RHD (Rheumatic heart disease)

- RHF (Rheumatic heart fever)

- Autoimmune disease that would cause inflammation of connective tissues of the heart and joints and CNS

- Due to reation to Group A beta hemolytic streptococcus infection

- Trigger:

o Sore throat (2 to 4 weaks)

o Impetigo

o Scarlet fever

o Tonsillitis

- Jones Criteria:

o Major S/Sx:

§ Carditis – palpitation

§ Arthritis – migratory polyarthritis

§ Subcutaneous nodules – painless

§ Erythema Marginatum – a long lasting rash which begins in trunk and spread outward

§ Chorea (Sydenham’s chorea/ St. Vitus dance) – Abnormal movement/sudden involuntary movement of the limbs

o Minor S/Sx:

§ Fever

§ Murmur

§ Tachycardia

§ Increase ESR

§ Leukocytosis

§ Arthralgia – joint pain without swelling

§ Increase ASO titer = N less than 160 tudd units

§ Prolonged PR interval in ECG

- Diagnosis:

o 2 major

o 1 major and 2 minor

- Priority:

o Decrease inflammation

- Admin aspirin and penicillin to prevent mitral valve disease

- Rest

ANGINA PECTORIS- A clinical syndrome characterized by paroxysmal chest pain usually relieved by REST or NGT nitroglycerin, resulting fr temp myocardial ischemia.

Predisposing Factor:

1. sex – male

2. black raise

3. hyperlipidemia

4. smoking

5. HPN

6. DM

7. oral contraceptive prolonged

8. sedentary lifestyle

9. obesity

10.hypothyroidism

Precipitating factors

4 E’s

1. Excessive physical exertion

2. Exposure to cold environment - Vasoconstriction

3. Extreme emotional response

4. Excessive intake of food – saturated fats.

Signs & Symptoms

1. Initial symptoms – Levine’s sign – hand clutching of chest

2. Chest pain – sharp, stabbing excruciating pain. Location – substernal

-radiates back, shoulders, axilla, arms & jaw muscles

-relieve by rest or NGT

3. Dyspnea

4. Tachycardia

5. Palpitation

6.diaphoresis

Diagnosis

1.History taking & PE

2. ECG – ST segment depression

3. Stress test – treadmill = abnormal ECG

4. Serum cholesterol & uric acid - increase.

Nursing Management

1.) Enforce CBR

2.) Administer meds

NTG – small doses – venodilator

Large dose – vasodilator

1^st dose NTG – give 3 – 5 min

2^nd dose NTG – 3 – 5 min

3^rd & last dose – 3 – 5 min

Still painful after 3^rd dose – notify doc. MI!

55 yrs old with chest pain:

1^st question to ask pt: what did you do before you had chest pain.

2^nd question: does pain radiate? If radiate – heart in nature. If not radiate – pulmonary origin

Venodilator – veins of lower ext – increase venous pooling lead to decrease venous return.

Meds:

A. NTG- Nsg Mgt:

1. Keep in a dry place. Avoid moisture & heat, may inactivate the drug.
2. Monitor S/E:

orthostatic hypotension – dec bp

transient headache

dizziness

3. Rise slowly from sitting position

4. Assist in ambulation.

5. If giving NTG via patch:

i. avoid placing it near hairy areas-will dec drug absorption

ii. avoid rotating transdermal patches- will dec drug absorption

iii. avoid placing near microwave oven or during defibrillation-will burn pt due aluminum foil in patch

B. Beta blockers – propanolol

C. ACE inhibitors – captopril

D. Ca antagonist - nefedipine

3.) Administer O2 inhalation

4.) Semi-fowler

5.) Diet- Decrease Na and saturated fats

6.) Monitor VS, I&O, ECG

7.) HT: Discharge planning:

1. Avoid precipitating factors – 4 E’s
2. Prevent complications – MI
3. Take meds before physical exertion-to achieve maximum therapeutic effect of drug
4. Importance of follow-up care.