Rheumatic Fever (RF)

Definition
Rheumatic Fever (RF) is an acute, inflammatory,
autoimmune disease that develops as a
complication of untreated or inadequately treated
Group A β-hemolytic Streptococcal (GAS) throat
infection (streptococcal pharyngitis).

It mainly affects:

* Heart

* Joints

* Skin

* Brain

* Blood vessels

Rheumatic fever commonly occurs in children aged

5–15 years.
Etiology (Causes)
The main cause is:

* Untreated Streptococcus pyogenes throat

infection

* Recurrent sore throat

* Poor socioeconomic conditions

* Overcrowding

* Malnutrition

* Family history

Pathophysiology
Child develops a streptococcal throat infection.

The body’s immune system produces antibodies

against the bacteria.
These antibodies mistakenly attack the body’s own
tissues (autoimmune reaction).

Inflammation develops in:

* Heart

* Joints

* Skin

* Brain

Repeated attacks may cause permanent heart valve

damage known as Rheumatic Heart Disease (RHD).

Clinical Manifestations
Major Manifestations (Jones Criteria)

1. Carditis

Inflammation of the heart.

Signs:

* Tachycardia

* Chest pain

* Shortness of breath

* Heart murmur

* Heart failure

2. Polyarthritis

* Painful swollen joints

* Knees, ankles, elbows, wrists commonly affected

* Migratory nature (moves from one joint to

another)

3. Chorea (Sydenham’s chorea)

* Involuntary jerky movements

* Emotional instability

* Poor handwriting
* Muscle weakness

4. Erythema Marginatum

* Pink ring-shaped skin rash

* Non-itchy

* Appears on trunk and limbs

Minor Manifestations

* Fever

* Arthralgia (joint pain)

* Elevated ESR

* Elevated CRP

* Leukocytosis
Diagnostic Evaluation

 Laboratory Tests
 Blood Tests

* ESR

* CRP

* WBC count

 Streptococcal Infection Evidence

* Throat culture positive

 ECG
 Echocardiography

* Detects valvular damage

* Evaluates carditis

 Chest X-ray
Medical Management

1. Antibiotic Therapy

Benzathine Penicillin G

Used to eradicate streptococcal infection.

Alternative:

* Erythromycin (if allergic to penicillin)

2. Anti-inflammatory Drugs

Aspirin

* Reduces fever

* Relieves joint pain

Corticosteroids

* Prednisolone for severe carditis

3. Management of Heart Failure

If present:

*Digoxin
* Diuretics

* Oxygen therapy

4. Bed Rest

Nursing Management

Assessment

* Monitor temperature

* Assess joint pain and swelling

* Observe involuntary movements

* Monitor heart sounds

* Assess respiratory status

Nursing Diagnoses

1. Acute Pain related to joint inflammation

Interventions

* Provide comfortable position

* Administer prescribed analgesics

2. Activity Intolerance related to carditis

Interventions

* Encourage bed rest

* Assist with daily activities

* Monitor fatigue

3. Risk for Decreased Cardiac Output

Interventions

* Monitor pulse and BP

* Observe for signs of heart failure

* Monitor intake and output

4. Knowledge Deficit regarding disease process

Interventions

* Teach medication adherence

* Explain importance of follow-up

Prevention

Primary Prevention

* Early diagnosis and treatment of streptococcal

throat infection

* Complete antibiotic course

Secondary Prevention

Long-term prophylaxis with:

* Benzathine Penicillin G every 3–4 weeks

This prevents recurrence and rheumatic heart

disease.
Complications

* Rheumatic Heart Disease (RHD)

* Mitral valve stenosis

* Heart failure

* Arrhythmias

* Permanent valvular damage

 Rheumatic Heart Disease (RHD)

Definition
Rheumatic Heart Disease (RHD) is a chronic heart
disease caused by permanent damage to the heart
valves following one or more attacks of Rheumatic
Fever.

It is the most serious complication of rheumatic

fever and commonly affects children and young
adults.

Etiology (Causes)
Primary Cause

* Untreated or inadequately treated streptococcal

throat infection.

Risk Factors

* Recurrent sore throat

* Poor hygiene
* Overcrowding

* Malnutrition

* Low socioeconomic status

* Family history of rheumatic fever

Pathophysiology
Streptococcal throat infection occurs.

The immune system produces antibodies against the

bacteria.

Antibodies cross-react with heart tissues

(autoimmune reaction).

Inflammation develops in all layers of the heart

Heart valves become thickened and deformed.

Valvular stenosis or regurgitation develops.

Cardiac output decreases, leading to heart failure if

severe.
Types of Valve Lesions
1. Mitral Stenosis

* Narrowing of the mitral valve.

* Obstructs blood flow from the left atrium to the

left ventricle.

2. Mitral Regurgitation

* Incomplete closure of the mitral valve.

* Blood flows backward into the left atrium.

3. Aortic Stenosis

* Narrowing of the aortic valve.

4. Aortic Regurgitation

Backflow of blood from the aorta into the left

ventricle.

Clinical Manifestations
General Symptoms

* Fatigue

* Weakness

* Fever (during active rheumatic fever)

* Reduced exercise tolerance

Cardiac Symptoms

* Chest pain

* Breathlessness

* Tachycardia

* Heart murmur
Signs of Heart Failure

* Dyspnea

* Orthopnea

* Peripheral edema

* Cyanosis

Diagnostic Evaluation
Laboratory Tests

* ESR

* CRP

Electrocardiogram (ECG)

Echocardiography (Most Important Test)

* Detects valve damage

* Assesses severity of stenosis or regurgitation

Chest X-ray

* Enlarged heart

* Pulmonary congestion

Medical Management
1. Antibiotic Therapy

Benzathine Penicillin G

* Prevents recurrent streptococcal infection.

* Long-term prophylaxis every 3–4 weeks.

Alternative:

* Erythromycin

2. Anti-inflammatory Therapy

* Aspirin

* Corticosteroids (for severe carditis)

3. Treatment of Heart Failure

* Diuretics

* Digoxin

* ACE inhibitors

* Oxygen therapy

4. Surgical Management

Valve Repair

* Repair of damaged valve.

Valve Replacement

* Mechanical or biological valve replacement.

Balloon Valvotomy

* Used for severe mitral stenosis.

Nursing Management

Assessment

* Monitor vital signs.

* Assess heart sounds and murmurs.

* Monitor respiratory status.

* Assess for edema and cyanosis.

* Monitor intake and output.

Nursing Diagnoses

1. Decreased Cardiac Output related to valvular

damage

Interventions

* Monitor pulse, BP, and oxygen saturation.

* Observe for signs of heart failure.

* Administer prescribed medications.

2. Activity Intolerance related to decreased oxygen
supply

Interventions

* Provide adequate rest.

* Assist with daily activities.

3. Excess Fluid Volume related to heart failure

Interventions

* Monitor fluid balance.

* Restrict fluids if prescribed.

* Administer diuretics.

4. Knowledge Deficit regarding disease and

treatment

Interventions

* Teach medication compliance.

* Explain importance of follow-up visits.

* Educate parents regarding prevention of recurrent

infections.

Prevention

Primary Prevention

* Early diagnosis and treatment of streptococcal

throat infection.

* Complete antibiotic course.

Secondary Prevention

* Regular Benzathine Penicillin G prophylaxis.

* Follow-up with cardiologist.

Complications

* Congestive heart failure

*hypertension
* Stroke

* Severe valvular disease

* Sudden cardiac death (rare)