Rheumatic heart disease is an autoimmune disease that normally occurs after an episodic Beta- hemolytic streptococcus infection. It is a non-suppurative infection means there is no evidence of pus formation.
After Beta hemolytic infection an antibody is developed to fight infection, but due to some similarities of beta hemolyticus bacterial cell membrane and some of our own body cells like osteocytes, myocardial cells, brain cells, and skin cells.
Having these types of similarities previously developed antibody starts attacking our own body, and can develop very different types of Rheumatic disease.
ICD11 classification:- According to ICD 11 Rheumatic fever with heart involvement is classified in 1B42
Cause- Streptococcus Beta Hemolyticus Infection
Epidemiology/ Incidence- it affects 395/10000 people every year and 9.2/100000 people died because of it.
pathophysiology -
Repidic episode of streptococcal Beta hemolyticus infection
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Antibodies generated by body's immune response
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Due to similarities of some body cells with the causative organism ( Beta hemolyticus)
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Stated attacking their own healthy body cells
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- JOINTS:- Rheumatic Arthritis
- HEART
- Endothelium (Rheumatic Endocarditis)
- the myocardium (Rheumatic Myocarditis)
- Pericardial (Rheumatic pericarditis)
- If all 3 layers are affected then it is known as "pencarditis"
- CNS:- Sydenham's chorea ( An inflammation of basal ganglia)
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RHEUMATIC HEART DISEASE occurs
Signs and Symptoms:-
- Fever
- Swollen painful joints ( Arthralgia)
- Sinus tachycardia
- There are different types of S/S that appear in every type of Rheumatic heart disease which is following.
- Pericardial chest pain ( featured by sharp and well-localized pain)
- pericardial Rub:- Screechy heart sound due to friction of pericardial layers with each other.
3) Rheumatic Endocarditis:-
- In rheumatic endocarditis, valvular stenosis is seen mostly, due to this valvular stenosis some common symptoms began to appear.
- sinus tachycardia
- chest pain
- Hypertension
- Agitation
- Palpitation
- Valvular vegetation ( Formation of small nodules at the opening of heart valves)
- Palpitation
- Restlessness
- Nausea
- Discomfort
- Echocardiography
- ECG
- Blood test for sensitivity for GAS( group A streptococcus)
- Chest X-Ray
- Treatment:- There is no cure for rheumatic heart disease, but some medicines are prescribed to reduce the risk and complications, in the case of valvular stenosis surgical interventions are done
- Antibiotic drugs:-
- Aim- To reduce infection and kill bacteria
- Choice- Penicillin
- NSAID drugs-
- Aim- To relieve the pain of infection, reduce inflammation, to stop the spreading of infection. NSAID drugs have broad and very unknown effects.
- Choice- Ibuprofen
- Antihypertensive drugs-
- To reduce elevated blood pressure
- Choice- Atrovastitine
- Surgical Treatment:- It is only needed in the case of endocarditis RHD. If the heart valve is badly affected and stenosis occurs then open-heart surgery is performed to repair the valve.
- Mainly the heart valve is changed with bioprosthetics.
Nursing care:-
- Assessment:-
- Assess the heart rate very closely
- Assess the patient's mobility and physical activity
- Assess vital signs regularly
- Nursing Diagnosis:-
- Acute chest pain Related to an inflammatory process or GAS infection
- Decreased cardiac output Related to Valvular stenosis
- Activity intolerance is Related to decrease oxygen supply to body organ
- Nutritional level imbalance related to hospitalization or infection
- Nursing Intervention:-
- Goal- To relieve pain
- Ask the patient to lean forward to reduce pericardial chest pain
- Tell the patient to breathe slowly
- Provide good bed rest for client
- Administer analgesic drugs according to prescription
- Provide recreational therapy
- Goal- To decrease body temperature
- Provide tepid sponging to reduce the temperature
- maintain room temperature
- remove excessive bedsheets from the bed
- Administer antibiotic drugs
- Goal- Reduce the risk of cardiac arrest
- Monitor vital signs especially blood pressure
- encourage the patient to drink water
- Administer prescribed medicine
- Prepare patient for surgical procedure in the case of valvular stenosis
- Don't leave the patient alone in the room
- Keep the bell within reach of the patient
- Goal- Maintain the weight of the client
- Assess the patient eating habits
- Assess the skin turgor of the client
- Ask the patient about his/her likes or dislikes about food
- Provide a small and frequent meal
- Provide a soft diet to the client.
