Rheumatic Heart Disease

 

Rheumatic Heart Disease 

It is a serious heart disease. It is seen more often in young and middle aged persons. It is of two types, acute and chronic. Acute form is usually due to rheumatic disease and sometimes due to chorea.

Rheumatic Fever :

It is an inflammatory disease that can develop after an untreated strep throat or scarlet fever infection, often affecting the heart, joints, skin, and brain and potentially causing long term-heart damage.                           

 Aetiology:

1.Age:5 to 15 years.

2.Sex:male=female.

3. Genetic predisposition may be seen.

4.Low socioeconomic class.

5.Malnutrition. High humidity.

6.It is secondary to group, A beta haemolytic streptococcal infection of the throat  or tonsils. It starts 7 to 12 days after the infection.

7.Hereditary.

 Clinical features 

1.Fever:101 F to 103 F. It lasts for a few days in mild cases. In severe cases it may last for up to a week. There is profuse sweating.

2.There is profuse sweating.

3.There is fitting polyarthritis. At one time one joint is affected. After some time that joint gets well and another joint gets affected. pus does not form the joints.

4.The pulse rate is more rapid than expected from the fever.

5.Cardiac murmur is heard with a stethoscope.

6.Tender rheumatic nodules are felt behind the elbows, ankles or over the spine.

7.Tiredness.

8.Loss of weight.

9.Sleeplessness.

10.Delirium:Talking irrelevantly due to high fever.

 

Treatment

Drug	Features
Antibiotic	Procaine penicillin 50000 u/kg/d IM for 10 days. If the patient is allergic to penicillin, he is given erythromycin 40 to 50mg/kg/d orally.
Anti inflammatory drugs	Salicylates are given for two weeks if there if there is only joint involvement, and for 6 weeks if there is.
Steroids	Involvement of the heart. Prednisolone 2 mg/kg/d orally in 3 divided does for 3  weeks. Aspirin is continued after discontinuation of prevent steroid rebound effect.
Digoxin	For cardiac failure.
Codeine	For cough and chest pain.
Iron	For anaemia.

 Nursing care

1.The patient is kept in a well ventilated room in which there will not be any direct breeze on him.

2. The cot should be wooden or metallic, but without springs.

3.The mattress should e of cotton. The bed should be rheumatic because of the following reasons.

                 .The painful joints are kept warm by the use of blankets.

                 .The joints can be supported with sandbags.

                 .Cradles can be used to keep the weight of the bedclothes off the joints.

4.Complete bed rest is given.

5.Children refuse to remain in bed. They are given toys to play with in bed so that they remain in bed. They may be given story books to read or stories may be read to them.

6.painful joints are wrapped in warm cloth to relieve pain.

7.Sponging is done, so that, the patient feels clean and fresh and does not smell of sweat.

8.Temperature, pulse, respiration are recorded every 4hours.

9.If the patient has high fever, it is lowered by using the following measures.

               .Paracetamol.

               .Tepid sponging.

10.Oral hygiene is maintained every 4 hours .Glycerine borax is applied to the lips and tongue.

11.Plenty of fluids are given orally, eg  milk, tea, coffee, lime juice, fruit  juice etc.

12.Light diet is given when the fever is gone. It is increased gradually care.

13.Care is taken of the back and the pressure points every 4hours.

14.If the patient cannot sleep well at night, the cause is found out and treated.

Chronic valular Disease

 

Chronic disease of the cardiac valves are secondary to rheumatic fever. In this condition the valves of the heart are thickened and their elasticity is lost. As a result the function of the valves is disturbed. Two types of effects are seen due to chronic inflammation of the valves.

 

1.Stenosis of the valve: the cups stick to one another and hence their orifice gets narrowed.

2.Regurgitation: The valve cannot close and there is regurgitation of blood through the valve.

 

Through the valves of the heart can be affected , the mitral valve is affected most often. Mitral stenosis is the commonest lesion. The other lesions in the order of frequency of their occurrence are as follows:-

                                                                                      

1.Mitral regurgitation.

2.Mitral stenosis plus regurgitation.

3.Aortic stenosis.

4. Aortic stenosis plus regurgitation.

5.Aortic stenosis plus regurgitation.

6.Pulmonary stenosis.