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Rheumatic Heart Disease - Coggle Diagram
Rheumatic Heart Disease
Definition
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Rheumatic fever can occur at any age, but
usually occurs in children ages 5 to 15 years old
Risk Factors
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Children who get repeated strep throat infections are at the most risk for rheumatic fever and rheumatic heart disease
Pathophysiology
Streptococcal A carries M-proteins that are similar in structure and makeup to cardiac antigens in humans
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Assessment
Skin lesions such as red, raised, lattice-like erythema marginatum on the chest, back, and stomach (5% of patients)
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Chest pain, swelling, and weaknes
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Heart murmur: Mitral regurgitation, Sometimes aortic regurgitation
Diagnostic Test
CXR
Normal heart size except myocarditis, heart failure
or pericardial effusion
Elevated WBC and ESR, slight anemia during inflammation
Echocardiography
Valvular damage, chamber size,
ventricular function
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Throat culture
Symptoms of strep throat include sore throat,
swollen tonsils, fatigue, fever, headache, and chills
Complications
Bacterial endocarditis
This is an infection of the inner lining of the heart, and may occur when rheumatic fever has damaged the heart valves
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Medical Management
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Corticosteroids
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Prednisolone
2 mg/kg/day (up to 80 mg/day) or methylprednisolone for 2-3 weeks, overlapping with aspirin
Aspirin
100 mg/kg/day divided into 4-5 doses (125 mg/kg/day in children for adequate response but avoid toxicity)
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Additional measures
Bed rest, steroids for severe symptoms
Use of diuretics, ACE inhibitors (ACEI), digoxin
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Nursing Care Plan
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Nursing Intervention
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Educate on signs of recurrent streptococcal infection (sore throat, swollen glands, fever) and to report immediately
Instruct patient to observe for signs of heart failure (dyspnea, cough) to prevent cardiac decompensation
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Inform patient to report immediately if any signs of allergy appear (e.g., rash, fever, chills)
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