Medical-MS38-Rheumatic carditis
Terms
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Define rheumatic carditis (also called rheumatic endocarditis)?
impaired contractile function
of myocardium
thickening of the pericardium
valvular damage -
a sensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic stretococci, which occurs in about 40% of clients with rheumatic fever and affects more than one million Americans...
inflammation is evident in all layers of heart...what does the inflammation result in? -
What is rheumatic carditis characterized by?
pericardium becomes thickened and covered with exudate, and a serosanguinous pleural effusion may develop...where does the most serious damage occur?
mitral and aortic valves -
formation of Aschoff's bodies..
small nodules in myocardium that are replaced by scar
tissue...
a diffuse cellular infiltrate
also develops and appears to
be responsible for HF....what happens to the pericardium?
most serious damage is to endocardium, with inflammation of the valve leaflets developing...hemorrhagic and fibrous lesions form along the inflamed surfaces of the valves, resulting in stenosis or regurgitation primarily of? - Rheumatic fever is a complication of about 3% of group A beta-hemolytic?
- throat infections
- Although the primary attacks occur most often in childhood, rheumatic fever may occur in?
- adulthood
- The most common clinical manifestations of rheumatic carditis is?
-
tachycardia
cardiomegaly
development of a new murmur
or a change in an existing
murmur
pericardial friction rub
precordial pain
electrocardiogram (ECG),
changes (prolonged PR
interval)
indications of heart failure
(HF)
evidence of an existing
streptococcal infection - What is extremely important concerning rheumatic carditis?
- PRIMARY prevention
-
What are the following indications of streptococcal pharyngitis?
Erythromycin (Eryc, Erythromid) -
moderate to high fever
abrupt onset of a sore throat...
reddened throat with exudate..
and enlarged and tender lymph
nodes...
penicillin is the antibiotic of choice...
what is the alternative for penicillin-sensitive patients? - The signs of rheumatic carditis must be recognized promptly, and what is SECONDARY prevention?
- antibiotic therapy
- How long is the patient required to continue antibiotic treatment?
- full 10 days
- What are ways to control fever?
-
maintain hydration
administer pyretics
rest - TERTIARY prevention by educating and explaining that a recurrence of rheumatic carditis is probable with?
- reinfection by streptococcus....antibiotic prophylaxis is necessary for the rest of the patient's life