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.  Untreated, RHD causes heart failure and those affected are at risk of arrhythmias, stroke, endocarditis and complications of pregnancy. These conditions cause progressive disability, reduce quality of life and can cause premature death in young adults. Heart surgery can manage some of these problems and prolong life but does not cure RHD. RHD is the a chronic condition characterized by scarring and deformity of the heart valves following rheumatic fever infection. Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the heart, joints, brain or skin. It usually starts out as a strep throat (streptococcal) infection.

1. MR. ANILKUMAR B R, M.SC. ASSISTANT PROFESSOR
MEDICAL – SURGICAL NURSING.
RHEUMATIC HEART
DISEASE

2. Overview
•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.

3. Overview
•Untreated, RHD causes heart failure and those
affected are at risk of arrhythmias, stroke,
endocarditis and complications of pregnancy.
•These conditions cause progressive disability, reduce
quality of life and can cause premature death in
young adults.
•Heart surgery can manage some of these problems
and prolong life but does not cure RHD.

4. • Rheumatic heart disease describes a group of short-term
(acute) and long-term (chronic) heart disorders that occur as a
result of acute rheumatic fever.
• Damage of the heart valves is a common result of rheumatic
fever. It is these damages that lead to the defect in the heart.
• Acute rheumatic fever is a condition in which the connective
tissues of the body, the heart, joints, brain, and skin are
swollen. It is usually seen in children who are 5 to 15 years
old.

5. •RHD is the a chronic condition characterized
by scarring and deformity of the heart valves
following rheumatic fever infection.
Rheumatic fever is an inflammatory disease of
the heart potentially involving all the layers of
the heart i.e. endocardium ,myocardium and
pericardium.

6. Rheumatic fever
•Rheumatic fever is an inflammatory disease
that may affect many connective tissues of the
body, especially those of the heart, joints, brain
or skin. It usually starts out as a strep throat
(streptococcal) infection.

8. • Acute rheumatic fever, which occurs most often in school-
age children, follows 0.3% to 3% of cases of group A
beta-hemolytic streptococcal pharyngitis.
• Prompt treatment of strep throat with antibiotics can
prevent the development of rheumatic fever.
• The Streptococcus is spread by direct contact with oral or
respiratory secretions. Although the bacteria are the
causative agents, malnutrition, overcrowding, and lower
socioeconomic status may predispose individuals to
rheumatic fever.

9. Sequence of RF & RHD

11. Pathophysiology
•Rheumatic fever is a sequela to group Astreptococcal
infection that occurs in about 3% of untreated
infections.
•It is a preventable disease through the detection and
adequate treatment of streptococcal pharyngitis.
•Connective tissue of the heart, blood vessels, joints,
and subcutaneous tissues are affected.
•Lesions in connective tissue are known as Aschoff
bodies, which are localized areas of tissue necrosis
surrounded by immune cells.

12. Pathophysiology
•Heart valves are affected, resulting in valveleakage
and narrowing.
•Compensatory changes in the chamber sizesand
thickness of chamber walls occur.
•Heart involvement (carditis) also includes
pericarditis, myocarditis, and endocarditis

13. Clinical manifestations
 Sudden onset of sore throat; throat reddened
with exudate.
 Swollen, tender lymph nodes at angle of jaw.
 Headache and fever >38 degrees Celsius.
 Abdominal pain (children).
 Some cases of streptococcal throat infection
are relatively asymptomatic
 Warm and swollen joints(polyarthritis)

14. Clinical manifestations
• Chorea -(irregular, jerky, involuntary, unpredictable muscular
movements especially affecting the head, face or limbs).
• Erythema marginatum -(transient meshlike macular rash on
trunk and extremities.
• Subcutaneous nodules (hard, painless nodules over
extensor surfaces of extremities; rare)
• Fever >38 degrees Celsius.
• Prolonged Pulse Rate (heart beat) interval demonstrated by
ECG.
• Heart murmurs; pleural and pericardial rubs.

15. Erythema marginatum -(transient meshlike macular rash on
trunk and extremities.

16. Subcutaneous nodules (hard, painless nodules over
extensor surfaces of extremities; rare)

17. Modified Jones criteria of RF and RHD
• Jones criteria were established for the diagnosis of
acute rheumatic fever ones criteria are guidelines
decided on by the American Heart Association to help
doctors clinically diagnose rheumatic fever.
•Two major criteria or one major and two minor plus a
history of a streptococcal throat infection are required
to make the diagnosis of rheumatic fever.

18. Modified Jones criteria for diagnosis Rheumatic fever
MAJOR CRITERIA MINOR CRITERIA
Carditis Fever
Polyarthritis Arthralgia
Chorea Previous rheumatic fever or
rheumatic heart disease
Erythema marginatum Acute phase reactions: ESR /
CRP / Leukocytosis
Subcutaneous Nodules Prolonged PR interval

19. Jones modified criteria for RF and RHD

20. Assessment and diagnostic evaluation
1. Throat culture-to determine presence of
streptococcal organisms.
2. Sedimentation rate, WBC count anddifferential,
and CRP increased during acute phase of infection.
3. Elevated antistreptolysin-O (ASO)titer
4. ECG-prolonged Pulse Rate interval or heartblock.

21. Complications
•Heart failure
•Atrial fibrillation
•Infectiveendocarditis
•Atrial and ventriculararrhythmias

22. Medical management
•Goals:
1. Suppression of acute inflammatory process –
steroids, aspirin for fever and joint pain
2. Eradication of the streptococcal infection –
antibiotics (Penicillin/ Erythromycin)
3. Prevention of disease occurrence
4. To protect the heart against damaging effects of
carditis.

23. Management
1. Bed rest – reduce strain on the heart produced by
activity - minimize metabolic needs during acute,
febrile state.
2. Diet –  protein,  calorie,  Vitamin.,  sodium
- adequate nutrition to promote healing
- if w/ CHF – restrict fluids

24. 4. Diuretics, digitalis if w/ signs of CHF
5. Prevent recurrence – teach pt. on good nutrition,
proper hygiene practices, adequate rest, immediate
treatment of sore throat
- taking prophylactic doses of Penicillin to prevent
- take prophylaxis of antibiotics before & after
surgery or dental procedures