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Analysis of the information and application to midwifery practice or broader issues.



“Rheumatic heart disease” is one of the most common heart diseases observed in the children especially noticed in the developing countries.  This disease is associated with rheumatic fever. It is an acute or chronic heart disorder which might be the result of valve damage causing rheumatic fever. The Rheumatic fever is an inflammatory condition that affects the connective tissues linked with the heart, skin and brain. The symptoms of this disease are excessive palpitations of the heart, chest pain, swollen stomach, ankles, or wrists and shortness of breath (Marijon et al., 2012).

Causes of the disease:                      

According to Marijon et al. (2012), the cause of rheumatic fever is a group of microorganisms namely “group A Streptococcus.” This bacterium causes the body to attack its own tissues. Such a reaction causes inflammation throughout the body. The bacteria also cause inflammation in the heart and trigger the auto-immune responses.

The acute stage consists of pancarditis which involves inflammation of the pericardium, myocardium, and the epicardium. The chronic stage is manifested by “valvular fibrosis.” This results in the stenosis or insufficiency. The main cause of the rheumatic heart disease is the body generates antibodies to struggle with the microbe, but in its place, the antibodies hit dissimilar target i.e. the body’s own tissues. The antibodies commence with the joints and frequently shift on to the heart and adjacent tissues. “Over time, there is progressive damage (rheumatic heart disease, RHD) that may lead to heart failure, stroke, infection of the valves (infective endocarditis), and death” (Irlamet al. 2013)

Strategies used:

The prevention strategies involved in the nursing profession related to the infection may be continued at a numeral of diverse levels. “Primordial and primary prevention” aims to end the disease happening in the first set, while the objective of the “secondary and tertiary prevention” is to edge the progression and decrease the consequences of recognized disease (Singh et al., 2012).

Primary preventions –

The primordial prevention aims to develop risk factors related to the disease in the pool. This involves the prevention of GAS infections by implementing activities and measures that relate to the environmental, social, economic and behavioral conditions that elevate the risk of the infection (Irlam et al. 2013).

Secondary preventions –

“Secondary prophylaxis with BPG is recommended for all people with a history of ARF or RHD. Four-weekly BPG is currently the treatment of choice, except in patients considered to be at high risk, for whom three weekly administration is recommended. The benefits of three-weekly BPG injections are offset. Three to four weekly intramuscular injections of benzathine penicillin is the treatment of choice. Oral antibiotics may be more convenient but carry higher rates of relapse by the difficulties of achieving good adherence, even to the standard four-weekly regimen” (Irlamet al. 2013).

Tertiary prevention –

The intervention in human beings with “Rheumatic Heart Disease” to decrease symptoms and disability, and avoid premature death. “The tertiary level surgical intervention for one patient is equivalent to the annual running costs for a national RHD control program in Pacific countries with small populations” ((Singh et al., 2012).



Irlam, J., Mayosi, B. M., Engel, M., & Gaziano, T. A. (2013). Primary Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease With Penicillin in South African Children With Pharyngitis A Cost-Effectiveness Analysis. Circulation: Cardiovascular Quality and Outcomes, 6(3), 343-351.

Marijon, E., Mirabel, M., Celermajer, D. S., & Jouven, X. (2012). Rheumatic heart disease. The Lancet, 379(9819), 953-964.

Marijon, E., Mirabel, M., Celermajer, D. S., & Jouven, X. (2012). Rheumatic heart disease. The Lancet, 379(9819), 953-964.

Singh, J. A., Furst, D. E., Bharat, A., Curtis, J. R., Kavanaugh, A. F., Kremer, J. M., ... & Bridges, S. L. (2012). 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease‐modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis care & research, 64(5), 625-639.


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