Rheu

matic
Heart

Diseas
e
Carl Stephen B. Perez, RN

I.

Definition
A systemic inflammatory disease of childhood, acute rheumatic fever develops after
infection of the upper respiratory tract with Group A Beta- Hemolytic streptococci.
Rheumatic fever principally involves the heart, joints, CNS (Central Nervous System), skin,
subcutaneous tissues.
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.

*Endocarditis- causes valve leaflet, swelling, erosion along the lines of leaflet closure and
blood, platelet and fibrin deposits, which form beadlike vegetation.

A narrowed or stenotic valve requires the heart to pump harder, which can strain the
heart and reduce blood flow to the body.
A regurgitant (incompetent, insufficient, or leaky) valve does not close completely,
letting blood move backward through the valve.

II. Causative Factors

GABS (Group A Beta- Hemolytic Streptococci)

Rheumatic fever

III. Risk Factors

5-15 years old

Family history of RF
Low socioeconomic status (poverty, poor hygiene, medical deprivation)
Untreated strepthroat

IV. Pathophysiology

V. Signs and Symptoms

Poly arthritis- sharp, sudden pain starts over sternum and radiates to neck, shoulders,
back and arms.
Erythema marginatum- a non- pruritic, muscular, transient rash.
Subcutaneous nodules- a firm, movable, non-tender and about 3 mm-2 cm in diameter.
Transient chorea- involuntary grimace and an inability to use skeletal muscles in a
coordinated manner.
Heart murmur
CHF

VI. Laboratory and Diagnostic Test

There is no diagnostic studies are specific for rheumatic heart disease, but the following
can support the diagnosis:
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.
Echocardiography helps evaluate valvular damage, chamber size, ventricular function and
the presence of a pericardial effusion.
Cardiac catheter evaluates valvular damage and left ventricular function in severe cardiac
dysfunction.

VII. Nursing Diagnosis

Acute Pain related to migratory inflammation of the joints.

Activity Intolerance related to joint pain.
Hyperthermia related to inflammatory process

VIII. Nursing Intervention

a. Acute Pain related to migratory inflammation of the joints.
Provide adequate rest periods. To prevent fatigue.
Suggest parent be present during procedures. To comfort child
b. Activity Intolerance related to joint pain.
Check vital signs before and immediately after activity Orthostatic hypotension can
occur with activity because of compromised cardiac pumping function.
c. Hyperthermia related to inflammatory process
Administer medication as indicated, to treat the underlying cause, such as
antibiotics (for infection).
Provide supplemental oxygen to offset increased oxygen demand.
Administer replacement fluids and electrolytes to support circulating volume and
tissue perfusion.
IX. Treatment
Severe mitral or aortic valve dysfunction that causes persistent heart failure requires corrective
surgery such as:

Commissurotomy surgical procedure performed to open a stenotic (narrowed) valve

Valvuloplasty procedure to improve blood flow through a narrow valve with the use of a
catheter
Valve replacement

Name: ______________________________________

Date: __________________

MULTIPLE CHOICE: Encircle the letter of your desired answer.

1. What is a systemic inflammatory
disease of childhood, acute rheumatic
fever develops after infection of the
upper respiratory tract with Group A
Beta- Hemolytic streptococci?
a. Rheumatic Heart Disease
b. Heart Failure
c. Osteoporosis
d. Lung Cancer
2. What is the primary organism that is
caused about by rheumatic fever which
may lead to, if untreated, rheumatic
heart disease?

a. GABS
b. Pseudomonas
c. Retrovirus
d. None of the above
3. What causes valve leaflet, swelling,
erosion along the lines of leaflet closure
and blood, platelet and fibrin deposits,
which form beadlike vegetation?
a. Endocarditis
b. Tubercolosis
c. Lung Cancer
d. Heart Failure
4.