Rheumatic Heart Disease

Nature and Description

complication of Rheumatic fever cardiac and valvular manifestation of Rheumatic feverRefers to the chronic heart valve damage that leads to heart failureIts incidence has been greatly reduced by widespread use of antibiotics effective against the streptococcal bacterium that causes Rheumatic fever

Nature and Description

Includes carditis (myocarditis, endocarditis, & pericarditis) during the early acute phase and chronic valve disease in the later phaseRheumatic fever & Rheumatic Heart disease afflict about 1,800,000 AmericansAffects about half the people who have Rheumatic fever with carditis Rheumatic Heart disease is diagnosed 10 -20 years after being “triggered” by acute rheumatic fever

Definition of Terms

Rheumatism is a medical term once frequently used to describe disorders associated with many different parts of the body.

might apply to the symptoms of numerous conditions that can cause pain and/or weakness.

Definition of Terms

The group A streptococcus bacterium (Streptococcus pyogenes, or GAS) is a form of β-hemolytic Streptococcus bacteria responsible for most cases of streptococcal illness. Other types (B, C, D, and G) may also cause infection. Several virulence factors contribute to the pathogenesis of GAS, such as M protein, hemolysins, and extracellular enzymes.

Pathophysiology

GAS (group- A streptococcus)

Rheumatic Fever

Often produces inflammation of heart

(carditis)

Damage heart valves (MITRAL VALVE)

Mitral Valve Disease

Laden with heavy calcium deposits

Predisposing Factors :

—AGE – 90% occur between the ages of 5 – 15 y.o. - Also the AGED, severe cardiac disability and death. —SOCIOECONOMIC FACTORS – slum, city dweller more than the farmer. — GENETICS – may appear to develop in household members.Anitgens of GAS bind to

receptors

Antibodies may attack healthy cells

Aotic valve stenosis or regurgitation in both

Prevent the valve from closing completely

Failure of the valve to open completely

Mitral regurgitation (leaky valve)

Mitral stenosis

Atrial Fibrillation

Increase workload on the heart muscle

Heart Failure

Higher pressure must be generated to

propel blood

Regurgitation of blood

Signs and Symptoms

Pleuritic chest pain refers to pain arising from pleural irritation

characterically sharp in nature, well localised and exacerbated by inspiration, and is thus

a form of somatic pain,

Dyspnea Tachypnea Fatigue Fainting attacks Palpitations Nonproductive cough Bibasilar crackles & edema due to heart

failure

Diagnostics

1.) Blood testDetermine Hemoglobin level and

Hematocrit ( may show slight anemia due to suppression of erythropoiesis during inflammation and elevated ESR)

Determine WBC (may be elevated)Cardiac enzyme may be increased in

severe carditis

Diagnostics

2.) Chest X-rays may show normal heart size or cardiomegaly, pericardial effusion, or heart failure

3.) Echocardiography provides various findings

It can detect valvular damage and preicardial effusion

It can measure chamber sizeIt can provide information on

ventricular function

Treatment

1.) Corticosteroids for carditis or if salicylates fail to relieve pain and inflammation

2.) Strict bed rest for about 5 weeks for patients with active carditis

3.) Bed rest, sodium restriction, ACE inhibitors, digoxin, and diuretics to treat heart failure

4.) Corrective surgery, such as commissurotomy (separation of adhered valves or surrounding tissues), valvuplasty, or valve replacement for severe mitral or aortic valvular dysfunction that causes persistent heart failure

COMMISSUROTOMY

5.) Coumadin rheumatic mitral disease and atrial fibrillation

Drug Study

1.) Corticosteroids2.) ACE inhibitors3.) Digoxin – increase contractility4.) Diuretics5.) Coumadin

Corticosteroids

Corticosteroids, also called glucocorticoids or just "steroids", are powerful drugs that can quickly reduce inflammation and pain.

ACE Inhibitors

Angiotensin II is a very potent chemical that causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing high blood pressure (hypertension).

Digoxin

Digoxin otherwise known as Digitalis is a cardiac glycoside derived from Digitalis lanata. It is widely used in the treatment of several heart conditions like atrial fibrillation, atrial flutter, and at times heart failure.

Diuretics

GENERIC NAME: furosemide BRAND NAME: Lasix

DRUG CLASS AND MECHANISM: Furosemide is a potent diuretic (water pill) that is used to eliminate water and salt from the body. In the kidneys, salt (composed of sodium and chloride), water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney.

Coumadin

GENERIC NAME: warfarin BRAND NAME: Coumadin

DRUG CLASS AND MECHANISM: Coumadin is an oral anticoagulant that inhibits the synthesis of clotting factors, thus preventing blood clot formation.

Nursing Considerations:

Teach patient about the disease and the need for prolonged antibiotic therapy promote compliance with the prescribed therapyCheck for antibiotic allergies, especially to penicillins and cephalosporins, before administering drugs from these classesInstruct the patient and his family to report early signs of heart failure, such as dyspnea and a hacking, nonproductive cough

It is important to have regular monitoring of the condition of the heart valves ad musclesEmphasize that it should be under the watchful eye of an experienced cardiologists

Stress the need for bed rest during the acute phase and suggest appropriate, physically undemanding diversionsPromote good dental hygiene to prevent infection

Prevention

1. For client’s with Rheumatic fever. should be on preventive, or

prophylactic, therapy with antibiotics to prevent recurrence

Should have physical examination annually to monitor heart size

2. Echocardiogram Confirm presence or absence of heart

valve damage

Echocardiogram

Update:

Vitamin K2Formerly “Activator X”Dr. Weston Price identified this

compound he called Activator X in butterfat, organs and fat of animals consuming rapidly growing green grass, and in certain sea foods such as fish eggs. Price died before the factor was finally identified.

continuation

Activator X, now known as vitamin K2, does protect against tooth decay, supports growth and development and is involved in normal reproduction; it protects against calcification of the arteries that leads to heart disease, and is a major component of the brain.

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