Inflammation that follows an URTI (tonsillitis, pharyngitis, laryngitis) caused by GABHS. When the heart becomes affected, it becomes “Rheumatic Carditis/Endocarditis”.
- Antibodies are formed to destroy GABHS, which cross-react to proteins found in the connective tissues of the heart, joints, skin, and nervous system.
- This may result in Pancarditis, inflammation of all layers of the heart including valvulitis.
- WBCs migrate to the endocardium where the inflammation is, which end up accumulating inflammatory debris (dead cells from phagocytosis) called “vegetations” around the valve leaflets, which can cause obstruction in blood flow (circulatory stasis).
- The vegetations or thrombi formed from obstruction may embolize and settle in any part of the body.
- Atrial fibrillation may result from the vegetations.
Assessment
Major/Classic Symptoms
(Separate manifestations of the autoimmune reaction towards the heart, joints, nervous system, and skin)
- Carditis: characterized by the formation of Aschoff’s Bodies, Murmurs, and a Pericardial Friction Rub, which may result in CHF.
- Polyarthritis: swelling of multiple joints that is warm, red, and painful.
- Chorea (Sydenham’s Chorea, St. Vitu’s Dance): involuntary grimacing and inability to use skeletal muscles in a coordinated manner (involvement of the CNS)
- Subcutaneous Nodules: marble-sized nodules around the joints.
- Erythema Marginatum: quickly-disappearing red spotty rashes that leave irregular circles on the skin.
Minor Symptoms
- Reliable history of RF or evidence of pre-existing RHF.
- Arthralgia without inflammation, pain, or limited movement
- Fever: 38.9 - 40C
- Increased ESR, ASO Filter and CRP
- ECG: Prolonged PR Interval
Diagnosis
Clinical diagnosis of Rheumatic Carditis is done with the Jone’s Criteria: assessment of 2 Major, or 1 Major + 2 Minor Symptoms + Supporting evidence of recent streptococcal infection
Intervention
The best intervention is prevention; prevention of early identification of a streptococcal infection and prophylaxis with proper antibiotics. The nurse should be familiar with the S/S of streptococcal pharyngitis.
Streptococcal Pharyngitis
- Fever (38.9 - 40C)
- Chills
- Sore Throat
- Diffuse redness of throat with exudates on the oropharynx.
- Enlarged/tender lymph nodes (Cervical Lymphadenopathy)
- Abdominal Pain
- Acute Sinusitis and Acute Otitis Media
Management
- Antibiotics, the drug of choice of which is penicillin.
- Aspirin as an anticoagulant
- Steroids as an antiinflammatory
- Antipyretics and Hydration for fevers
- Antibiotic Prophylaxis with a monthly injection of penicillin
- Bed Rest with diversionary low-effort activities
- Assess for progression or improvement of heart involvement