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    BSC Nursing: Medical Surgical Nursing Unit V - Disorders of The Cardio Vascular System

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    Poova Ragavan
    Rheumatic heart disease is a chronic condition caused by rheumatic fever, which results from a previous untreated Group A streptococcal infection. It involves inflammation and scarring of the heart valves, most commonly affecting the mitral and aortic valves and causing stenosis or regurgitation. Symptoms vary depending on the affected valves but can include heart failure, arrhythmias, and embolic events. Treatment involves antibiotics, medications, surgery such as valve repair or replacement, and lifelong prophylactic antibiotics to prevent future streptococcal infections. Nursing care focuses on managing symptoms, educating patients, and preventing complications.

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    BSC Nursing: Medical Surgical Nursing Unit V - Disorders of The Cardio Vascular System

    Uploaded by

    Poova Ragavan
    205 views34 pages
    Rheumatic heart disease is a chronic condition caused by rheumatic fever, which results from a previous untreated Group A streptococcal infection. It involves inflammation and scarring of the heart valves, most commonly affecting the mitral and aortic valves and causing stenosis or regurgitation. Symptoms vary depending on the affected valves but can include heart failure, arrhythmias, and embolic events. Treatment involves antibiotics, medications, surgery such as valve repair or replacement, and lifelong prophylactic antibiotics to prevent future streptococcal infections. Nursing care focuses on managing symptoms, educating patients, and preventing complications.

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    Rheumatic Heart Disease

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    Rheumatic heart disease is a chronic condition caused by rheumatic fever, which results from a previous untreated Group A streptococcal infection. It involves inflammation and scarring of the heart valves, most commonly affecting the mitral and aortic valves and causing stenosis or regurgitation. Symptoms vary depending on the affected valves but can include heart failure, arrhythmias, and embolic events. Treatment involves antibiotics, medications, surgery such as valve repair or replacement, and lifelong prophylactic antibiotics to prevent future streptococcal infections. Nursing care focuses on managing symptoms, educating patients, and preventing complications.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    205 views34 pages

    BSC Nursing: Medical Surgical Nursing Unit V - Disorders of The Cardio Vascular System

    Uploaded by

    Poova Ragavan
    Rheumatic heart disease is a chronic condition caused by rheumatic fever, which results from a previous untreated Group A streptococcal infection. It involves inflammation and scarring of the heart valves, most commonly affecting the mitral and aortic valves and causing stenosis or regurgitation. Symptoms vary depending on the affected valves but can include heart failure, arrhythmias, and embolic events. Treatment involves antibiotics, medications, surgery such as valve repair or replacement, and lifelong prophylactic antibiotics to prevent future streptococcal infections. Nursing care focuses on managing symptoms, educating patients, and preventing complications.

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    BSC NURSING

    MEDICAL SURGICAL NURSING


    UNIT V – DISORDERS OF THE
    CARDIO VASCULAR SYSTEM
    RHEUMATIC HEART DISEASE
    Objectives

    • Define Rheumatic fever and rheumatic heart


    disease.
    • Describe the etiology, risk factors, clinical
    manifestations, diagnostic criteria and
    management of RHD.
    • Explain the pathophysiology of RHD.

    • Describe the management of RHD.


    Introduction

    Rheumatic fever is a diffuse inflammatory disease


    characterized by a delayed response to an infection
    by group A beta hemolytic streptococci ( GABS )
    in the tonsilopharyngeal area, affecting the heart,
    joints, central nervous system, skin and
    subcutaneous tissues.

    Rheumatic heart disease condition caused by


    rheumatic fever that can be prevented and controlled.
    Definition

    • Rheumatic heart disease is a chronic condition


    resulting from rheumatic fever which involves all the
    layers of the heart ( pancarditis) and is
    characterized by scarring and deformity of the heart
    valves.
    • The commonest valves affecting are the mitral and
    aortic also affects all four valves either results in
    stenosis or regurgitation.
    Etiology
    • Group A beta hemolytic streptococcus.
    • Rheumatic fever
    • Everyday oral activities such as brushing and chewing
    food
    • An infection or other medical condition such as skin sore,
    gum diseases and sexually transmitted disease.
    • Weakened immune system
    • Certain dental procedures.
    Risk factors

    • Poor socio economic status


    • Over crowding
    • Age appears most commonly in children between
    the age of 5 to 15 years.
    • Climate and season
    • Upper respiratory tract infection
    • Previous history of rheumatic fever
    • Genetic predisposition
    Pathophysiology

    Causative agent ( Group A Beta hemolytic


    streptococci)
    ↓
    Untreated strep throat
    ↓
    Rheumatic fever
    ↓
    All layers of the heart and the mitral valve become
    inflamed
    Pathophysiology

    Vegetation forms
    ↓
    Chordae tendinae shortening, leaflet thickeninng,
    commisural fusion of valve leaflets
    ↓
    Valvular regurgitations and stenosis
    ↓
    Heart failure
    Clinical manifestations

    Major manifestations:
    •J-Joint inflammation- Polyarthritis

    •O- Carditis inflammation of the layers of the heart

    •N-nodule formations under the subcutaneous tissue.

    •E-Erythema marginatum map like non pruritic lesions on


    skin
    •S-Sydenham’s chorea neurological manifestation.
    Clinical
    Clinical manifestations
    Manifestation
    Jones Criteria: Major Criteria
     Carditis
     Mono or polyarthritis
     Chorea (sydenham’s chorea)
     Erythema marginatum
     Subcutaneous nodules
    Minor Criteria
     Fever
     Polyarthralgia
     Elevated ESR, WBC & CRP
     ECG – prolonged P-R interval
    Major criteria

    Arthritis Carditis
    Erythema
    Marginatum
    Subcutaneous Nodule
    Minor manifestations

    • C- Increased C reactive protein

    • A- Arthralgia

    • F- fever

    • E- Epistaxis, Increased erythrocyte


    sedimentation rate.
    Diagnostic evaluation

    • Modified Jones Criteria is used for diagnosing


    RHD
    • 2 Major + Essential criteria

    • 1 Major+ 2 Minor + Essential criteria

    • Along with evidence of streptococcal infection.


    Laboratory investigations

    • High ESR

    • Anemia, leucocytosis, Aschoff bodies present


    in pericardium, perivascular regions of
    myocardium, endocardium
    • Elevated C-reactive protein

    • Elevated ASO or other streptococcal antibody


    titer
    Laboratory investigations

    • Anti-D Nase B test

    • Throat culture-GABH streptococci

    • ECG: prolonged PR interval

    • Chest x ray

    • Echocardiography, Cardiac catherization.


    Prolonged P-R interval
    Management

    Antibiotic therapy:-
    • Oral penicillin 500 mg BD x 10 days OR
    • A single dose of Benzathine penicillin 1.2 million
    units I/M
    • Tab. Erythromycin 250 mg BD x 10 days(in case
    of penicillin allergy)
    (the patient should be started on long-term
    antibiotic prophylaxis)
    • Arthritis , arthralgia :
    Salicylates or NSAIDS (eg: aspirin) 80 -100
    mg/kg/day in 4-5 divided doses x 3-5wks
    • Severe carditis :-
    Corticosteroids (prednisolone 1-2 mg /kg/day ;
    max 60 mg x 4-6 wks, then taper 20-25 mg/wk)
    • Sydenham’s Chorea :-
    Haloperidol -0.5mg/kg/day.
    Carbamazepine or sodium valproate -15-
    20mg/kg/day x1-2 wks.
    Treatment for Valvular Heart Disease

    • Medical- digoxin, diuretics, antibiotic prophylaxis,

    control arrhythmias.
    • Surgical- closed mitral commisurotomy,
    percutaneous transluminal ballon valvuloplasty,
    • Others –Ross procedure, Bentalls procedure
    Surgical

    BALLOON
    VALVULOPLASTY MITRAL COMMISUROTOMY
    Leaflet Repair

    Leaflet Resection
    Elongated leaflets
    Leaflet plication
    Leaflet resection
    Holes in the leaflets
    Pericardial patch
    repair
    Short leaflets
    Most often repaired by
    chordoplasty
    Chordoplasty

    • Repair of the chordae


    tendinae
    • Mostly used for mitral
    valve
    • Gore-Tex can be used
    to create Chordae
    Tendinae.
    Ross Procedure
    Bentall Procedure
    Valve Replacement

    Process :
    • Performed when
    valvuloplasty is not
    suitable
    • Approached through a
    median sternotomy or
    mitral valve (at times) –
    right thoracotomy
    incision
    Types of prosthetic valves

    MECHANICAL VALVES TISSUE BIOLOGIC VALVES


    Types Of Mechanical Valves

    • Caged ball valve (Starr-Edwards)


    • Tilting disc valve (Med trionic-
    Hall)
    • Bileaflet valve(St. Jude Medical)
    • Trileaflet valve
    Next generation of mechanical valve:
    trileaflet valve

    • More physiological
    better hemo dynamics
    central blood flow’
    • Reduced thrombosis
    risk
    Complications

    • Congestive heart failure

    • Infective endocarditis

    • Arrhythmias mainly
    atrial fibrillation
    • Embolic episodes

    • Cardiomegaly
    Nursing Management
    1.Ineffective breathing pattern R/T altered hemo
    dynamics
    • Assess the alteration in lung function like
    hypoxemia, atelectasis,abnormal lung sounds,
    work of breathing etc.
    • Monitor ABG
    • Position properly for maximum lung expansion.
    • Administer O2 therapy.
    • Teach deep breathing and coughing.
    • Schedule activities to conserve energy.
    • Medications for pain to prevent tachypnea
    2. Fluid volume excess R/T CHF

    • Observe and assess clinical signs that indicate


    impending or present heart failure.
    • Monitor patient’s intake and output.
    • Weigh the patient daily.
    • Take abdominal girth measurements if
    abdominal distention or ascitis is present.
    • Provide rest periods, administer prescribed
    medications
    3. Decreased CO R/T altered hemodynamics
    as manifested by fatigue, dizziness or
    syncope
    • Assess, document and report signs of
    decreased CO such as decreased systolic BP,
    increased HR, presence of murmurs, decrease
    urine out put, cool clammy skin etc.
    • Position the patient properly.
    • Administer medications as prescribed.
    • Explain the need to limit activities.
    References

    • Suzanne C , Brenda G. Textbook of medical surgical


    nursing,2003;9
    • Black J M, Hawks J H . Medical surgica nursingg,2005;7

    • Woods S L .Cardiac nursing,1995;3;847-850

    • www.medicalcriteria.com

    • www.wikipedia.com

    • www.emedicine.medscape.com

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