Best Approach To Rheumatic Heart Disease Nursing Management
Best Approach To Rheumatic Heart Disease Nursing Management
Introduction
The damage to the heart due to RHD or rheumatic heart disease is permanent in nature. This makes it necessary for the condition to be managed as it cannot be cured. It is therefore important to adopt the right approach to rheumatic heart disease nursing management for the best outcomes.
What Are The Pathological Changes In Rheumatic Heart Disease?
To understand rheumatic heart disease nursing management it is necessary to know more about the pathological changes due to inflammation and scarring of the heart valves. This is mainly as a result of the unusual immune response after untreated strep throat infection or scarlet fever. Here is a look at the pathological changes in RHD.
Changes to the valve – The main changes to the valve are of three types, apart from other changes.
- Mitral valve stenosis – As a result of inflammation, the mitral valve is thickened, scarred, and calcified, causing narrowing.
- Mitral valve regurgitation – The scarred and retracted valve leaflets bring about incomplete closure, resulting in leakage of blood.
- Aortic valve involvement – The above two conditions also occur with the aortic valve.
Myocardial changes – The two main types include the following:
- Aschoff bodies – Refers to nodules of inflammation in the heart muscle.
- Fibrosis and scarring – Due to chronic inflammation causing myocardial scarring, abnormalities and weakened heart muscle.
Pericarditis – The outer lining of the pericardium ends up inflamed, causing fibrinous pericarditis, resulting in chest pain and pericardial fibrosis.
Endocardial issues – Two types of issues are commonly reported as outlined below.
- Inflammation and thrombosis – Wart like formations occur on the inner lining of the heart, especially along the valve leaflets.
- Scarring and calcification – Chronic inflammation occurs over a period of time, resulting in fibrosis and calcification, impacting valve function.
Structural changes – Three major changes affect the functioning, as outlined below.
- Valve deformity – Due to scarring and deformity, the valves are thickened, turn stiff and dysfunctional, affecting flow of blood.
- Cardiac chamber dilation and hypertrophy – Due to chronic valve disease, there is increased workload on the heart chambers.
- Pulmonary hypertension – As a result of mitral stenosis or regurgitation, there is increased pressure in the left atrium. This causes pulmonary hypertension and possible right heart failure.
What Are The Main Features Of Rheumatic Heart Disease?
As part of understanding of rheumatic heart disease nursing management here is a look at the main aspects of RHD. The effects are primarily as a result of the damage caused by the immune response post Strep throat infection. This results in inflammation and scarring of the heart valves.
- Valve lesions – The mitral valve is the most commonly affected valve, experiencing narrowing and/or leakage. These effects are the outcome of inflammation, scarring, and calcification, resulting in stiffened valves. The second most affected valve is the aortic valve, with same effects – narrowing and/or leakage. In a small percentage of cases, multiple valves may be affected, aggravating the effects on flow of blood.
- Structural changes – Due to chronic inflammation, the valve thickens, apart from fusion of the points where the valve leaflets join. Additionally, wart-like nodules begin to form on the valve leaflets, as a result of the inflammation. These structural changes result in the valve surfaces having an irregular shape, texture, exposing the valves to risk of bacterial endocarditis.
- Changes to heart chamber – The narrowing of the mitral valve causes the left atrium to enlarge gradually. This is because of the increased burden to push blood through a valve that has narrowed. Similarly, the left ventricle may also enlarge due to increased workload from valve dysfunction. A fallout of the increased pressure in the left atrium affects pulmonary circulation, resulting in pulmonary hypertension.
- Arrhythmias – As a result of the atrial enlargement, atrial fibrillation occurs, and the irregular heartbeat exposes the person to risk of blood clots, stroke, and heart failure.
Various symptoms may manifest due to RHD, including difficulty breathing, overall fatigue, pain in the chest, irregular heartbeats, fluid retention and edema. RHD exposes the patient to increased risk of complications, and it is therefore necessary for proper management of the condition.
Short Rheumatic Heart Disease Summary
A quick outline of RHD will help caregivers get better insights into rheumatic heart disease nursing management. It is essentially a chronic condition from an immune reaction, and mostly when strep throat infections are either untreated or poorly treated. This is followed by inflammation, scarring, and structural changes in the heart, especially the mitral and aortic valves.
The effects include thickening of the valve, narrowing of the valve and leakage from the valve. These effects are the main reason for symptoms experienced, such as breathlessness, fatigue, and palpitations. As this is a chronic condition, it progresses to heart failure, arrhythmias, and greater risk of stroke. Management includes medical monitoring of the patient, timely intake of medications, and wherever required, valve surgery.
What Is The Rate Of Rheumatic Heart Disease Incidence?
Globally, incidence rates of RHD are skewed towards countries with poor health infrastructure and sanitation. Low-income and middle-income countries have lesser focus on preventive treatment and this causes higher incidence rates of strep throat. This in turn leads to increased incidence rates of RHD. To complete the understanding of rheumatic heart disease nursing management lets look at the incidence rates of the disease.
Annually, around 282,000 cases of RHD are diagnosed globally. Regions that are classified as high-risk include sub-Saharan Africa, south Asia, Pacific Islands, and some nations in Latin America. In these high-risk countries, the rates are between 10 to 15 cases per 100,000 population. Locations that belong to the low-income category have between 30–40 cases per 100,000 population. Locations known as high-income category, have less than 1 case per 100,000 population. The most vulnerable age groups are children and adolescents.
Factors that influence incidence rates in India
Various factors, such as poverty, cramped and overcrowded communities, poor healthcare facilities result in higher incidence rates. This is amplified in rural areas, and regions with limited access to antibiotics and health care, that end up delaying treatment for strep throat.
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Shetty B s a cardiologist in Chennai, with extensive experience in the field. He completed his MBBS from Madurai Kamaraj University, followed by an MD in General Medicine and a DM in Cardiology from The Tamil Nadu Dr. M.G.R. Medical University (TNMGRMU).