Peds, part 26: Cardiovascular Disorders - Infective Endocarditis, Rheumatic Fever
December 31, 2021 Updated: January 17, 2022 4 min read
Hi. I'm Cathy with Level Up RN. In this video, I will be talking about infective endocarditis as well as rheumatic fever. These are two very important topics, so if you have our Level Up RN pediatric nursing flashcards, definitely pay close attention to the bold red text. At the end of this video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that.
First up, let's talk about infective endocarditis, which is the infection of the inner layer of the heart. So if you break down the word endocarditis, endo means inside or inner, and then card means pertaining to the heart. Itis means inflammation of, so we have inflammation and infection of the inner layer of the heart. So with this condition, bacteria adheres to the heart, and it forms these vegetative growths on the heart valves or on the endocardium, which is the inner layer of the heart. Signs and symptoms of this condition include fever, malaise and lethargy, loss of appetite, as well as splinter hemorrhages, which are these blood spots that form underneath the fingernails. In addition, the patient may have petechiae, which are those little red dots that form underneath the skin, as well as a murmur and muscle and joint pain. Diagnosis of infective endocarditis can be done using an echocardiogram. We're also going to want to run blood cultures. And then with labs, ESR and CRP will be elevated. So that is erythrocyte sedimentation rate and C-reactive protein, which are two key labs that are elevated when there is inflammation in the body.
In terms of treatment, treatment of infective endocarditis typically requires IV antibiotic therapy over two to six weeks, usually delivered through a PICC line. In addition, if we have had valve damage due to infective endocarditis, the patient may require a valve repair or valve replacement. And then in terms of family teaching, a patient who has had infective endocarditis will likely be recommended to take antibiotics prophylactically prior to any dental work or any invasive procedure or surgery.
Next, let's talk about rheumatic fever, which is an inflammatory disorder of the heart, blood vessels, and joints. The pathophysiology behind this condition is that the child will have an abnormal immune response to a group A beta-hemolytic Streptococcus infection, so GABHS. And this will cause widespread inflammation in the body, and long-term it can lead to cardiac damage, which we would call rheumatic heart disease. So the key risk factor with rheumatic fever, and the one thing you definitely have to remember if you remember nothing else from this video, is that a partially treated or untreated strep throat infection - so a GABHS infection - can lead to rheumatic fever. So in terms of labs, if the patient has had a strep throat infection, then a throat culture will be positive for GABHS. In addition, they will have a positive antistreptolycin O titer, or ASO titer, because this is where they have antibodies to that GABH infection. So if they've had that infection, that titer will be positive. In addition, their ESR and CRP levels will be elevated, so that's erythrocyte sedimentation rate and C-reactive protein. Those labs are elevated any time we have inflammation in the body.
Rheumatic fever is diagnosed using the Jones criteria. So with the Jones criteria, if the child has two major criteria present or one major criteria and two minor criteria present, then that would be indicative of rheumatic fever. So let's go through the major criteria. That includes carditis, which is inflammation of the heart, which in turn can lead to murmurs, a pericardial friction rub, cardiomegaly - so enlargement of the heart - as well as arrhythmias and congestive heart failure. Then we have polyarthritis, which is the painful swelling of the large joints in the body. And then we have something called erythema marginatum, which is where we have a non-pruritic rash, so meaning it's not itchy on the trunk and on the limbs, so arms and legs. And then we have something called chorea, and that's spelled C-H-O-R-E-A. This is where the patient has involuntary muscle movements. And then finally, we have non-tender subcutaneous nodules, so you'll see these little bumps underneath the skin. So again, those are the major criteria. And then the minor criteria include a fever, arthralgia - which means that the patient has joint pain - as well as an elevation in ESR or CRP. And then a prolonged PR interval is also a minor criteria, which is an important one to consider. So you will see that prolonged PR interval on the patient's EKG. So in terms of treatment of rheumatic fever, it requires long-term penicillin administration, and bed rest is usually recommended as well.
All right, it's time for a quiz. You guys can probably predict what I'm going to ask about rheumatic fever, but I'm going to ask it anyway. So question number one. What is the key risk factor in the development of rheumatic fever? The answer is an untreated or partially treated GABHS infection. Question number two. What key symptom of rheumatic fever is characterized by involuntary muscle movements? The answer is chorea. Question number three. What EKG abnormality may be caused by rheumatic fever? The answer is a prolonged PR interval. All right. That's it for this video. I hope you found it helpful. If so, be sure to like this video, leave me a comment, and if you haven't already done so, be sure to subscribe to our channel. Take care and thank you so much for watching.
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