Introduction

Commonly called arthritis (inflammation of the joint) and thought as one condition, the
rheumatic heart diseases are more than 100 different types of disorders that primarily affect
skeletal muscle, bones, cartilage, ligaments, tendons, and joints in males and females of all
ages. (Brunner and Suddarth).
A rheumatic heart disease describes a group of short-term (acute) and long-term
(chronic) heart disorders that can occur as a result of rheumatic fever. One common result of
rheumatic fever is heart valve damage. This damage to the heart valves may lead to a valve
disorder. It usually starts out as a strep throat (streptococcal) infection. Anyone can get acute
rheumatic fever, but it usually occurs in children between the ages of 5 and 15 years. About
60% of people with rheumatic fever develop some degree of subsequent heart disease.
Every part of the heart, including the outer sac (the pericardium), the inner lining (the
endocardium) and the valves may be damaged by inflammation caused by acute rheumatic
fever. However, the most common form of rheumatic heart disease affects the heart valves,
particularly the mitral valve. It may take several years after an episode of rheumatic fever for
valve damage to develop or symptoms to appear.
Symptoms of heart valve problems, which are often the result of rheumatic heart
disease, can include: chest pain, excessive fatigue, heart palpitations (when the heart flutters or
misses beats), a thumping sensation in the chest, shortness of breath, and swollen ankles, wrists
or stomach. The symptoms of arthritis usually pass within one to four weeks and the symptoms
of fever within one to three weeks. Other symptoms may persist for around six weeks. If
symptoms are particularly severe, they can last for several months.
In diagnosing rheumatic fever, as rheumatic fever can cause so many different
symptoms, a type of checklist known as the 'Jones Criteria' is used to help in the diagnosis
process. The Jones Criteria involves checking whether you have certain signs and symptoms
strongly associated with rheumatic fevers. These signs and symptoms are collectively known
as criteria.
There are two types of criteria: major criteria, which are signs and symptoms strongly
associated with rheumatic fever, and minor criteria, which are signs and symptoms moderately
associated with rheumatic fever.
The criteria are listed below:
1. Major criteria
Carditis: inflammation of the heart.
Polyarthritis: where several joints become stiff, painful and swollen.
Chorea: jerky involuntary body movements.
Erythema marginatum: red or pink rash on the skin.
Subcutaneous nodules: small lumps under the skin that tend appear on the elbows,
knees, ankles and knuckles.
2. Minor criteria
 Arthralgia: joint pain, but less severe than arthritis joint pain.
Fever: usually over 39C (102F).
Elevated ESR or CRP: erythrocyte sedimentation rate (ESR) and C reactive protein
(CRP) are both types of blood tests that can detect inflammatory conditions (see blood
tests below).
Prolonged PR interval: irregular heart rhythm.
A confident diagnosis of rheumatic fever can be made if you have at least two major
criteria or one major and two minor criteria.
Testing
While some of the criteria listed above can be assessed by a physical examination and
asking you (or your child) about your symptoms, others, such as inflammation of the
heart, will require testing to confirm. Tests used in the diagnosis of rheumatic fever are
outlined below.
Electrocardiogram (ECG)
To help confirm a diagnosis of rheumatic fever, you will usually be required to have an
electrocardiogram (ECG). During an ECG up to 12 adhesive electrodes are attached to
certain areas of the body, such as the arms, legs and chest. A machine will then measure
the electrical activity of your heart, so that your doctor can check for any abnormal
heart rhythms. Inflammation of the heart is a common complication of rheumatic fever,
and so it is important that any abnormal heart rhythms are detected early on so that
prompt treatment can be given.
Blood tests
A number of different blood tests may be used to look for indications of rheumatic
fever. The tests the level of C reactive protein in your blood. CRP is produced by the
liver. If there is more CRP in the blood than usual then this means there is inflammation
in the body.
Another blood test is known as erythrocyte sedimentation rate (ESR). In an ESR test a
sample of your red blood cells are placed into a test tube of liquid. They are then timed to see
how fast they fall to the bottom of the tube. If they are sinking faster than usual, this could
mean that you have an inflammatory condition such as rheumatic fever.
Cardiac diseases complicate 1% to 4% of pregnancies in women without preexisting
cardiac abnormalities. A working knowledge of the normal physiology of pregnancy is often
helpful in the management of patients with heart disease. Pregnancy is associated with several
cardio circulatory changes that can significantly impact underlying cardiac disease. These
changes begin early in pregnancy (within the first five to eight weeks), reach their peak during
the late second trimester, and then remain relatively constant until delivery. (World Heart
Federation, 2013) Risk factors for developing Rheumatic Heart Disease include poverty,
overcrowding, and family history, repeated upper respiratory tract infection, and reduced
access to medical care. (American Heart Association, 2012) The mortality rate from this
disease remains 1-10%. A comprehensive resource provided by the World Health Organization
(WHO) addresses the diagnosis and treatment of this latter population. Estimations worldwide
are that 5-30 million children and young adults have chronic Rheumatic heart disease, and
90,000 patients die from this disease each year.
In the Philippines, about 2, 389 Filipinos under all age groups die because of Chronic
Rheumatic Heart Disease each year and 873 of that are young Filipinos under 10-24 years old.
(Philippine Health Statistics 2009, DOH) Rheumatic heart disease was the most common
underlying condition (27% of cases) found in pregnant patients. It is accounted for 88% of
cardiac diseases in pregnant women. (American Heart Association, 2012) The group decided
to choose this case because we find it to be challenging and interesting since this case deals
with one of the most important part of the body. Moreover, we can gain adequate knowledge
and information about the said topic and its management.