PATHOPHYSIOLOGY

Rheumatic Heart Disease (RHD)

(Diagram)

Precipitating Factors:

• Asthma
• Epilepsy
Predisposing Factors • Migraines
• Male • Poor living conditions
• Age: 14 years old • Improper food handling

Streptococcal Infection:
The process usually begins with a streptococcal infection,
commonly a throat infection (pharyngitis) or less commonly
a skin infection (impetigo) caused by group A Streptococcus
bacteria.

Immune Response:
In some individuals, the immune system responds to the
streptococcal infection by producing antibodies, particularly
anti-streptolysin O (ASO) and anti-DNAase B. These
antibodies are effective in eliminating the bacteria.

Autoimmune Reaction:
Unfortunately, in susceptible individuals, the antibodies
produced in response to the streptococcal infection can
cross-react with host tissues, particularly the heart valves.
This cross-reactivity leads to an autoimmune response.
 Inflammatory Response: Client
Diagnostic Test Manifestation
The autoimmune response triggers an inflammatory process,
leading to inflammation in various parts of the heart,
especially in the endocardium (inner lining of the heart
chambers), myocardium (heart muscle), and heart valves. Cardiac Symptoms:
• CBC Imaging
• Urinalysis • Murmurs
• Arterial Blood Gas Formation of Rheumatic Nodules: • Palpitations
• Liver Enzyme
Small nodules called Aschoff bodies may form in the • Chest Pain
SGPT, SGOT
• 2D Echocardiogram affected heart tissues. These nodules consist of Respiratory Symptoms:
• X-ray Test inflammatory cells and fibrous tissue and are characteristic
APL of rheumatic fever. • Shortness of Breath
• Cough
Valve Involvement (Valvulitis):
The heart valves, particularly the mitral and aortic valves,
General Symptoms:
are commonly affected. Valvulitis occurs, causing swelling,
thickening, and scarring of the valve leaflets. This process • Fatigue
can lead to functional impairment of the valves. • Weakness
Joint Symptoms:
Chronic Changes in Valves:
• Polyarthritis
Over time, the chronic inflammation and scarring can result
in permanent changes in the heart valves. The valves may
become stenotic (narrowed) or insufficient (leaky). These
changes affect the normal flow of blood through the heart.

Hemodynamic Consequences:
The altered valve function can lead to hemodynamic
consequences, such as reduced cardiac output and increased
workload on the heart. This can ultimately result in heart
failure.
 Complications: Other Systemic Symptoms:
Rheumatic heart disease can lead to various complications, • Fever
including infective endocarditis (infection of the heart • Weight Loss
valves), thromboembolism (formation of blood clots that can
travel to other parts of the body), and arrhythmias (abnormal Complications:
heart rhythms). • Thromboembolism
• Infective Endocarditis
Long-Term Impact: Symptoms of Heart Failure:
Rheumatic heart disease, if not properly managed, can have • Swelling (Edema)
a significant long-term impact on the patient's cardiovascular • Increased Urination
health. The individual may require ongoing medical • Enlarged Liver
treatment, and in severe cases, surgical intervention may be
necessary to repair or replace damaged heart valves.

If left untreated If treated

Progression of Valve Damage Resolution of Acute Symptoms

Treatment with antibiotics, such as penicillin or other
The inflammation and scarring of the heart suitable alternatives, can effectively eliminate the
valves continue to progress, leading to more underlying streptococcal infection and resolve the acute
significant structural damage. This can result symptoms of rheumatic fever. This is crucial in preventing
in increased valve stenosis (narrowing) or the progression to chronic RHD.
insufficiency (leakiness).
 Worsening Cardiac
Function
As the heart valves become more damaged,
the heart's ability to pump blood efficiently
is compromised. This can lead to progressive
heart failure, characterized by symptoms
such as fatigue, shortness of breath, and fluid
retention.
Increased Risk of Infective Endocarditis
Damaged heart valves are more
susceptible to bacterial infection,
leading to infective endocarditis. This
is a serious and potentially life-
threatening condition that requires
prompt medical intervention.
Thromboembolic Events
Individuals with RHD are at an increased risk of developing
blood clots on the damaged heart valves. These clots can
break loose and travel through the bloodstream, causing
thromboembolic events such as strokes or pulmonary
embolism.
Chronic Health Issues
The chronic nature of RHD can lead to persistent health
issues and a reduced quality of life. Individuals may
experience ongoing symptoms, limitations in physical
activity, and a need for continuous medical management.
Prevention of Recurrent Episodes
Long-term antibiotic prophylaxis, often in the form of
regular injections or oral medications, is prescribed to
prevent recurrent streptococcal infections. This helps
minimize the risk of further autoimmune reactions and the
development of additional rheumatic fever episodes.
Anti-Inflammatory Medications
In some cases, anti-inflammatory medications, such as
nonsteroidal anti-inflammatory drugs (NSAIDs) or
corticosteroids, may be prescribed to manage
inflammation and reduce symptoms.
Management of Heart Failure
Medications such as diuretics, angiotensin-converting
enzyme (ACE) inhibitors, or beta-blockers may be
prescribed to manage heart failure symptoms, improve
cardiac function, and enhance the overall well-being of the
patient.
Regular Medical Follow-Up
Ongoing medical follow-up is essential to monitor the
progression of the disease, assess cardiac function, and
adjust treatment plans as needed. Regular check-ups help
ensure that any changes in the patient's condition are
identified and addressed promptly.
 Surgical Interventions
In advanced cases, individuals with untreated RHD may
require surgical interventions to repair or replace damaged
heart valves. Valve replacement surgeries can be associated
with their own set of risks and complications.
Reduced Life Expectancy
The cumulative effects of heart failure, thromboembolic
events, and other complications can contribute to a reduced
life expectancy for individuals with untreated RHD.
In severe cases or without timely
intervention, Heart Failure, Cardiac
Arrhythmias, Thromboembolic Events,
Infective Endocarditis, Cardiac
Tamponade, Multiorgan Failure,
Reduced Quality of Life, and even
death.
Surgical Interventions
In cases where valve damage is severe, surgical
interventions may be necessary. This can include valve
repair or replacement procedures to restore proper valve
function and improve overall cardiac performance.
Improved Quality of Life
With appropriate treatment and management, individuals
with RHD can experience an improved quality of life.
Symptoms such as fatigue, shortness of breath, and chest
pain can be alleviated, allowing for better physical
functioning and overall well-being.
Prevention of Complications
Timely and effective treatment helps prevent complications
such as infective endocarditis, thromboembolic events, and
the need for more extensive surgical interventions.
Legend:

= Predisposing Factor

= Precipitating Factor

= Client Manifestation

= Disease Process

= Diagnostic Test

= Treatment/ Management

= If treated

= If left untreated

= Death