Rheumatic Fever and Related Conditions

This set of flashcards covers key concepts related to rheumatic fever, endocarditis, myocarditis, and cardiomyopathies, helping to reinforce understanding of symptoms, treatments, and complications.

Rheumatic Fever

A systemic inflammatory disease caused by an abnormal immune response to a pharyngeal infection, typically from streptococcus.

Complications of Rheumatic Fever

Can lead to serious complications affecting the heart, joints, skin, and brain if not treated promptly.

Rheumatic Heart Disease

A condition where significant long-term damage to heart valves occurs due to rheumatic fever.

Common Heart Valves Affected

Primarily the mitral and aortic valves, leading to stenosis or regurgitation.

Manifestations of Rheumatic Fever

Common symptoms include fever, joint pain, carditis, subcutaneous nodules, and Sydenham’s chorea.

Sydenham’s Chorea

A neurological manifestation of rheumatic fever characterized by involuntary movements and behavior changes.

Subcutaneous Nodules Appearance

Firm, painless nodules that appear over the extensors of joints such as wrist and knee.

Cardiac Symptoms of Rheumatic Fever

Chest pain, friction rub, and heart murmur indicating inflammation of the heart.

Changes in Rheumatic Heart Disease

Valve leaflets become rigid and deformed, leading to stenosis or regurgitation.

Long-term Effects of Carditis

Include cardiomegaly, valvular disease, heart failure, and pericardial effusion.

Diagnostic Tests for Rheumatic Fever

Include erythrocyte sedimentation rate, C-reactive protein, throat culture, and ASO titer.

Erythrocyte Sedimentation Rate (ESR)

An elevated ESR indicates the presence of inflammation.

C-Reactive Protein Significance

A positive test indicates an inflammatory process is present.

Throat Culture Findings

Positive for group A beta-hemolytic streptococcus in 25-40% of cases of acute rheumatic fever.

Antistreptolysin O (ASO) Titer

Measures streptococcal antibodies that rise with recent infection.

Medications for Rheumatic Fever

Antibiotics to kill bacteria, NSAIDs for pain and fever, and corticosteroids for extreme inflammation.

Nursing Management Focus

Relieve joint pain, monitor cardiac function, and educate patients about treatment adherence.

Endocarditis Definition

Inflammation of the endocardium caused by a microorganism entering the bloodstream.

Pathogen Entry Mechanisms

Pathogens can enter through oral lesions, dental work, IV drug use, or infections.

Symptoms of Endocarditis

Fever, flu-like symptoms, cough, shortness of breath, and arthralgias.

Physical Manifestations of Endocarditis

Include petechiae, splinter hemorrhages, Roth spots, Janeway lesions, and Osler nodes.

Risk Factors for Endocarditis

Previous heart damage, dental procedures, poor dental health, and IV drug use.

Murmurs in Endocarditis

Murmurs indicate turbulent blood flow due to valve damage and occur in 90% of cases.

Supportive Care in Endocarditis

Helps manage symptoms and complications associated with endocarditis.

Goal of Preventing Recurrence

Reduce the risk of future episodes of endocarditis with prophylactic antibiotics.

Education on Valvular Disease Symptoms

Important for early detection and management of complications like shortness of breath.

Relationship Between Heart Failure and Endocarditis

Endocarditis can exacerbate heart failure symptoms and complicate management.

Common Causes of Infective Endocarditis

Usually caused by foreign bacteria entering the bloodstream, commonly streptococcus and staphylococcus.

Janeway Lesions

Non-painful erythematous macules found on palms and soles associated with endocarditis.

Role of Splenomegaly in Endocarditis

May indicate systemic involvement due to infection.

Roth Spots Significance

Retinal findings indicating embolic events related to endocarditis.

Blood Cultures in Endocarditis

Used to identify bacteria or fungi in the bloodstream crucial for diagnosis.

Echocardiogram Role

Visualizes heart structure and function to detect vegetations or abnormalities.

Immune Testing in Endocarditis

Evaluates immune response to infections, helping to diagnose and assess endocarditis.

CBC and ESR in Endocarditis Diagnosis

Assess infection presence and inflammation, aiding diagnosis.

Duration of Antibiotic Therapy

Typically lasts 2 to 8 weeks; common duration is 4 to 6 weeks.

Purpose of Prophylactic Antibiotics

Prevent bacterial endocarditis in at-risk patients during dental procedures.

Complications of Endocarditis

Include embolization, heart failure, abscesses, and aneurysms.

Organs Affected by Embolization

Can affect the lungs, brain, kidneys, skin, and mucous membranes.

Patient Education for Endocarditis

Focus on infection awareness, valve damage prevention, and symptom recognition.

Myocarditis Definition

Inflammation of the myocardial wall caused by microorganisms, drugs, or toxins.

Signs/Symptoms of Myocarditis

Nonspecific inflammatory responses; may include fever and muffled heart sounds.

Cardiac Markers in Myocarditis Diagnosis

Increased cardiac markers indicate myocardial injury.

Diagnostic Tests for Myocarditis

Includes increased cardiac markers, ST changes on ECG, dysrhythmias, and biopsy.

Treatment Options for Myocarditis

Include antivirals, immunosuppressive therapy, antidysrhythmics, and anticoagulants.

Nursing Interventions for Myocarditis

Include activity restrictions and regular assessment for heart failure.

Pericarditis Definition

Inflammation of the pericardium, presenting as acute or chronic illness.

Normal Pericardial Fluid Volume

10-50 mL, serving as a lubricant for the heart.

Fluid Volume in Pericarditis

Exceeds 50 mL, potentially leading to pericardial effusion.

Acute Manifestations of Pericarditis

Chest pain, EKG changes, pericardial friction rub, effusion, and fever.

Complications of Pericarditis

Include pericardial effusion, cardiac tamponade, and chronic constrictive pericarditis.

Pericardial Effusion Definition

Accumulates fluid in pericardial sac, possibly requiring pericardiocentesis.

Cardiac Tamponade Definition

Excess fluid puts pressure on the heart, preventing proper beating.

Signs of Chronic Constrictive Pericarditis

Include decreased cardiac output, paradoxical pulse, and peripheral edema.

Diagnosis of Pericarditis

Involves white blood cell count, echocardiogram, and imaging.

Treatments for Pericarditis

Include NSAIDs, acetaminophen, and pericardiocentesis.

Surgical Procedure for Pericardium

Involves removing tissue for fluid drainage in chronic cases.

Right Sided Heart Failure Definition

Occurs when blood backs up in systemic circulation due to right heart issues.

Left Sided Heart Failure Definition

The most common type of heart failure, leading to pulmonary congestion.

Valvular Heart Disease Definition

Conditions that interfere with blood flow within and from the heart.

Mitral Stenosis Definition

Narrowing of the mitral valve, obstructing blood flow during diastole.

Manifestations of Mitral Stenosis

Include dyspnea, cough, fatigue, and possible atrial fibrillation.

Mitral Regurgitation Definition

Occurs when the mitral valve does not close properly, allowing back flow.

Common Manifestations of Mitral Regurgitation

Include dyspnea on exertion, fatigue, and signs of heart failure.

Tricuspid Stenosis Definition

Narrowing of the tricuspid valve obstructing blood flow to the right ventricle.

Impact of Tricuspid Stenosis

Leads to right atrial enlargement and possible right-sided heart failure.

Tricuspid Regurgitation Consequences

Can cause atrial overload and symptoms of heart failure.

Aortic Stenosis Definition

Obstruction of blood flow from the left ventricle to the aorta.

Manifestations of Aortic Stenosis

Include left ventricular failure, dyspnea, angina, and syncope.

Aortic Regurgitation Mechanism

Allows backflow of blood into the left ventricle during diastole.

Symptoms of Aortic Regurgitation

Include left ventricular hypertrophy and nocturnal angina.

Pulmonic Stenosis Definition

Obstructs blood flow from the right ventricle to the pulmonary system.

Severe Pulmonic Stenosis Effects

Leads to right ventricular hypertrophy and decreased cardiac output.

Pulmonic Regurgitation Definition

Incomplete closure of the valve between the right ventricle and pulmonary system.

Medications for Valvular Disorders

Include ACE inhibitors, diuretics, and prophylactic antibiotics.

Right-sided Heart Failure Relation to Valvular Conditions

Due to increased workload from tricuspid and pulmonic dysfunctions.

Aortic Stenosis and Myocardial Ischemia Relationship

Ventricular hypertrophy from aortic stenosis increases oxygen demand.

Treatments for Valvular Disorders

Include percutaneous balloon valvotomy, and valve replacement options.

Cardiomyopathy Definition

Disorders of the heart muscle affecting its structure and function.

Dilated Cardiomyopathy Characteristics

Dilation of heart chambers and reduced contractility leading to heart failure.

Hypertrophic Cardiomyopathy Effects

Decreased compliance and hypertrophy impairing ventricular filling.

Restrictive Cardiomyopathy Features

Rigid ventricular walls impair diastolic filling, leading to heart failure.

Medications for Cardiomyopathy

Include ACE inhibitors and anticoagulants, avoiding certain dysrhythmics.