Nature and Description

complication of Rheumatic fever cardiac and valvular manifestation of Rheumatic fever Refers to the chronic heart valve damage that leads to heart failure Its 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 phase Rheumatic fever & Rheumatic Heart disease afflict about 1,800,000 Americans Affects 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 -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) 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. Predisposing Factors :

Rheumatic Fever Anitgens of GAS bind to receptors

Damage heart valves (MITRAL VALVE) Antibodies may attack healthy cells Mitral Valve Disease Laden with heavy calcium deposits

Often produces inflammation of heart (carditis)

Aotic valve stenosis or regurgitation in both

Prevent the valve from closing completely

Failure of the valve to open completely

Mitral stenosis

Mitral regurgitation (leaky valve)

Higher pressure must be generated to propel blood

Regurgitation of blood

Atrial Fibrillation

Increase workload on the heart muscle Heart Failure

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 test Determine 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 size It 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.) Corticosteroids 2.) ACE inhibitors 3.) Digoxin increase contractility 4.) Diuretics 5.) 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 therapy Check for antibiotic allergies, especially to penicillins and cephalosporins, before administering drugs from these classes Instruct 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 muscles Emphasize 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 diversions Promote good dental hygiene to prevent infection

Prevention
1. For clients 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 K2 Formerly 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.