Parts of the Human Heart

The outer covering of the heart is a strong, thin membrane called The ventricles make up the largest part of the heart. They form The atria form the upper, smaller part of the
thepericardium. The superior vena cava, aorta, and other large the whole lower portion. Their thick, strong muscles pump heart. They have thin walls, and are smaller than
blood vessles lead in and out of the heart. Smaller blood vessels the ventricles. Each atrium serves as a collecting
blood throughout the body.
nourish the heart itself. station for the blood that flows into the heart.
 The Invader occurs in 20 percent of all reported cases. Rheumatic heart disease
targets men and women equally.
1. Rheumatic fever's most dangerous complication is rheumatic heart
disease . Bacteria called Streptococcus pyogenes lurk in your body Treatment
and attack skin cells lining the nose, throat and windpipe causing
sore throat, headache, fever and fatigue. Without proper treatment 5. To stop rheumatic fever from transforming into rheumatic heart
of rheumatic fever, the disease progresses to rheumatic heart disease, you must use antibiotics against Strep pyogenes. Penicillin
disease and leads to an autoimmune attack on your heart's valves. is the drug of choice. Rheumatic fever is rare nowadays since
This means that your body begins to attack the narrowing penicillin is so easily accessible. Rheumatic heart disease has
structures in the heart, wreaking havoc on the organ. therefore declined but it does exist, especially in underdeveloped
countries.
Attacks on the Heart
http://www.scribd.com/doc/18318109/Rheumatic-Heart-Disease-Alfrin
2. Your heart contains three layers. The outer layer is a sac-like
structure called the pericardium. The middle layer of muscle is the http://www.scribd.com/doc/20207870/Rheumatic-heart-disease-CS
myocardium. The inner layer is the endocardium. When your
immune system begins to attack the heart, it may affect any or all of
the three layers; this is called pancarditis. An infection of the ANTOBODIES AGAINST
pericardium is called pericarditis. Myocarditis is an infection of your
myocardium and specific areas of inflammation called Aschoff Beeta-Haemolytic streptococci group A
bodies occur in this area. This inflammation affects your heart's Anti-streptolysin O (ASO)
electrical activity, and you develop a strange heart rhythm called an Anti-streptokinase
arrythmia. An infection of the endocardium is known as endocarditis Anti-streptohyaluronidase
and the heart valves become involved this time. This effects blood Anti DNA ase B
flow through your heart and oxygenation through your body.
Rheumatic Fever
Valves Involved A sequelae of rheumatic fever, can be acute

3. According to the website Emedicine, rheumatic heart disease leads or chronic.

mostly to mitral stenosis 99 percent of the time. Remember, valves Rheumatic fever is an acute
are like doors that open and close depending upon the pressure on
each side. With mitral stenosis, blood continues to flow in one immunologically mediated multi system
direction, but because of the stenosis, or narrowing, less blood
moves through the heart. Inflammatory disease.

It occurs 10 days to 6 weeks after an

Population Targeted episode of group A (Beta-hemolytic)streptococcal (pharyngitis) and
ofteninvolves the heart.
4. Children are more likely to get rheumatic fever and develop
rheumatic heart disease than are adults. The disease is spread Diagnosed by Jones Criteria:
through coughing and sneezing. According to the website
Emedicine, adults are not immune and rheumatic heart disease Either two of the major manifestations or

one major and two minor manifestations

IV. Anatomy and Physiology

The Anatomy of the Heart

Your heart is located under the ribcage in the center of your chest between
your right and left lung. It’s shaped like an upside-down pear. Its muscular
walls beat, or contract, pumping blood continuously to all parts of your body.

The size of your heart can vary depending on your age, size, or the condition
of your heart. A normal, healthy, adult heart most often is the size of an
average clenched adult fist. Some diseases of the heart can cause it to
become larger.

The Exterior of the Heart

Below is a picture of the outside of a normal, healthy, human heart.

The illustration shows the front surface of the heart, including the coronary
arteries and major blood vessels.
The heart is the muscle in the lower half of the picture. The heart has four
chambers. The right and left atria (AY-tree-uh) are shown in purple. The right
and left ventricles (VEN-trih-kuls) are shown in red.
Connected to the heart are some of the main blood vessels—
arteries and veins—that make up your blood circulatory system.
The ventricle on the right side of your heart pumps blood from the
heart to your lungs. When you breathe air in, oxygen passes from your lungs
through blood vessels where it’s added to your blood. Carbon dioxide, a
waste product, is passed from your blood through blood vessels to your
lungs and is removed from your body when you breathe air out.
The atrium on the left side of your heart receives oxygen-rich blood
from the lungs. The pumping action of your left ventricle sends this oxygen-
rich blood through the aorta (a main artery) to the rest of your body.

The Right Side of Your Heart

The superior and inferior vena cavae are in blue to the left of the
muscle as you look at the picture. These veins are the largest veins in your
body. They carry used (oxygen-poor) blood to the right atrium of your heart. Heart Interior
“Used” blood has had its oxygen removed and used by your body’s organs
and tissues. The superior vena cava carries used blood from the upper parts
of your body, including your head, chest, arms, and neck. The inferior vena
cava carries used blood from the lower parts of your body.

The used blood from the vena cavae flows into your heart’s right
atrium and then on to the right ventricle. From the right ventricle, the used
blood is pumped through the pulmonary (PULL-mun-ary) arteries (in blue in
the center of picture) to your lungs. Here, through many small, thin blood
vessels called capillaries, your blood picks up oxygen needed by all the
areas of your body.

The oxygen-rich blood passes from your lungs back to your heart
through the pulmonary veins (in red to the left of the right atrium in the
picture).

The Left Side of Your Heart

The illustration shows a cross-section of a healthy heart and its inside

Oxygen-rich blood from your lungs passes through the pulmonary
structures. The blue arrow shows the direction in which low-oxygen blood
veins (in red to the right of the left atrium in the picture). It enters the left
flows from the body to the lungs. The red arrow shows the direction in
atrium and is pumped into the left ventricle. From the left ventricle, your
which oxygen-rich blood flows from the lungs to the rest of the body.
blood is pumped to the rest of your body through the aorta.

The Septum
Like all of your organs, your heart needs blood rich with oxygen.
This oxygen is supplied through the coronary arteries as it’s pumped out of
The right and left sides of your heart are divided by an internal wall
your heart’s left ventricle. Your coronary arteries are located on your heart’s
of tissue called the septum. The area of the septum that divides the two
surface at the beginning of the aorta. Your coronary arteries (shown in red in
upper chambers (atria) of your heart is called the atrial or interatrial septum.
the drawing) carry oxygen-rich blood to all parts of your heart.
The area of the septum that divides the two lower chambers (ventricles) of
your heart is called the ventricular or interventricular septum.
Heart Chambers
The picture shows the inside of your heart and how it’s divided into
four chambers. The two upper chambers of your heart are called atria. The
atria receive and collect blood. The two lower chambers of your heart are
called ventricles. The ventricles pump blood out of your heart into the
circulatory system to other parts of your body.
Heart Valves
The picture shows your heart’s four valves. Shown
counterclockwise in the picture, the valves include the aortic (ay-OR-tik)
valve, the tricuspid (tri-CUSS-pid) valve, the pulmonary valve, and the mitral
(MI-trul) valve.
Blood Flow
The arrows in the drawing show the direction that blood flows
through your heart. The light blue arrows show that blood enters the right
atrium of your heart from the superior and inferior vena cavae. From the right
atrium, blood is pumped into the right ventricle. From the right ventricle,
blood is pumped to your lungs through the pulmonary arteries.
The light red arrows show the oxygen-rich blood coming in from
your lungs through the pulmonary veins into your heart’s left atrium. From
the left atrium, the blood is pumped into the left ventricle, where it’s pumped
to the rest of your body through the aorta.
For the heart to function properly, your blood flows in only one
direction. Your heart’s valves make this possible. Both of your heart’s
ventricles has an “in” (inlet) valve from the atria and an “out” (outlet) valve
leading to your arteries. Healthy valves open and close in very exact
coordination with the pumping action of your heart’s atria and ventricles.
Each valve has a set of flaps called leaflets or cusps, which seal or open the
valves. This allows pumped blood to pass through the chambers and into
your arteries without backing up or flowing backward.
The nervous system is a network of specialized nerve cells that conduct
impulses from or to areas of the body to the brain and spinal cord and within
the brain. It is composed of neurons and other specialized cells, like glial
cells and neuroglia, that aid in the function of the neurons. Nerve cells are
interconnected in complex arrangements and use electrochemical signals to
transmit impulses between cells, they respond to a great variety of stimuli
and form neural circuits that regulate an organisms perception and behavior.
Nervous systems are found in many multicellular animals but differ greatly in
complexity between species.\ he human nervous system can be grouped
into both with gross anatomy, (which describes the parts that are large
enough to be seen with the naked eye,) and microanatomy, (which
describes the system at a cellular level.) At gross anatomy, the nervous
system can be grouped in distinct organs, these being actually stations
which the neural pathways cross through. Thus, with a didactical purpose,
these organs, according to their ubication, can be divided in two parts: the
central nervous system (CNS) and the peripheral nervous system (PNS).[2]
Central nervous system
The central nervous system (CNS) represents the largest part of the nervous
system, including the brain and the spinal cord. The CNS is contained within
the dorsal cavity, with the brain within the cranial cavity, and the spinal cord
in the spinal cavity. The CNS is covered by the meninges. The brain is also
protected by the skull, and the spinal cord is also protected by the vertebrae.
The nervous system can be connected into many systems that can function
together. The two systems are central nervous system (CNS) and the
peripheral nervous system (PNS).
Peripheral nervous system
The PNS consists of all the other nervous structures that do not lie in the
CNS. The large majority of what are commonly called nerves (which are
actually axonal processes of nerve cells) are considered to be PNS.
Microanatomy
The nervous system is, on a small scale, primarily made up of neurons.
However, glial cells also play a major role.
Neurons
Neurons are electrically excitable cells in the nervous system that process
and transmit information. Neurons are the core components of the brain, the
vertebrate spinal cord, the invertebrate ventral nerve cord, and the
peripheral nerves. A number of different types of neurons exist: sensory
neurons respond to touch, sound, light and numerous other stimuli effecting
sensory organs and send signals to the spinal cord and brain, motor neurons
receive signals from the brain and spinal cord and cause muscle
contractions and effect glands, Interneurons connect neurons to other
neurons with in the brain and spinal cord.
Glial cells
Glial cells are non-neuronal cells that provide support and nutrition, maintain
homeostasis, form myelin, and participate in signal transmission in the
nervous system. In the human brain, glia are estimated to outnumber
neurons by about 10 to 1.
Glial cells provide support and protection for neurons. They are thus known
as the "glue" of the nervous system. The four main functions of glial cells are
to surround neurons and hold them in place, to supply nutrients and oxygen
to neurons, to insulate one neuron from another, and to destroy pathogens
and remove dead neurons.
Physiological division
A less anatomical but much more functional division of the human nervous
system is that classifying it according to the role that the different neural
pathways play, regardless whether these cross through the CNS or the PNS:
The somatic nervous system is responsible for coordinating the body's
movements, and also for receiving external stimuli. It is the system that
regulates activities that are under conscious control.
Of digestion, it regulates from the esophagus to the stomach, small intestine
and colon.
In turn, these pathways can be divided according to the direction in which
they conduct stimuli:
 Afferent system by sensory neurons, which carry impulses from a
receptor to the CNS
  Efferent system by motor neurons, which carry impulses from the
CNS to an effector
 Relay system by relay neurons (also called interneurons), which
transmit impulses between the sensory and motor neurones.
However, there are relay neurons in the CNS as well.
The junction between two neurones is called a synapse. There is a very
narrow gap (about 20nm in width) between the neurons - the synaptic cleft,
where an action potential is transmitted from one neuron to a neighboring
one. They do this by relaying the message with the use of neurotransmitters
which the next neuron then receives the electrical signal, known as a nerve
impulse. The nerve impulse is determined by the neurotransmitter to then
carry the message to its appropriate destination. These nerve impulses are a
change in ion balance in the nerve cell, which the central nervous system
can then interpret. The fact that the nervous system uses a mixture of
electrical and chemical signals makes it incredibly fast, which is necessary to
acknowledge the presence of danger. For example, a hand touching a hot
stove. If the nervous system was only comprised of chemical signals, the
body would not tell the arm to move fast enough to escape dangerous burns.
So the speed of the nervous system is a necessity for life.
 Preventive antibiotics - to prevent bacterial heart conditions
Development
Some landmarks of embryonic neural development include the birth and
differentiation of neurons from stem cell precursors, the migration of
immature neurons from their birthplaces in the embryo to their final positions,
outgrowth of axons from neurons and guidance of the motile growth cone
through the embryo towards postsynaptic partners, the generation of
synapses between these axons and their postsynaptic partners, and finally
the lifelong changes in synapses which are thought to underlie learning and
memory.
Importance
Many people have lost basic motor skills and other skills because of spinal
cord injuries. If this portion is damaged, the biggest nerve and the most
important one get damaged. This leads to paralysis or other permanent
damage.
Abilities
The nervous system is able to make basic motor skills and other skills
possible. The basic 5 senses of texture, taste, sight, smell, and hearing are
powered by the nervous system. If disabled, basic motor skills may be lost.
Treatment List for Rheumatic heart disease
The list of treatments mentioned in various sources for Rheumatic heart
disease includes the following list. Always seek professional medical advice
about any treatment or change in treatment plans.
 Preventive antibiotics before surgery  Preventive antibiotics for tooth extraction
 Preventive antibiotics before dental procedures  Preventive antibiotics for an injury

Read more at http://www.wrongdiagnosis.com/r/rheumatic_heart_disease/treatments.htm?ktrack=kcplink#treatment_list

assessment DIAGNOSIS plan INTERVENTION RATIONALE EVALUATION

Independent:

Objectives: Potential for At the end of 1. Observed color/ 1. Yellow/ green At the end of 24
infection 24 to 48 hours odor purulent to 48 hours of
 Attached related to of nursing, characteristicsof odorous nursing
tracheos invasive intervention, sputum. Note sputum is intervention,
tomy tube procedure- patient will be drainage around indicate of patient was
 Long tracheostomy infection;
tracheostomy protected from protected from
hospital – tube. while thick,
lization tube possible possible
attached. potential 2. Reduced tenacious potential
infection. nosocomial risk sputum infection.
ex. suggests
Handwashing, dehydration.
maintaining 2. These factors
sterile suction may be the
technique. simplest but are
3. Encouraged the most
deep breathin, important keys
ito prevention of
coughing and
 hospital-
frequent acquired-
position infection.
changes. 3. Maximizes lung
4. Instructed expansion and
Significant others mobilization of
and patient in secretions to
proper secretion prevent/reduce
disposal ex. accumulation of
Tissues soiled secretions.
tracheostomy 4. Reduces
dressing. transmission of
fluid-borne
organisms.
Dependent:

5. Administer
antimicrobials as
indicated. 5. One or more
may be used
dependent on
identified
pathogens if
infection does
occur.
 Assessment DIAGNOSIS planning INTERVENTION RATIONALE EVALUATION

Independent:

Objectives: Altered At the end of 1. Monitored 1. These symptoms At the end of 3

Nutrition: less 3 days to 1 patient’s are indicative of days to 1 week
 poor than body week nursing generalized depletion of nursing
muscle requirements. intervention, muscle wasting. muscle energy and intervention,
tone patient will be 2. Documented oral can reduce patient was able
 poor skin intake if/when respiratory muscle
able to to increased
turgor consumed. Offer function.
 body increase body body weight to a
weight to a foods that patient 2. Appetite is usually more desirable
malaise
 Sunken more enjoys. poor and intake of weight within
eyeballs desirable 3. Providedsmall essential nutrients normal limits.
frequent feedings may be reduced.
weight within
of soft/ easily Offering favorite
normal limits.
digested foods if foods can enhance
able to swallow. oral intake.
3. Prevents
excessive
 fatigue,enhances
Dependent: intake and reduces
risk of gastric
4. Administer fluid distress.
intake of atleast 4. Prevents
2500 ml/ day dehydration that
within cardiac can be
tolerance. exacerbated by
5. Adjusted diet with increased
help of dietician insensible losses
to meet and reduces risk of
respiratory constipation.
needs.
 Assessment DIAGNOSIS planning INTERVENTION RATIONALE EVALUATION

Independent:

Objectives: Activity At the end of 1. Adjusted 1. Prevents At the end of

intolerance 24 hours activities as overexertion, allows 24 hours
 weak in related to nursing necessary, for some activity nursing
appearance generalized intervention reducing within patient ability. intervention
 limited range weakness. patient will intensity level/ 2. Provides for sense patient was
of motion discontinuing of control and feeling
be able to able to remain
 decreased activities as of accomplishments.
performance remain free free of
of indicated. 3. Enhances preventable
 inability to
maintain preventable 2. Encouraged performance while discomfort.
usual routines discomfort. patient to do conserving limited
whatever energy, preventing
possible ex. increase in level of
Self care. fatigue.
3. Stressed 4. Necessary to meet
necessities in energy needs for
of allowing for activity.
frequent rest 5. Increase
periods. oxygenation.
4. Encouraged Evaluates
 nutritional eefctiveness in
intake/ use of therapy.
supplements as
appropriate.

Dependent:

5. Administer O2
at 2l/min to
sustain patient
oxygenation, if
necessary.