Inflammatory Heart Disease (Rheumatic Heart Disease)

Rheumatic

Rheumatic fever is an inflammatory condition that mostly affects the brain, skin, subcutaneous tissue, and joints of the hea. The infection frequently damages the heart, especially if the heart valves become scarred, making the heart work harder to pump blood. Congestive heart failure may develop as a result of the damage, which may eventually go away on its own or remain permanent.

Epidemiology of Rheumatic Fever

• Ages 5 to 15 are the most vulnerable
• Uncommon 3 years
• Girls>boys
• Common in third-world nations
• Environmental variables, including poverty, squalor, and overpopulation
• More occurrences throughout the fall, winter, and early spring

Signs and Symptoms

Major manifestation

• The most harmful effect of this illness is carditis. The manifestation of CHF is the inflammation of the heart muscle:
  • Cardiomegaly, significant murmur
  • A pericarditis that causes a lot of friction rub
  • Inflamed pericardium causing chest discomfort
  • Arterial fibrillation or abnormalities in the electrical conduction of the atria
  • Heart attack
• Migratory polyarthritis (temporary):
  • The main observation is a migrating pain. major joints, such as the ankles, knees, elbows, shoulders, and wrists, are most frequently affected. It lasts for hours or days and may or may not be symmetrical.
• Chorea:
  • A CNS condition is characterized by sudden, erratic, aimless, involuntary movement that goes away on its own and leaves no lasting effects.
• Erythema marginatum:
  • A peculiar rash that mostly affects the trunk.
  • The lesions are round and have obvious borders.
  • Rash is transient and can vary in appearance in minutes or hours. 
  • Long lasting rashes start in the arms and trunk and extend upward to resemble a snake.
• Subcutaneous nodules:
  • A thin layer of collagen fiber covering bones or tendons that is firm and painless. frequently happens on the front of the knee, outside elbow, and back of the wrist.

Minor manifestations

• Fever: Periods of high fever and normal temperature
• Fever pain likely caused weakness, malaise, weight loss, and anorexia to develop.
• Arthralgia: A common condition in which there is pain in one or more joints but no sign of arthritis
• In some situations, nasal bleeding and abdominal pain may also be present.

Diagnosis

• Recent disease history, risk factors, and sore throat history.
• Einspection of the body
• ASO (anti-streptolysin 0) titer, CBC, and c- reactive protein
• Throat swab culture: streptococcal A positive
• A chest X-ray and an echocardiogram
• ECG

Management

• The goals of medical therapy are to treat congestive heart failure, decrease inflammation brought on by the inflammatory reaction, and eradicate group A streptococcal pharyngitis (if it is still present).
• Surgical intervention
• Preventing complications from illness

Treatment

• Step I: Primary Prevention of Rheumatic Fever (streptococcal tonsilopharyngitis)

  • Penicillin V oral 500 mg 1-2 times per day for ten days (drug f choice)
  • Injection benzathine penicillin G 600 000 U IM for patients, 27 kg (60 lb), 200 000 U for patients >27 kg single dosage when oral penicillin is not available
  • 20–40 mg/kg/d of erythromycin 2-4 times per day for 10 days, or 2-4 times per day of ethylsuccinate 40 mg/kg/d. for 10 days, oral (for individuals who have allergic to penicillin)
  • A narrow-spectrum (first-generation) cephalosporin for 10 days, azithromycin for 5 days, or clarithromycin for 10 days are additional options.

• Step II: Anti inflammatory treatment

  • Aspirin 75-100 mg/kg/day/day/ay Give 4 evenly spaced doses over the course of 6 weeks (blood level of 20 to 30 mg/dl). With the exception of chorea, aspirin can successfully alleviate all illness symptoms when taken in anti-inflammatory doses.
  • Prednisolone: 2 to 2.5 mg/kg/day given twice daily for two weeks. Depending on how severe the carditis is, prednisone should be taken for another 2–6 weeks.
  • If cardiomegaly or congestive heart failure indicate moderate-to-severe carditis, oral prednisone should be added to salicylate therapy.

• Step III: Supportive management & management of complications

  • Sleep rest.
  • Congestive heart failure treatment options include a salt diet, diuretics, and 02 therapy.
  • Diazepam or haloperidol for the treatment of chorea
  • Arthralgia: Splinting and rest for the joints

• Step IV: Preventive prophylaxis therapy

  • Penicillin V 250 mg twice a day or Benzathine penicillin G 600000-1200000 U every four weeks IM are both effective antibiotics.
  • In regions where rheumatic fever is endemic, in patients with lingering carditis, and in high-risk individuals, the same dosage should be administered for three weeks.
  • Erythromycin 250 mg BD for those with penicillin allergies

Complications of RHD

• Acute rheumatic carditis (valve insufficiency) or stenosis-related heart failure (chronic rheumatic carditis).
• Associated cardiac complications:
  • Fcreation of an intracardiac thrombus.
  • Lung emboli that recur.
  • Emboli systemic.
  • Bacterial endocarditis
  • Respiratory edema.
  • Arrhythmias.

Nursing Management

Assessment

• Take baseline historical, subjective, and objective data
• Physical evaluation: listen for any unexpected cardiac sounds, take and record vital signs, and check for fever, tachycardia, and high blood pressure.
• Examining lab report data
• Get an ECG
• Feel the perivascular pulses.
• Determine your comfort level and your tolerance for activities.
• Analyze your dietary intake.
• Psychological information, including emotions, a support network, coping mechanisms, and understanding of the disease process

Nursing Diagnosis

• Possibility of persistent pain brought on by the body's inflammatory response to the heart or joints
• Inflammatory illness process R / T increased body temperature
• Nutritional imbalance risk: body requirements not met due to anorexia or fever
• Risk of an ineffective treatment plan associated with the requirement for extensive medical care and therapy

Intervention

• Encourage rest at home to lower myocardial 02 Demands or comfort measures, such as elevating the head when in bed and slouching forward on a cardiac table
• When a fever occurs, give an antipyretic and a cold compress.
• Give sedatives if chorea appears, keep the patient in bed, and keep them safe from harm. Examine the patient's discomfort level.
• Maintain a balance between periods of activity and rest.
• Give a high-calorie, high-protein diet.
• Provide more vitamins and minerals as necessary.
• daily weigh the patient to look out for issues Encourage adequate hydration and keep a careful eye out for fluid overload.
• Ensure oral health
• Recommendations for risk clients who need prophylactic antibiotics before invasive procedures
• On time delivery of medication
• Tell them to call if their heartbeat suddenly changes or if they experience palpitations.
• Promote self-care, activity control, and rest periods.
• If surgery is recommended, get consent, and give pre- and post-operative care.
• Teach about: diet, medications, keeping track of one's own progress and complications, and a follow-up schedule.