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Rheumatic heart disease: Texts
TEXT-A
• People with a history of acute rheumatic fever (ARF) and a diagnosis of rheumatic heart disease (RHD)
• Aboriginal and Torres Strait Islander people (children aged between 5 and 14 are most at risk) and
immigrants from developing countries
• Increased cardiac load during pregnancy will exacerbate pre-existing rheumatic valvular heart disease
• Importance of early diagnosis and regular secondary prophylaxis will help prevent
deterioration of disease to a point where pregnancy is a risk
• Secondary prophylaxis is safe and should be continued during pregnancy
• Antibiotic prophylaxis to prevent endocarditis if prolonged labour and/or ruptured
membranes
• Pre-conception counselling and assessment for all women with known rheumatic
valvular disease
What is rheumatic heart disease (RHD)?
• When a person becomes infected by Group A Streptococcus bacterium (GAS), the immune response
can cause acute generalised inflammation that affects the heart, joints, brain and skin. This is called
acute rheumatic fever (ARF)
• Recurrent ARF can cause permanent damage to the heart valves - most commonly the
mitral and aortic valves
• This damage is known as rheumatic heart disease (RHD)
• RHD can be classified as mild, moderate or severe
• In a mild case there will be no clinical evidence of heart failure
• In severe cases there are signs of valvular disease, oedema, angina and syncope
TEXT-B
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TEXT-C
Management
• The fundamental long term goal to manage RHD is to prevent ARF recurrences and therefore prevent
the progression of valve disease
• This is achieved by regular delivery of secondary prophylaxis with intramuscular LA Bicillin
• Where adherence to secondary prevention is poor there is greater need for surgical
intervention and long term surgical outcomes are poor
Client education and health promotion
• Discuss what RHD is, how it progresses and its association with throat and skin infections
• Recognizing the signs and symptoms of recurrent ARF and of RHD
• The need for timely access to health services and follow up
• Encourage the client to identify barriers to adequate lifestyle modification and medical adherence and to
set goals to overcome those barriers based on their capacity and
understanding
• Provide relevant service and educational resources
Social emotional support
• A self- or clinician-rated mood scale can be used to assess for altered moo. Rating scales should be
supplemented by a clinical assessment by suitably qualified mental health clinician to make a diagnosis
• Acknowledge any client concerns and reassure them that good adherence to appropriate treatment can
improve the symptoms of their condition
Secondary prophylaxis (antibiotics)
• All clients with evidence of RHD and a history of ARF should have secondary antibiotic
prophylaxis to control streptococcal infections
• Discuss the effectiveness of Bicillin regimes to prevent recurrence of ARF and minimize RHD
• Consider adverse reactions to medications
Regular physical health and specialist review
• Follow the care plan for RHD, Access to timely specialist physician, paediatric and/or cardiologist
services for examination of heart and lungs
• Echocardiography
• Examination of throat, teeth and skin every presentation
• Assessment for shortness of breath, ankle swelling, palpitations or dizziness and chest pain
Dental care
• The risk of infective endocarditis and further heart valve damage increases with poor
dental hygiene and oral infections
• 6 - 12 monthly dental care (depending on classification level) is essential for clients with a history of ARF
and RHD
• Discuss dental hygiene and oral health at each visit
• Where appropriate, antibiotic prophylaxis are given prior to dental procedures
• A dental assessment and any treatment is required prior to valvular surgery
Recall and review
• Place client on a facility ARF/RHD recall system
• Provide client with the date of the next scheduled Bicillin injection
• Recall client from 21 days after the last injection to ensure that injections are given no more than 28
days apart
• Provide the client and other health services with Bicillin prophylaxis details when client
is travelling to different communities
Surgery
• Surgery is determined by the severity of damage to the heart valves (severe RHD)
• Early referral to a cardiologist is required to identify heart failure and consideration for
valve repair
• Repair or replacement of damaged heart valves prevents left ventricular dysfunction and
severe pulmonary hypertension
• Heart valve replacement risks include stroke and infective endocarditis
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TEXT-D
Medications
• Primary prophylaxis involves prompt treatment with antibiotics for treatment of
streptococcal infection
• Secondary prophylaxis involves regular administration of Bicillin to prevent recurrent
ARF
Secondary prophylaxis
• Decisions to cease secondary prophylaxis should be based on clinical and echocardiographic
assessment by a specialist ARF/RHD physician
• All persons with
––ARF or RHD should have prophylaxis for a minimum of 10 years after most recent
episode of ARF or until age 21 years (whichever is longer). Clients > 25 years of age who
are diagnosed with RHD, without any documented history of prior ARF, should receive
prophylaxis until the age of 35 years and then
––no RHD or mild RHD, if clinically assessed by echocardiography can discontinue prophylaxis at this
time
––moderate RHD continue prophylaxis until 35 years of age
––severe RHD continue prophylaxis until 40 years of age. Although the risk of
recurrence is extremely low in people aged > 40 years, in some cases prophylaxis
may be continued beyond the age of 40 years, or even for life e.g. when a client
decides they want to reduce even a minimal risk of recurrence
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Copyright © 2018 by New OET Materials. Any portion thereof may not be reproduced or used in any manner
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PART A
TIME: 15 minutes
• Look at the four texts, A-D, in the separate Text Booklet.
• For each question, 1-20, look through the texts, A-D, to find the relevant information.
• Write your answers on the spaces provided in this Question Paper.
• Answer all the questions within the 15-minute time limit.
• Your answers should be correctly spelt
Rheumatic heart disease: Questions
Questions 1-7
For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may
use any letter more than once.
In which text can you find information about?
1. Classification of RHD _____________
2. Steps to be taken when assessing a patient _____________
3. Providing proper medicines _____________
4. How to determine a patient with RHD _____________
5. High risk groups _____________
6. Giving support to patients _____________
7. Counseling and assessment for women _____________
Questions 8-13
Complete each of the sentences, 8-14, with a word or short phrase from one of the texts. Each
answer may include words, numbers or both.
8. Heart valve substitution dangers include _____________and infective endocarditic.
9. _____________to continue, when a client decides they want to reduce even a minimal
risk of recurrence over 40 years of age.
10. The prevention of recurring Acute Rheumatic Fever is achieved by regular delivery of
secondary prophylaxis with _____________
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11. _____________months of dental care is essential for a patient with history of ARF/ RHD
12. Moderate RHD has been given the_____________priority
13. No evidence of _____________can be identified in person identified with mild RHD
Questions 14-20
Answer each of the following questions, 15-20, with a word or short phrase from one of the
texts. Each answer may include words, numbers or both.
14. If IM route is not possible or refused to take medicines, what antibiotic is used to treat?
________________________________________________________________
15. The ultimate aim of RHD is to prevent?
________________________________________________________________
16. If a patient identified with mild rheumatic heart disease while review, what to discontinue
________________________________________________________________
17. Which heart valves will damage, if RHD is attacking again and again?
________________________________________________________________
18. When does a doctor can assess and give the patient Priority 1 of RHD?
________________________________________________________________
19. What should have done prior to Valvular surgery?
________________________________________________________________
20. What involves in Secondary prophylaxis to prevent recurring Acute Rheumatic Fever
________________________________________________________________
END OF PART A
Proceed to Part B & C
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