Medical-Surgical Nursing
A 65 year-old woman is admitted to the Surgical Unit for a mitral valve replacement.
Her medical history includes severe mitral stenosis and mitral valve regurgitation. The nurse interviews the patient for hospital admission. Which of the following childhood disease was most likely?
Explanation
Core Concept: Rheumatic heart disease (RHD), which frequently manifests as mitral stenosis and/or regurgitation, is a long-term complication of untreated or inadequately treated Group A Streptococcal (GAS) pharyngitis (strep throat) or scarlet fever during childhood. The autoimmune response cross-reacts with cardiac tissue (molecular mimicry).
Clinical Presentation: • Dyspnea on exertion, orthopnea, fatigue, palpitations, atrial fibrillation, and a diastolic murmur (mitral stenosis). • Complications: Heart failure, thromboembolism (stroke), infective endocarditis.
Diagnosis: 1) First-line: Transthoracic echocardiogram (TTE) to assess valve morphology and stenosis gradient. 2) Gold standard: Transesophageal echocardiogram (TEE) for detailed pre-surgical planning.
Management: Acute: Rate control for atrial fibrillation, diuretics for heart failure symptoms, and anticoagulation. Definitive: Surgical mitral valve repair or replacement. Secondary prevention of RHD includes long-term penicillin prophylaxis.