I.

Definition:
Is a diffuse inflammatory disease A delayed response to Group A hemolytic streptococcus due to untreated or partially treated infection Rheumatic heart disease serious complication of RF -was formerly one of the most serious forms of heart disease of childhood and adolescence, involving damage to the entire heart and its membranes.

II. Anatomy & Physiology of the Heart

HEART: - It is a small four-chambered muscular pump, weighing approximately 11 ounces and approximately the size of a mans fist. -It is located within the mediastinium which is the space between the lungs and throracic cavity.

FUNCTIONAL ANATOMY OF THE HEART

The 3 walls of the heart Pericardium: consists of a tough outer fibrous layer and a thin serous layer.

Myocardium: the muscular portion and is composed of actin and myosin Endocardium: the innermost portion of the heart which comprises of the auricles

The Heart Valves Tricuspid Valve: located between the R atrium and R ventricle, it has 3 triangular flaps Bicuspid/ Mitral valve: located between the L atrium and L ventricle and is having two flaps. Aortic and Pulmonary semilunar valves; composed of three halfmoon shaped pockets that catch the blood and balloon out to close the orifices.

Electrophysiologic Properties of the Heart. Excitability; it is the ability of the cardiac muscle to depolarize in response to any stimulus. Automaticity/ Rhythmicity; it is the ability of the cardiac cells to initiate an impulse spontaneously and repetitively without external neurohormonal control. Refractoriness: hearts inability to respond to a new stimulus while in state of contraction due to earlier stimulus.

Conductivity:

Regulation of Cardiac Performance

Preload: ventricular filling, the work imposed to the heart before the contraction begins. Afterload: the tension work of the heart. The work presented to the heart after contraction. Cardiac Contractility: refers to the ability of the heart to change its force of contraction without changing its resting length. Heart Rate: determines the frequency with which blood is ejected from the heart.

Circulation Process

III. Pathphysiology

IV. Diagnostic Assessment

( +) throat culture of group A - hemolytic streptococcus Elevated WBC Elevated Erythrocyte sedimentation rate C-reactive protein Prolonged PR interval

V. Clinical Manifestations
Jones Criteria: A method of identifying patients with a high likelihood of having Rheumatic fever. Evidence of recent streptococcal infection (eg history of scarlet fever, positive throat swab) Plus 2 major criteria Or 1 major and 2 minor criteria

Major Criteria

Arthritis

Erythema Marginatum

Subcutaneous Nodules

Sydenham Chorea

Carditis

Minor symptoms
Clinical Findings - Arthralgia - Fever Laboratory Findings (presented in diagnostic assessment)

VI. Pharmacotherapy
Penicillin Erythromycin Corticosteroids Analgesics Cardiac glycosides Diuretics

Nursing Diagnoses
Pain r/t inflammatory response Activity Intolerance r/t reduced cardiac reserve and enforced bed rest Altered Nutrition: Less than body requirements r/t fever and infection associated with RF Altered Health Maintenance r/t preventive measures against initial and recurring attacks of RF