SL SPECIFI TI CONTENT METHOD A V TEACHING EVALUATION

NO. C M OF AID AND

OBJECTI E TEACHI S LEARNING
VES NG ACTIVITY
1 Introduce INTRODUCTION
the Lecture
rheumatic Rheumatic heart disease is a method
heart complication of rheumatic fever in which the
disease heart valves are damaged. Rheumatic fever is an
inflammatory disease that begins with strep
throat. It can affect connective tissue throughout
the body, especiall y in the heart, joints, brain
and skin. Although rheumatic fever can strike
people of all ages, it is most common in
children between 5 and 15 years old.
Rheumatic heart disease (RHD) is damage to
one or more heart valves that remains after an
episode of acute rheumatic fever (ARF) is
resolved. It is caused by an episode or recurrent
episodes of ARF, where the heart has become
inflamed. The heart valves can remain stretched
and/or scarred, and normal blood flow through
damaged valves is interrupted. Blood may flow
backward through stretched valves that do not
close properly, or may be blocked due to
scarred valves not opening properly. When the
heart is damaged in this way, the heart valves
are unable to function adequately, and heart
surgery may be required.

DEFINITION
2 Define
the RHD Rheumatic heart disease is a condition in
 which the heart valves have been permanently
damaged by rheumatic fever. The heart valve
damage may start shortly after untreated or Ohp Lecture cum What you mean
under-treated streptococcal infection such as discussion by rheumatic
strep throat or scarlet fever. An immune heart disease?
response causes an inflammatory condition in
the body which can result in on-going valve
damage.

INCIDENCE
3 Enumerat RHD is a global problem. The WHO (2011)
e the reported that about 15 million people suffered Blac Lecture cum What is the
incidence from rheumatic heart disease world-wide.During k discussion incidence for
2008, there were 2, 20,000 deaths from RHD. In boar rheumatic
India, prevalence of RHD is about 6/1000 children d fever?
in the age group of 5-15 years. It is also reported
that there are about 1 million RHD cases in India.
RHD is the most common prevalent heart disease.
About 20%-30% of hospitals admissions due to
Cardio-Vascular Disease (CVD) in India are of RHD.

4 Describe CAUSES
the
causes of Rheumatic heart disease is caused by rheumatic
RHD fever. Rheumatic fever is a complication of an Lecture cum What are the
untreated or under-treated strep infection. discussion causes of
Children who get repeated strep throat rheumatic heart
infections are at the most risk for rheumatic disease?
fever and rheumatic heart disease.
 Enumerat EPIDEMOLOGY
5 e
epidemol Agent factors: ▫ Agent: RHD occurs as the
ogy of consequences of RF, which in turn is caused by
RHD infection of the tonsils, pharynx & adenoids
with group A beta hemolytic streptococci.

Host factors: ▫ Age: Highest among children

between 5-15 years of age. They are the high
risk groups.
Sex: Both sexes are equally affected.
Pre-disposing factors: Poverty, low socio-
economic status, poor housing, illiteracy,
ignorance, malnutrition & large families.When
the standard of living improves, the prevalence
of the disease comes down.

PATHOPHYSIOLOGY

6 Due to recurrent infection and rheumatic fever Han Lecture cum What is the
dout discussion pathophysiolog
s y?

Expalin Cross immune response between host and

the streptococcal antigen
pathophy
siology

Abnormal antigen - antibody reaction.

Erosion of valve leaflets

 Fibrous thickening and thickened valve.

Stenosis and regurgitation

7 Explain SIGNS AND SYMPTOMS

the signs
and The following clinical manifestation are seen in
symptom RHD:
s • Fever: There is low grade fever which may
last for about 3 months.
• Polyartheritis: Inflammation of the major
joints like ankles, knees, elbow & wrists occurs
which becomes painful. This subsides
spontaneously within about a week. The pain is
migratory in nature, i.e. as it subsides in one
joint, it appears in another joint. • Carditis: In
nearly 60-70% of cases, the heart is affected.
Pericardium, myocardium & valves are
involved. Tachycardia, cardiomegaly & heart
failure can occur. Damage to the mitral valve is
permanent.
• Subcutaneous nodules: These appear as
round, firm & painless nodules under the skin
& over bony prominences such as ankle, elbow
or wrist joints. They disappear after some time.
This is also called “erythema nodosum”.
• Chorea: This occurs as a late manifestation
in which there are jerky, purposeless
movements of the arms, legs & body. It
gradually disappears leaving no residual
damage.
• Erythema marginatum: These are pink, non-
pruritic skin rashes which appear on the trunk
& extremities. They appear on their own
without causing any abnormality. They
disappear after some time.
• Major manifestation: • Carditis, polyarthritis,
subcutaneous, nodules, cholera & erythema
marginatum.
• Minor manifestation: • Fever, polyarthralgia,
raised erythrocyte sedimentation rate or
leucocytosis.

DIAGNOSTIC FINDINGS
 Abnormal sounds, called murmurs can
be heared .
 Physical examination includes:
 Enlarged spleen
 Splinter hemorrhage in the fingernails
 Tests are:
 Blood culture and sensitivity
 Chest X ray
 Complete blood count
 CT of the chest
 Echocardiogram
 ESR
 Transesophageal echocardiogram.
PREVENTION & CONTROL OF
RHEUMATIC HEART DISEASE
1.Primary prevention:
• Health promotion:
• Prevention of malnutrition in children.
• Improving living condition & general
sanitation of the house & surrounding
environment. Housing standard should be
improved to avoid over-crowding.
• Health education to people to report sore
throat as it can be due to A beta hemolytic
streptococcus which can cause rheumatic fever.
Proper approach to high risk group such as
school-age children. They should be kept under
strict surveillance for streptococcal pharyngitis.
Ideally sore throat swab to confirm the
diagnosis should be cultured. Those found
positive should be treated.
2.Specific protection:
• Specific protection is afforded by giving
Benzathine benzyl penicillin to cases of sore-
throat by giving single dose of 1.2 million units
of Benzathine benzyl penicillin intra-
muscularly to all adult cases & 6,00,000 units
to children.
• Alternatively oral penicillin should be given
for 10 days. If allergic to penicillin,
erythromycin is the drug of choice.
• There is no vaccine for prevention.
3.Secondary prevention:
• Aims at prevention of recurrent attacks of
RF, especially in developing countries.
• Detection of cases that have RF by
conducting survey. They should be treated by 1
dose of 1.2 million units of Benzathine benzyl
penicillin to adults & 6, 00,000 units to
children at 3 weeks interval. This must be
continued for at least 5 years or until the child
reaches 18 years of age whichever is later.
• Nurses can assist in school health survey to
detect cases that have had RF & administering
the treatment as prescribed by the physician.
• For patients with carditis (mild mitral
regurgitation) the treatment should be
continued for 10 years after the last attack or at
least until 25 years of age, whichever is longer.
• More severe valvular disease cases need life-
long treatment. • Non-medical measures for
prevention/control of RF are improving the
living conditions & improving socio-economic
conditions of the people to bring them out of
poverty.
4.Tertiary prevention:
• Disability limitation: Patients, who have
already developed RHD, can have disability
due to joint pains & carditis. These can be
prevented by giving treatment with Aspirin for
joint pain & treatment with Benzathine benzyl
penicillin for life for carditis. Surgical
intervention may also be given in cases of
mitral stenosis.
•5.Rehabilitation: Patients suffering from RHD
are given social, vocational & psychological
rehabilitation. For example, if the patient has
mitral stenosis, his/her capacity for physical
activities is lowered. He/she has to be
rehabilitated to choose another occupation if
he/she is engaged in occupation requiring hard
 physical labor
COMPLICATION
Some complications of rheumatic heart disease
include:

 Heart failure. This can occur from either a

severely narrowed or leaking heart valve.
 Bacterial endocarditis. This is an infection
of the inner lining of the heart, and may
occur when rheumatic fever has damaged
the heart valves.
 Complications of pregnancy and delivery
due to heart damage. Women with
rheumatic heart disease should discuss their
condition with their healthcare provider
before getting pregnant.
 Ruptured heart valve. This is a medical
emergency that must be treated with surgery
to replace or repair the heart valve

STUDENT ASSIGNMENT

Write the nursing care plan for Rheumatic

fever.
CONCLUSION
Rheumatic heart disease is a condition in
which the heart valves have been permanently
damaged by rheumatic fever.Rheumatic fever
is an inflammatory disease that can affect
many connective tissues, especially in the
heart.Untreated or under-treated strep
infections put a person at increased risk.
Children who get repeated strep throat
infections are at the most risk for rheumatic
fever and rheumatic heart disease.Treatment
depends on how much damage has been done
to the heart valves. It may even include surgery
to replace or repair a badly damaged
valve.Since rheumatic fever is the cause of
rheumatic heart disease, the best treatment is to
prevent rheumatic fever by using antibiotics to
treat strep infections.

BIBLIOGRAPHY
1. Wongs essential pediatric 8th edition
Elseiver publishers Page no;893-894.
2.Rimple sharma Essentials of pediatric
nursing,2 nd edition,Jaypee publishers page
no;364-368.