nurse will encourage & educate the patient about the importance of the pacemaker
daily.

Prventions:-

 The best prevention is preventing episodes of rheumatic fever.

 Do not ignore sore throat.
 Get regular checkup.
 Keep sores clean and covered.
 Wash hands regularly.
 Reduce extra stress on the heart by maintaining a poor diet and not smoking.
 IV therapy.
 ENDOCARDITIS

Definition:-

Endocarditis is a rare condition. That involves inflammation of heart lining, heart valves. It is
also known as infective endocarditis. Endocarditis is an infection of the endocardium, which
is the inner lining of the heart chambers and heart valves.

 Endocarditis generally occurs when bacteria, fungi or other germs from another part
of the body, such as the mouth, spread through the bloodstream & attach to damaged
areas in the heart.

Causes of Endocarditis:-

Endocarditis is caused by bacterial or fungi that enter the blood stream from outside the body.

Congenital heart disease.

Valve disease.
Hypertrophic cardiomyopathy.
Implantation of an artificial heart valve.
Implanted devices, such as a pacemaker.

Risk factors of Endocarditis:-

 Previous history of endocarditis.

 Prosthetic heart valves.
 Cardiomegaly.
 Diabetes mellitus.
 Congenital heart disease.
 Ventricular septal defect.
 Aortic stenosis.
 Marfan syndrome.

Pathophysiology:-

Endothelial damage.

Formation of vegetation consisting of leukocytes, fibrin & platelets.


 Microorganism adherence.

Left & right sided heart embolization.

Affects various organs of body, sepsis, vascular damage, heart failure & heart.

Complications:-

 Congestive heart failure- valvular damage.

 Systemic and pulmonary embolism.
 Myotic aneurism.
 Neurological- stroke, neuropsychiatric syndromes.
 Renal- glomerulonephritis, renal infarcts.
 Hematological – anemia.
 A.V, fascicular or bundle branch block.

Signs & symptoms:-

low grade fever and chills.

SOB.
Abdomianl pain.
Pleuritic chest pain.
Back pain.
Anorexia & weight loss.
Arrhythmias Heart murmurs.
Headache.
Malaise.
Fatigue.
Arthralgia.
Backache.
Osler’s node- painful red or purple lesions.
Janeway’s lesions- painless red spots.
Splinter hemorrhage.
Petechiae.
Clubbing of fingers.

Diagnostic evaluations:-

 History collection- previous heart disease, chest injury, surgery, prosthetic heart valve.
 Physical examination- BP, temperature, diabetes.
  Complete blood count.
 CRP test- Increased C- reactive protein level.
 Echocardiogram- shows chamber enlargement, valvular dysfunction & vegetation.
 Chest x-ray shows cardiomegaly.
 ECG-1st or 2nd degree atrioventricular block.

Medical management:-

The most management includes:

i)Phormacological management:

 Administration of antibiotic- Benzyl penicillin IV/ 1.2gm 4 th hourly.

 Gentamycin IV/ 1gm/1kg Tds.
 Antipyretics- inj. Paracetamol Tds.
 Fungal endocardities requires specific anti- fungal treatment, such as amphotericin B.

ii) Non- pharmacological management:-

 Monitor vitals frequently and responds to the changes.

 Provide adequate rest to avoid exertion.
 Ensure adequate nutritional intake.

Surgiical management:-

 Surgical debridement of infected area.

 Replacement of the valve with a mechanical or bio prosthetic artificial heart valve.

Nursing management:-

 The nurse monitors the patient’s temperature. The patient may have a fever for weeks.
 The nurse administer antibiotics, antifungal, or antiviral medications as per prescribed.
 Assist for signs of heart failure, tachycardia, embolic manifestation.
 Provide comfort measures, (fever).
 Encourage adequate fluids and nutrition.
 Preventing recurrence of infection.
 MYOCARDITIES

Definition:-

Myocardium is a inflammation of the middle layer of the heart wall. Myocarditis is an

inflammatory disease of the myocardium cased by different infectious & noninfectious triggers.

 Myocarditis can effect the heart muscle and the heart electrical system, reducing the heart
ability to pump & causing rapid are abnormal heart rhythms (arrhythmias).
 A viral infection usually causes myocarditis, but it can result from a reaction to drug are
be part of a more general inflammatory condition.

Causes:-

Coxsackie B viruses.
Hepatitis C
Herpes.
HIV.
Parvovirus.
Chlamydia ( a common sexually transmitted)
Mycoplasma ( bacteria that cause a lung infection)
Streptococcal ( strep) bacteria.
Borrelia ( the cause of Lyme disease)

Risk factors:-

Increased risk of virus-induced myocarditis.

The course is hyper acute.
Young males.
Coronary artery disease.
High blood pressure.
Heart attck.
Diabetes mellitus.
Cardiomyopathy.
Heart valve disease.
Infection in the heart valves of the heart muscle.
Conginital heart disease.
Sever lung disease( e.g. pulmonary hypertension) or obstructive sleep apnea.
Pericardial disease.CHF is condition in which the heart can,t pump enough blood to the
body’s other organs.
Pathophysiology:-

Viral infection

Inflammation and injury

Decreased myocardial contractility

Heart enlarges increased LVEDV

Increased cardiac output

Increased sympathetic tone

Complications:-

Having cardiomyopathy may lead to other heart conditions, including:

Heart failure.
Blood clots.
Valve problems.
Cardiac arrest and sudden death.

Clinical manifestations:-

The symptoms of acute myocarditis depend on the.

Chest pain.
CHF( leading to edema, breathlessness, and hepatic congestion).
Sudden death (in young adults causes up to 20 of all cases of sudden death).
Palpations (due to arrhythmias).
Fever (especially when infectious).
Since myocarditis is often due to a viral illness, many patients give a history of symptoms
consistent with a recent viral infection, including fever, diarrhea, joint pains, and easy
fatigue ability.

Medical management:-
The patient receives specific treatment for the underlying cause if it is known (eg. penicillin for
hemolytic streptococcoi) and is placed on bed rest to decreases the cardiac workload.

 Digoxin.
 Diuretics.
 Bed rest.
 Oxygen therapy.
 Treatment is supportive.
 Treatment with corticosteroids or immunosuppressive agents has not been shown
effective.
 Myocarditis may resolve develop without further sequelae.

 Subacute disease may develop with persistent laboratory findings of inflammation.

Surgical management:-

 Myectomy (hypertrophied muscle).

 Cardiac Transplant.
 Surgical correction.

Nursing management:-

 Maintain normal cardiac function, increasing activity tolerance, relieve anxiety.

 Monitor for ant complications.
 Monitoring vital signs and symptoms of heart failure.
 Advice to take proper nutrition.
 Provide emotional support and relieve anxiety.
 Avoid the sternous exercise and dehydration.

Prevention:-

Although myocarditis is an unpredictable disease, the following measures may help

prevent its onset.
Take extra measures to avoid infections, and obatain appropriate treatment for
infections.
Limit alcohol consumption to no more than one or two drinks a day, if any.
Maintain current immunizations against diphtheria, tetanus, measles, rubella, and
polio.
Avoid anything that may cause the abnormal heart to work too hard, including salt
and vigorous exercise.
 PERICARDITIS

Definition:-

Pericarditis refers to inflammtion of the pericardium, two thin layers of sac- like tissue that
surround the heart, hold it in place and help it work.

 A swelling and irritation of the thin, sac-like membrane surrounding the heart
(pericardium).
 Pericarditis may be caused by a viral a viral infection or heart attack. In many causes, the
cause is unknown.

Cuases:-

The main causes of pericardium it includes:

Viral, tubercular.
Metastatic- lung or breast cancer, leukemia, melanoma.
Early infection percarditis.
Late post cardiac injury syndrome.
Early infraction percarditis.
Myocarditis.
Dissecting aortic aneurysm.
Rheumatic disease-including lumps, rheumatoid arthritis.

Risk factors:-

 Recovery from a heart attack.

 Autoimmune disease.
 Trauma or injury from an accident.
 Some bacterial, viral and fungal infections.
 Kidney failure.
 Post mi.
 Cancer.
 Drugs and toxins.
 Rheumatic disease.
 Infections.
 Radiations.
  Trauma.
 Heart failure.

Pathophysiology:-

Etiology  Inflammatory  Influx of neutrophils &

response other chemical mediators.

Change the
Restriction of heart Pericardial permeability of
motion & pain with inflammation &  pericardial
breathing.  edema vascularity

Signs & Symptoms:-

Symptoms of signs vary depending on the severity of inflammation and the amount and rate of
fluid accumulation.

 Pericardial rub, sometimes with dyspnea.

 Hypotension.
 Tachypnea. and nonproductive cough may be present.
 Fever, chills, and weakness are common.
 Pain in the back, neck or left sholder.
 Difficulty breathing when lying down.
 Anxiety or fatigue.
 Chest pain with deep inspiration may increase with coughing, swallowing, deep breathing
or lying forward.
 A dry cough.
  Mild fever.

Complications:-

 It is an acute emergency.
 It develops when intra pressure equal to diastolic pressure in the heart.
 Almost patients with tamponade have one or more of the following physical findings:
 Hypertension.
 Sinus tachycardia.
 Pulsus paradoxus ( it is changes in systolic blood pressure more than 10mm of Hg during
inspiration)
 General weakness, wasting, anaroxia, dyspnea.
 The history of previous attack of percarditis important.

Diagnostic Findings:-

Patient history.
Physical examination.
Chest x-ray cardiomegaly.
2D ECHO.
WBC, CRP, ESR percaridial biopsy- analysis

medical manifestations:-

Identifying treating the underlying problems.

patient is placed on bed rest.
Pericardiocentesis, procedure in which the pericardial fluid removed.
Antibiotic therapy.
Analgesics & NSAID such as or aspirin or ibuprofen.
Corticosteroids ( e., prednisone)

Surgical management:-

 Sternotomy.
 Anterior mediastinal dissection.
 Fibrotic parietal pericardium.
 Pericardium removed.

Nursing management;-
 Assessment

The nurse caring for the patient with pericarditis must be alert to the possibility of cardiac
tamponade.
Position patient in semi fowlers to relieve pain and allow expansion.
Monitor vital signs.
Maintain cardiac out put.
Monitor any complications.
Provide emotional support and relieve anxiety.
Monitor the patient temperature.
Administer the IV/ or medications as per doctors order.

Nursing diagnosis:-

 Impaired gas exchange related to ventilation perfusion imbalanced.

 Decreased cardiac out related to altered contractility, preload and afterload.
 Activity intolerance related to imbalanced between O2 supply and demand.
 Knowledge deficit
 Activity schedule.
 Recognizing worsening heart failure.
 Medications.
 Diet therapy.

SUMMARY:-

 Rheumatic heart disease is the only truly preventable chronic heart condition.
 Primary prevention:
Penicillin for suspected strep sore throat.
 Secondary prevention pencillin prophylaxis.

BIBLIOGRAPHY:-

BRUNNER AND SUDDARTHS, TEXT BOOK OF MEDICAL SURGICAL NURSING -II, SOUTH ASIAN
EDITION, SAE EDITORES: SURESH K SHARMA, S. MADHAVI, JANICEL, HINKLE, KERRY H. CHEEVER.
PAGE NO: 605-612.

RERENCE:-

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