Structural cardiac disorers

1. Infectious disorders 2. Valvular heart disease 3. Congenital disorders

Infectious disoredrs
Bacteria and other microbes are found in abundance in our environment. The heart can become infected by these microbes, a process that prompts inflammatory response. Involvement of the heart can be lethal during the acute stage or lead to structural damage

Rheumatic fever
Introduction: It is a diffuse inflammatory disease. It is a delayed response to an infection by group. Caused by 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.

Risk Factors
5-15 years old Family history of RF Low socioeconomic status (poverty, poor hygiene, medical deprivation) Untreated strepthroat

Pathophysiology & Sign/Symptoms

Causative agent Group A Beta-hemolytic streptococci Untreated strep throat Abnormal Humoral cell mediated response Antigen binds and starts inflammtion Heart Carditis Fever joints Arthritis pain Skin
S\C nodules

Brain
chorea

Other tissues

All layers of the heart and the mitral valve become inflammed Vegetation forms Valvular Regurgitation and stenosis Heart Failure

Erythmea marginatum

Signs and Symptoms

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

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 indicating inflammation. Cardiac enzmes levels may increase in severe carditis. Anti streptolysin- O titer 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.

Medical management
Goals: 1. Eradicating infection 2. Maximizing cardiac output 3. Prompting comfort

1. Eradicating infection
Administer antibiotics Penicillin if allergic then erythromycin 2. Maximizing cardiac output Corticosteroid to treat carditis Cardiac glycosides and diuretics in case of heart failure 3. Prompting comfort Salicylates Bed rest

Nursing Diagnosis
Activity intolerance related to reduced cardiac reserve and enforced bed rest Acute Pain related to migratory inflammation of the joints. Hyperthermia related to inflammatory process Altered Nutrition less than body requirement related to fever, inflammation, anorexia and fatigue.

Activity intolerance related to reduced cardiac reserve and enforced bed rest Provide bed rest to reduce myocardial oxygen demend Assess level of activity progression Assess V/S before and after exercise reduce activity if chest pain Protective measures for client with chorea

Nursing Intervention
Acute Pain related to migratory inflammation of the joints. -Assess the level of pain - provide analgesic -Provide adequate rest periods. To prevent fatigue. -use diversional therapies

 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.

 Altered Nutrition less than body requirement related to fever, inflammation, anorexia and fatigue. - High protein, high carbohydrate diet -vitamin and dietary supplements -maintain oral hygiene every 4 hourly. -Provide small and frequent meals. -encourage fluid intake to prevent dehydration

Surgical Treatment
Severe mitral or aortic valve dysfunction that causes persistent heart failure requires corrective surgery such as: Commissurotomy Valvuloplasty Valve replacement

Commissurotomy

Valvuloplasty

Valve Replacement