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Rheumatic Heart disease

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Rheumatic Heart disease

  1. 1. RHUEMATIC HEARTRHUEMATIC HEART DISEASEDISEASE
  2. 2. Rheumatic fever (RF) is generally classified as a connective tissue or collagen-vascular disease It is an inflammatory reaction that causes damage to collagen fibrils and to the ground substance of connective tissue Rheumatic fever principally involves the heart, joints, CNS (Central Nervous System), skin, subcutaneous tissues.
  3. 3. • Recurrent attacks of RF may cause fibrosis of heart valves, leading to chronic valvular heart disease • The term Rheumatic heart disease refers to the cardiac involvement develops to 50% of patients and may affect the endocardium, myocardium or pericardium. It may later affect the heart valves, causing chronic valvular disease. • The extent of damage to the heart depends on where the disorder strikes.
  4. 4. DEFINITION • Rheumatic heart disease is a chronic condition resulting from rheumatic fever that is characterized by scarring and deformity of the heart valves
  5. 5. Epidemiology •Peak incidence ages 5~15 years •Rare before age 4 years and after age 40 years •The incidence of RF and prevalence of rheumatic heart disease (RHD) are markedly variable in different countries: •In developed country, such as the united states, the incidence of RF < 2/100,000 •In many developing countries, the incidence of acute RF approaches or exceeds 100/100,000
  6. 6. Causative Factors • GABS (Group A Beta- Hemolytic Streptococci) • Rheumatic fever
  7. 7. PATHOPHYSIOLOGY Rheumatic fever+ recurrent infection Cross immune response between host and streptococcal antigens Abnormal reaction-autoimmunity disease rheumatic pancarditis $ Endocarditis in valves erosion of valve leaflets fibrous thickening $ thickened valves stenosis and regurgitation
  8. 8. Causative Factors • GABS (Group A Beta- Hemolytic Streptococci) • Rheumatic fever
  9. 9. Risk Factors • 5-15 years old • Family history of RF • Low socioeconomic status (poverty, poor hygiene, medical deprivation) • Untreated strepthroat
  10. 10. CLINICAL MANIFESTATION Jones Criteria for Diagnosis of Rheumatic Feve MAJOR CRITERIA • carditis • Poly arthritis- sharp, sudden pain starts over sternum and radiates to neck, shoulders, back and arms. • Erythema marginatum- Erythema marginatum: A long- lasting reddish rash that begins on the trunk or arms as macules, which spread outward.
  11. 11. • Subcutaneous nodules- a firm, movable, nontender collagen fibers over bones or tendons and about 3 mm-2 cm in diameter. • Transient chorea- involuntary grimace and an inability to use skeletal muscles in a coordinated manner.
  12. 12. MINOR CRITERIA 1. Fever 2. Arthralgia 3. Previous rheumatic fever or rheumatic heart disease 4. Acute phase reactions: ESR / CRP / Leukocytosis 5. Prolonged PR interval
  13. 13. •Supporting evidence of an antecedent group A •streptococcal infection: ① Positive throat culture or rapid streptococcal antigen test ② Elevated or rising titers of antistreptococcal antibodies (anti-streptolysin O and anti-DNase B)
  14. 14. Daignostic Evaluation •Modified Jones criteria were first published in 1944 by T. Duckett Jones, MD.They have been periodically revised by the American Heart Association in collaboration with other groups. •Guidelines for the diagnosis of initial attacks of RF (Jones criteria, updated 1992) •If supported by evidence of preceding group A streptococcal infection, the presence of two major manifestations or of one major and two minor manifestations establishes the diagnosis of acute RF
  15. 15.  WBC count and ESR is elevated  C- reactive protein is positive.  Cardiac enzmes levels may increase in severe carditis.  Anti streptolysin- O titser is elevated 95% of patients with in 2 months onset.  Throat cultures continue to presence of GABS; however they usually occur in small numbers. Isolating them is difficult.  ECG reveals no diagnostic changes, but 20% of patient show a prolonged PR interval.
  16. 16. Treatment General Measures Strict bed rest Medical Measures 1. Control streptococcal infection Penicillin is of choice benzathine penicillin, 1.2 million units im once, or procaine penicillin, 600,000 units im daily, 10 days If allergic to penicillin, erythromycin be given
  17. 17. 2. Antirheumatic therapy (1) Salicylates Of choice in patients with little or no cardiac involvement; Particularly effective in reducing fever and relieving joint pain and swelling Aspirin 0.6~0.9 g / 4h in adults; lower doses in children (2) Corticosteroids Used in patients who do not respond well to adequate doses of salicylates Prednisone 40~60 mg orally daily, tapering over 2 weeks
  18. 18. 3. Treatment of symptoms and complications If heart failure is present, digitalis preparations should be used cautiously because cardiac toxicity may occur with conventional dosages Prevention Primary prevention Early treatment of streptococcal pharyngitis Penicillin or erythromycin Secondary prevention To prevent recurrence of rheumatic activity Long-acting penicillin (benzathine penicillin) 1.2 million units im, every 4 weeks Sulfonamides or erythromycin may be substituted
  19. 19. Nursing Daignosis • Activity intolorence related to arthralgia secondry to joint pain • Decreased cardiac output related to valve dysfuntion,HF • Ineffective therapuetic regimen related to lack of knowledge
  20. 20. • HEALTH PROMOTION • ACUTE INTERVENTION • AMBULATORY AND HOME CARE
  21. 21. THANK YOU
  22. 22. 1) ALL ARE FEATURES OF ACUTE RHEUMATIC FEVER EXCEPT: a) Pancarditis b) Carey Coombs murmur c) Chorea d) Always causes residual joint damage 2) What heart problem may be caused, ironically, by the body's attempt to protect itself from a streptococcal throat infection? A)Cardiomyopathy B)rheumatic heart disease C)coronary atherosclerosis D)infectious endocarditis
  23. 23. 3) When teaching a patient about the long-term consequences of rheumatic fever, the nurse should discuss the possibility of  a. valvular heart disease b. pulmonary hypertension c. superior vena cava syndrome d. hypertrophy of the right ventricle 4) Which is a priority nursing intervention for a patient during the acute phase of rheumatic fever? a. administration of antibiotics as ordered b. management of pain with opioid analgesics c. encouragement of fluid intake for hydration d. performance of frequent, active range-of motion exercises
  24. 24. 5) Which of the following nursing actions should the nurse prioritize during the care of a patient who has recently recovered from rheumatic fever? a. Teach the patient how to manage his or her physical activity.  b. Teach the patient about the need for ongoing anticoagulation.  c. Teach the patient about his or her need for continuous antibiotic prophylaxis.  d. Teach the patient about the need to maintain standard infection control procedures.
  25. 25. 1) D 2) B 3) A 4) A 5) C

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