Heart Infections: Rheumatic Heart Diseases (Rheumatic Endocarditis)

 Definition and Related Terms

• Rheumatic Heart Disease - damage to the heart by one or more episodes of rheumatic fever. Pathogen is a group A streptococci.
• Rheumatic Endocarditis - damage to the heart, particularly the valves, resulting in valve leakage (regurgitation) and/or stenosis. To compensate, the heart's chambers enlarge and walls thicken.

Epidemiology

• Worldwide, 15-20 million new cases of rheumatic fever are reported each year
• Rheumatic Fever - follows a Group A streptococcal infection. We could prevent it by finding and treating streptococcal pharyngitis
• Where malnutrition and crowded living are common, rheumatic fever is most common in children between ages 5 and 15.
• Rheumatic Fever strikes most often during cool, damp weather. In the US, it is most common in the Northern States.
• It is unknown how and why group A streptococcal infections cause the lesions called Aschoff bodies
• Damage depends on site of infection: most often the mitral valve in females and the aortic valve in males
• Malfunction of these valves leads to severe pericarditis, and sometimes pericardial effusion and fatal heart failure. Of those who survive this complication, about 20% die within ten (10) years.

Findings

• Streptococcal Pharyngitis

1. Sudden sore throat
2. Throat reddened with exudate
3. Swollen, tender lymph nodes at angle of jaw
4. Headache and fever to 104 degrees Fahrenheit (40 degrees Celsius)

• Polyarthritis manifested by warm and swollen joints
• Carditis
• Chorea
• Erythema marginatum (wavy, thin red-line rash on trunk and extremities)
• Subcutaneous nodules
• Fever to 104 degrees Fahrenheit (40 degrees Celsius)
• Heart murmurs, pericardial friction rub, and pericardial rub
• No lab test confirms rheumatic fever, but some support the diagnosis

Management

• Give antibiotics steadily to maintain level in blood
• Provide analgesics - for pain/inflammation
• Oxygen to prevent tissue hypoxia
• Surgical - commissurotomy, valvuloplasty, prosthetic heart valve

Nursing Interventions

• Cardio-Care Six
• Help the client with chorea to grasp objects; prevent falls
• Encourage family and friends to spend time with client and fight boredom during the long, tedious convalescence.
• Client and family teaching:

1. Explain all tests and treatments
2. Nutrition
3. Hygienic practices
4. To resume ADLs slowly and schedule rest periods
5. To report penicillin reaction: rash, fever, chills
6. To report findings of streptococcal infection
• Sudden sore throat
• Diffuse throat redness and oropharyngeal exudate
• Swollen and tender cervical lymph glands
• Pain on swallowing
• Temperature of 101-104 degrees Fahrenheit (38.3-40 degrees Celsius)
• Headache
• Nausea
7. Keep client away from people with respiratory infections
8. Explain necessity of long-term antibiotics
9. Arrange for a visiting nurse if necessary
10. Help the family and client cope with temporary chorea

Diagnostic Studies

• Antistreptolysin O titer - increased
• ESR - increased
• Throat culture - positive for streptococci
• WBC count - increased
• RBC parameters - normocytic, normochromic anemia
• C-Reactive Protein - positive for streptococci

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