Rhemat

ichear
tdi
sease
I
ntr
oduct
ion
•Rheumat
icHear
tDi
seasei
samaj
orheal
thpr
obl
em i
nthewor
ld.

•Rheumat
icHear
tDi
seaseoccur
sasasqueal
ofr
heumat
icf
ever
.

I
nci
dence
Gl
obal
:

RHDi saglobalpr
oblem.TheWHO( 2011)reportedt hatabout15mil
l
ionpeoplesuffer
edfrom
rheumati
cheartdiseasewor ld-wide.
During2008, therewere2,20,
000deathsfr
om RHD. RHDa
majorcauseofmi tr
alinsuffi
ciency&stenosisint hewor ld.
Therei
safal
lintheinci
dence&
preval
enceof&mor t
alit
yfrom RHDi ndev el
opedcount ri
es.Thi
sdecr
easeismai nl
yduet o
i
mpr ovementinsocioeconomi ccondit
ionsrathert hanthemoderntr
eatmentbecausethef al
l
occurr
edbeforetheav ail
abil
ityofthemoder ntreatment .

I
ndi
an:

I
nI ndia,pr
evalenceofRHDisabout6/
1000chil
drenintheagegroupof5-15years.I
tisalso
report
edt hattherear
eabout1mill
i
onRHDcasesi nIndi
a.RHDist hemostcommonpr ev
alent
heartdisease.About20%-
30%ofhospital
sadmissi
onsduet oCardiov
ascul
arDisease(CVD)in
I
ndi aareofRHD.

Epi
demi
ologyofRHD
•Agentf
act
ors:

Agent :
RHDoccursast heconsequencesofRF,whichintur
niscausedbyi nf
ecti
onofthe
tonsil
s,phar
ynx&adenoidswithgroupAbet ahemolyt
icstr
eptococci.Thesecocciaregr
am
positi
ve,nonmoti
le,non-
sporeforming&spheri
calshapedbacil
li
,0.5ut o1.0uindiameter
,
arrangedinchai
ns.Recentl
y;vi
ruscoxsacki
eB-4issuggest
edt obet hecausati
veorgani
sm for
RF.

Reser
voi
rofI
nfect
ion

Al
lthecasesandcar
ri
ersofst
rept
ococcal
phar
yngi
ti
s.

Hostf
act
ors:

Age:Hi
ghestamongchi
l
drenbet
ween5-
15y
ear
sofage.Theyar
ethehi
ghr
iskgr
oups.
Sex:Bot
hsexesar
eequal
l
yaf
fect
ed.

Pr
edisposi
ngf
actor
s:Pover
ty,
lowsoci
o-economi
cstat
us,poorhousi
ng,i
l
li
teracy,
ignor
ance,
malnut
ri
ti
on&lar
gefamil
i
es.Whenthestandar
dofl
iv
ingimproves,
thepr
evalenceofthe
di
seasecomesdown.

Pat
hogenesi
s
Thereappear
san'
Aschoff
'snodul
e'whi
chist
hepathognomoni
csignisRF.I
tisper
i-
vascul
ar
col
lect
ionofl
ymphocy
tes&plasmacell
ssurr
oundi
ngaf i
bri
noi
dcore.

I
ntheheart,
mi t
ral
valvul
iti
sisthemostcommonl
esi
onwhi
chl
atercausesf
ibr
osi
s&nar
rowi
ng
(
stenosi
s)ofthemitr
al v
alve.

St
enosi
soft
hemi
tr
alv
alv
ecausesi
tsi
ncompet
ence.

Cl
ini
calf
eat
ures
•Thef
oll
owi
ngcl
i
nical
mani
fest
ati
onar
eseeni
nRHD:

•Fev
er:
Ther
eisl
owgr
adef
everwhi
chmayl
astf
orabout3mont
hs.

•Polyar
thri
ti
s:Inf
lammati
onofthemaj orj
oint
sli
keankles,
knees,el
bow&wri
stsoccur
swhich
becomespai nf
ul.Thi
ssubsi
desspontaneousl
ywithi
naboutaweek.Thepai
nismigrat
oryi
n
natur
e,i
.e.asitsubsi
desinonejoi
nt,
itappearsi
nanotherjoi
nt.

•Cardi
tis:I
nnearly60-
70%ofcases,t
hehear
tisaff
ected.Per
icar
dium,
my ocar
dium &valv
es
areinv
olved.Tachycar
dia,
car
diomegal
y&heartf
ail
urecanoccur.Damagetothemitral
valvei
s
permanent.

•Subcutaneousnodul
es:Theseappearasr
ound,
fir
m &painlessnodulesundert
heski
n&over
bonyprominencessuchasankle,el
boworwri
stj
oint
s.Theydisappearaf
tersometi
me.Thi
sis
al
socalled"ery
themanodosum" .

Chorea:
Thisoccur
sasalatemanif
estati
oninwhi
chther
earejer
ky,
pur
posel
essmov
ement
sof
thearms,l
egs&body.I
tgradual
l
ydisappear
sleav
ingnoresi
dual
damage.

Ery
themamar ginat
um: Thesear
epink,
nonpruri
ti
cskinr
asheswhichappearonthetr
unk&
ext
remit
ies.Theyappearonthei
rownwi t
houtcausi
nganyabnor
malit
y.Theydi
sappearaf
ter
sometime.
Mani
fest
ati
on
•Maj
ormani
fest
ati
on:

•Car
dit
is,
pol
yar
thr
it
is,
subcut
aneous,
nodul
es,
chol
era&er
ythemamar
ginat
um.

•Mi
normani
fest
ati
on:

•Fev
er,
pol
yar
thr
algi
a,r
aiseder
ythr
ocy
tesedi
ment
ati
onr
ateorl
eukocy
tosi
s.

Pr
eventi
on&controlofr
heumat
ichear
tdi
sease;
rol
eofnur
ses•
Pr
imaryprev
ent
ion:
•Heal
thpr
omot
ion:

•Pr
event
ionofmal
nut
ri
ti
oni
nchi
l
dren.

•I
mprovi
nglivi
ngcondit
ion&gener
alsani
tati
onoft
hehouse&sur
roundi
ngenv
ironment
.
Housi
ngstandardshoul
dbeimprovedtoavoi
dover
crowdi
ng.

Healt
heducationtopeopletoreportsor
ethroatasitcanbeduetoAbetahemolyti
c
str
eptococcuswhichcancauser heumati
cfever.Pr
operapproacht
ohighri
skgroupsuchas
school-
agechil
dren.Theyshouldbekeptunderstri
ctsurv
eil
l
anceforst
rept
ococcalphar
yngi
ti
s.

Ideal
l
ysorethr
oatswabt
oconf
ir
mthedi
agnosi
sshoul
dbecul
tur
ed.Thosef
oundposi
ti
ve
shouldbet
reat
ed.
Speci
fi
cpr
otect
ion:

•Speci
fi
cprotect
ioni
saff
ordedbygi v
ingBenzathi
nebenzylpeni
cil
l
intocasesofsoret
hroatby
giv
ingsi
ngledoseof1.2mil
l
ionunitsofBenzathi
nebenzyl
penici
ll
inint
ramuscul
arl
ytoalladul
t
cases&6,00,
000unit
stochil
dren.

•Alt
ernat
ivel
yor
alpeni
cil
l
inshoul
dbegi
venf
or10day
s.I
fal
l
ergi
ctopeni
cil
l
in,
ery
thr
omy
cini
s
thedrugofchoi
ce.

•Ther
eisnov
acci
nef
orpr
event
ion.

Secondar
ypr
event
ion:
•Ai
msatpr
event
ionofr
ecur
rentat
tacksofRF,
especi
all
yindev
elopi
ngcount
ri
es.

•Detecti
onofcasesthathaveRFbyconductingsurv
ey.Theyshouldbet r
eatedby1doseof1.2
mil
lionunit
sofBenzathi
nebenzylpeni
cil
li
ntoadult
s&6, 00,
000unitstochil
drenat3weeks
i
nterval
.Thismustbecontinuedf
oratleast5Yearsorunti
lthechi
l
dr eaches18yearsofage
whicheveri
slat
er.

Nursescanassisti
nschool
healthsur
veyt
odet
ectcasest
hathav
ehadRF&admi
nist
eri
ngt
he
t
reatmentasprescri
bedbythephysi
ci
an.

•Forpat
ientswit
hcardit
is(
mildmi t
ralregurgi
tat
ion)t
hetreat
mentshouldbecont
inuedfor10
year
saft
ert hel
astatt
ackoratleastuntil25yearsofage,
whichev
erislonger
.Mor
esev er
e
val
vul
ardiseasecasesneedli
fe-
longtreatment.

•Non-
medi
calmeasuresf
orprev
enti
oncontr
olofRFarei
mprov
ingtheli
vi
ngcondit
ions&
i
mprovi
ngsoci
o-economi
ccondi
ti
onsofthepeopl
etobri
ngt
hem outofpover
ty.

Ter
ti
arypr
event
ion:
•Disabil
i
tyli
mitati
on:Pati
ents,whohavealr
eadydevelopedRHD, canhavedisabi
li
tyduet
ojoi
nt
pains&cardit
is.Thesecanbepr event
edbygivi
ngtreatmentwi t
hAspir
inforjoi
ntpai
n&
tr
eatmentwi t
hBenzat hi
nebenzylpeni
cil
l
inforl
i
feforcardit
is.Surgi
cal
int
erventi
onmayalsobe
gi
veni ncasesofmi t
ralstenosi
s.

•Rehabili
tat
ion:Pati
entssuffer i
ngfr
om RHDar egivensocial
,vocational&psychol
ogical
rehabi
lit
ati
on.Forexampl e,
ift hepati
enthasmi t
ral
stenosis,
his/hercapacit
yforphysical
acti
vit
iesislowered.He/shehast oberehabil
i
tat
edt ochooseanot heroccupat
ioni
fhe/ shei
s
engagedi noccupati
onrequiringhardphy si
call
abor.
Ref
erences
•PREVENTIVESOCALParkK.,TextBookofPr
event
iveandSoci
alMedi
cine.
18t
hEdi
ti
on,
Banar
sidasBhanot
:378381.

•Si
nghSimratKaurN.
J.,
Communi
tyHeal
thARKNur
sing.1stEdi
ti
on,
Lot
usPubl
i
sher
s.Page
No.522-
525.