Rheumatic Heart Disease and Rheumatic Fever

Vocabulary flashcards detailing the causes, clinical features, pathophysiology, complications, diagnostics, medical treatments, and nursing care for Rheumatic Fever and Rheumatic Heart Disease.

Rheumatic Fever

A diffuse inflammatory disease occurring as a delayed response to infection by a group of beta-hemolytic streptococci.

Risk Factors for Rheumatic Fever

Poor hygiene, overcrowding, and poverty.

Clinical Features of Rheumatic Fever

Fever, arthritis, carditis, small painless firm subcutaneous nodules, erythema margnatum, chorea, and abdominal pain.

Erythema Margnatum

An unusual rash on the trunk presented as a clinical feature of rheumatic fever.

Chorea

Sudden and irregular CNS disorders occurring as a clinical feature of rheumatic fever.

Pathophysiology of Rheumatic Heart Disease

A non-infectious sensitivity or inflammatory reaction to streptococci where leucocytes accumulate in affected tissue to form nodules that are eventually replaced by scar tissue.

Rheumatic Myocarditis

Inflammation of the myocardium during the acute phase that temporarily weakens heart power, characteristically marked by an unusual rapid and irregular pulse.

Rheumatic Pericarditis

Inflammation of the pericardium in severe acute cases, which can be dry with a friction rub heard at the left sternal edge in the 4th intercostal space, or wet with pericardial effusion.

Cardiac Tamponade

A condition caused when too much fluid from a wet pericardial effusion presses on the heart.

Rheumatic Endocarditis

Inflammation of the endocardium with serious crippling adverse effects on the valves, leading to bacterial vegetation and small clots (thrombi) attracting fibrin, RBC, and platelets.

Valvular Regurgitation

A complication caused by thickening and shortening of the valves that allows blood to flow back wall through the valves, occurring most commonly in the mitral valve.

Valvular Stenosis

A condition occurring when the inflamed margins of valve leaflets become adherent.

Rheumatic Endocarditis Vegetation

Small clots (thrombi) on roughened valve areas attracting fibrin, RBC, and platelets, which cause scarring and heart sound alterations but, unlike bacterial endocarditis, rarely break off to become emboli.

Diagnostic Methods for Rheumatic Heart Disease

History and physical examination, throat swab, and ECG.

Penicillin Management

One time benzathine penicillin 1.2mg followed by a 10 days course of oral penicillin, with erythromycin/cephalosporin used for patients allergic to penicillin.

Prophylactic Penicillin Treatment

Intramuscular penicillin given every 3-4 weeks to prevent recurrence for 3-5 yrs or until the age of 7-21 yrs.

Anti-inflammatory and Steroid Medications

Aspirin 1gm 4hrly, Hydrocortisone 20mg 2-3 times, and Prednisolone 4-30mg/day.

Chorea Management Medications

Diazepam and phenobarbitol.

Nursing Management Interventions

Putting the patient on complete bed rest, nursing in a recumbent position, hourly vital observations, using a bed craddle, providing well balanced meals, and advising slowly progressive passive exercise in bed and occupational therapy.

Chronic Rheumatic Heart Disease

A condition following the acute stage that causes chronic inflammation, thickening, and loss of elasticity/function of heart valves, leading to mitral valve stenosis/incompetence and aortic valve stenosis/incompetence.