Infectious Diseases of the Heart
two or more joints are usually involved at the
Rheumatic Heart Disease (Rheumatic Endocarditis)
- Most serious complication of rheumatic fever
- Result to an autoimmune response
- Result of a permanent heart valve damage
secondary to acute rheumatic fever
S/sx:
 Fever
 Swollen, tender, red, and extremely painful joints
particularly in the knees and ankle.
 Nodules, lumps under the skin
 Red rash on the chest, back, and abdomen
 Shortness of breath, chest discomfort
 Uncontrolled movements of arms, legs, and facial
muscles
 Weakness
Risk Factors:
 May be transmitted via oral and respiratory
secretions
 Malnutrition
 Overcrowding
 Low socioeconomic status
 Family history of rheumatic fever
Classic Signs and Symptoms of Rheumatic Fever:
Pericarditis (during acute phase)
Myocarditis (lesions called Aschoff’s Bodies on the interstitial
tissue as well as swelling and fragmentation leads to
formation and fibrotic nodules and scars)
Endocarditis (causes valve leaflet swelling, erosion along the
lines of valves, blood platelet and fibrin deposits)
Carditis (severe heart inflammation)
Classic Signs of Rheumatic Fever
Major Criteria:
 Carditis (occurs 50% with RF pxs)
Early cardiac signs: previously undetected murmur, chest
pain due to pericardial inflammation, and friction rub due
to pericardial effusion
 Erythema marginatum (truncal rash that is
nonpruritic, pink, erythematous macules; does not
occur on face and hands; can change appearance
within minutes to hours)
 Syndenham’s chorea (disorder of the CNS that
causes sudden aimless, irregular and involuntary
movements; most commonly acquired chorea in
children and affects girls more than boys)
 Migratory polyarthritis (it occurs in 60-80% of RF
pxs)
 Large joints are commonly affected; there are
same time or in succession for two to three
days at a time; usually lasts for three weeks)
 Subcutaneous nodules
Minor Criteria:
 Fever
 Arthralgia
 Leukocytosis/↑ESR (Normal is 0-22 mm/hr in males
and 0-29 mm/hr in females/ ↑C-Reactive Protein –
N is below 10 mg/L
 ECG: Prolonged P-R interval
 Small translucent vegetations or growths in the
valve flaps
 Valvular regurgitation or stenosis
 S/sx of heart failure
Diagnostic:
o Throat culture
o Increased WBC and ESR levels
o Incresed cardiac enzyme levels
o (+) Antistreptolysin (ASO) Titer
Treatment
Goals: to stop or prevent streptococcal infection
: control of the infectious process and prevent
development of autoimmune response which may lead to
cardiac damage
1. Penicillin parenteral (IM,IV) – drug of choice;
erythromycin for patients who are allergic to
penicillin or as part of long term therapy.
2. Treatment of heart failure
3. Cardiac valve surgeries
 Valvuloplasty
 Valve replacement
General Nursing Diagnoses for Patients with Infectious
Diseases of the Heart
Activity intolerance related to compromised
oxygen transport system secondary to heart
muscle dysfunction
Risk for ineffective breathing pattern related to
decreased respiratory depth secondary to pain
Pain related to friction rub and inflammatory
process
Mucocutaneous Lymph Node Syndrome (Kawasaki Disease)
- Acute febrile illness of unknown cause; principally
involving the cardiovascular system, with extensive
perivasculitis of arterioles, venules, capillaries,
including the coronary arteries; panvasculitis of the
main coronary arteries may cause stenosis or
obstruction with aneurysm formation, pericarditis,
interstitial myocarditis and endocarditis, and
phlebitis of the larger veins
- Geographic and season outbreaks
Clinical Findings
o Fever for 5 or more days
o Bilateral congestion of the ocular conjunctiva
without exudation
o Changes of the mucous membranes of the oral
cavity, such as erythema, dryness, and fissuring of
the lips, oropharyngeal reddening, or “strawberry
tongue”
o Changes in the extremities, such as peripheral
edema, peripheral erythema and desquamation of
the palms and soles, particularly periungual peeling
o Polymorphous rash, primarily of the trunk
o Cervical lymphadenopathy

Treatment:
1. Primarily supportive and directed toward controlling
fever, preventing dehydration, and minimizing
possible cardiac complications
2. Intravenous gamma globulin
3. Large doses of aspirin
4. Monitoring cardiac status