Predisposing Factors: Etiology: Precipitating Factor:

• Familial tendency Group A-beta hemolytic • History of group A-

• 5-15 years old streptococcus beta hemolytic
• Female streptococcus
• Poor living conditions pharyngeal infection
(strep throat)
Activated antigen-
presenting cells present
the bacterial antigen to
helper T-cells

Helper T-cells
subsequently activate B-
cells

Induce the production of

antibodies against the
cell wall of the
streptococcus

M-protein in the cell wall

of the streptococcus
induces cross-reactivity

Antibodies cross-react with cardiac

myosin, and antigens of tissue
glycoprotein in the joints, skin, brain, and
other connective tissues

A
 A

Induces cytokine
release
S/Sx: Mgt.:
• Syndenham • Anti-
Induce the expression chorea inflammatory
Diagnostic Tests: of E-selectin • Carditis medications
• JONES criteria • Polyarthritis such as
• Strep throat • Erythema aspirin and
culture marginatum corticosteroi
• ESR Inflammatory response ds
• Subcutaneous
• WBC • Low-dose
nodules
antibiotics
• ECG • Arthralgia
If unmanaged and if there is such as
subsequent exposure to the antigen • Fever penicillin,
• Elevated ESR erythromycin
• Prolonged PR and
interval sulfadiazine
Subsequent re-infiltration by
lymphocytes and cycle of scarring

Fibroid necrosis and verrucae

formation along the lines of closure of
Mgt.:
the left sided heart valves
• Percutaneous
Diagnostic Tests: mitral balloon
• ECG valvotomy
Leaflet thickening, commissural • Open mitral
• Doppler fusion, shortening and thickening of
investigation commissurotomy
tendinous chords • Mitral valve
replacement
B

B
 Decrease blood flow from the left atrium Mgt.:
into the left ventricle during diastole • Digitalis

Increase blood volume and Decrease cardiac output

pressure in the left atrium

Stimulates SNS
Decrease blood flow from
the pulmonary vessels
Release of epinephrine
and norepinephrine

Increase pulmonary venous

blood flow and pressure
Mgt.: Continuous response causes loss
Diagno S/Sx: • Avoidance of of beta 1-adrenergic receptor cells
stic • Dyspnea excessive
Test: Pulmonary congestion • Cough fluid intake
• Chest • Pulmonary • Oxygen
Further damage to the
radiography crackles therapy heart muscles
Pulmonary edema

Decreases renal
S/Sx: Mgt.: perfusion
Impairs gas exchange • Lower-than- • Oxygen
normal oxygen therapy
saturation levels
Release of renin by the kidneys
C
D
 C D

Pulmonary hypertension Formation of angiotensin

Respiratory failure ACE converts angiotensin I to

angiotensin II

Right ventricular failure

Promotes the release of
aldosterone
S/Sx:
Congestion of the • JVD Mgt.:
viscera and peripheral • Edema • Diuretics
Promotes sodium and
tissues
water retention

Blood backs up in the

hepatic veins Increases preload and
afterload

Liver becomes S/Sx:

engorged • Hepatomegaly Further increases the
stress on ventricular wall

Increase pressure within

the portal vessels Further increase in the
workload of the heart

Portal hypertension

G
 E F
E F G

Increases the thickness of

Force fluid into the abdominal cavity Development of high pressure the heart muscle
gradient between portal vein and
Mgt.: S/Sx: inferior vena cava
• Diuretics Ascites • Abdomina
Further increases ventricular
• Paracentesi l pain
pressure and resistance to
s • Anorexia Venous collaterals develop
If unmanaged ventricular filling
• Sodium • Nausea
restriction
Abnormal varicoid vessels
S/Sx: Subsequent decrease in
Mgt.: Spontaneous • n/v cardiac output
• Antibiotics bacterial peritonitis • Abdominal Prone to rupture and
pain bleeding
• Fever
If unmanaged Successive decrease
Mgt.: in renal perfusion
Diagnostic Bleeding • Vasopress S/Sx:
in • S
Sepsis Test: • Balloon har
If unmanaged Tamponade Decreases GFR p
in u.o.
• in
Hemorrhagic shock Further decrease in GFR BU
N
S/Sx:
• HPN Accumulation of nitrogenous wastes;
• Edema alterations in water, electrolyte, and acid-
base balance; inactivation of Vitamin D;
• Hyperkalemia
disruption in erythropoietin production
• Anemia
• Acidosis
DEATH
Mgt.: • Osteodystrophi Increase risk of infection
• Dialysis es
• Renal • Hypocalcemia
transplantati • Hyper-
 I
I

Mgt.:
Actual Infection • Antibiotics

If unmanaged

Sepsis

DEATH