A case report: Rheumatic heart disease and congestive heart failure in antenatal mother

Jaya Menon1, Jane Abishak J2, Mariya Jencia P3, Jenofia4

1Nursing Superintendent, Kauvery Heartcity, Trichy, India

2Nursing Supervisor, Kauvery Heartcity, Trichy, India

3Clinical Ward Senior Staff, Kauvery Heartcity, Trichy, India

4Nurse Educator, Kauvery Heartcity, Trichy, India

Abstract

Rheumatic Heart Disease (RHD) is a chronic cardiovascular condition resulting from damage to the heart valves following repeated episodes of acute rheumatic fever (ARF), an inflammatory disease triggered by Streptococcus pyogenes (group A streptococcal) infections.  Ongoing research aims to develop effective vaccines and novel therapeutics to address this preventable yet life-threatening disease.

Definition

Rheumatic Heart Disease (RHD) and Congestive Heart Failure (CHF) post significant risks during pregnancy.  RHD caused by rheumatic fever, can lead to valve damage, particularly mitral stenosis which becomes more problematic during pregnancy due to increased blood volume and cardiac output.  This can result in heart failure and other complications for both the mother and the fetus.

Rheumatic Heart Disease (RHD)

Preexisting mitral Stenosis

This is the most common heart lesion in women with RHD and pregnancy can worsen it due to increased blood volume and heart rate.

Mitral Regurgitation

Another common valvular issue in RHD, which can also be exacerbated by pregnancy.

Poor Socioeconomic Conditions

Poverty limited accessed healthcare and poor living conditions are significant risk factors for developing RHD, which may go undiagnosed until pregnancy.

Repeated Strep Throat Infection

These infections can lead to rheumatic fever, which can damage heart valves and result in RHD.

Congestive Heart Failure (CHF)

Pre Existing Heart Conditions

RHD, cardio myopathy and other heart disease can lead to CHF during pregnancy due to the increase in work load on the heart.

Obstetric Complications

Conditions like preeclampsia, gestational hypertension and postpartum hemorrhage can put extra strain on the heart and lead to CHF.

Multiple Gestations

Carrying twins or higher – order multiples increase the hearts work load and can contribute to CHF.

Age and Face: Older mothers and black women have a higher risk of CHF during pregnancy.

Other Factors: Smoking, alcohol and drug use and a history of spontaneous coronary Artery dissection (SCAD) can also increase the risk.

Impact of RHD and CHF on pregnancy

Increased Maternal Mortality

Pregnant women with RHD and CHF have a higher risk of maternal death especially if they develop heart failure.

Preterm Delivery

Both RHD and CHF can lead to premature birth which can have negative consequences for both mother and baby.

Increased risk of other complications

These include arrhythmias heart failure exacerbation and the need for internentions like balloon valvotomy or valve replacement.

Fetal Risks

  • Preterm birth
  • Intrauterine growth restriction(IVRG)
  • Fetal distress
  • Congenital Heart Defects.
  • Increased risk of peri-natal mortality.

Anatomy

Rheumatic Heart Disease

Rheumatic heart disease is a condition where the heart valves have been permanently damaged by rheumatic fever.  The heart valve damage may start shortly after untreated or undertreated streptococcal infection. Such as strep throat or scarlet fever.  An immune response causes an inflammatory condition in the body.

Congestive Heart Failure

With right side heart failure your heart is too weak to pump enough blood to your lungs to get oxygen.  With left side heart failure, your heart can’t pump enough oxygen rich blood out to your body. This happen when the left side of your hear becomes too weak to pump enough blood.

Signs and Symptoms of RHD:

  • Shortness of Breath
  • Chest Pain
  • Swelling
  • Heart palpitations
  • Breathlessness on exertion
  • Swelling (oedema)
  • Fainting (Syncope)
  • Stroke
  • Fever associated with infection of damaged heart valves.

Signs and Symptoms of (CHF)

Heart failure present with signs and symptoms of congestion and may also present with oxygen hypoperfusion or cardiogenic shock and shortness of breath as the most commonly reported symptom.  The following are some of the signs and symptoms of congestive heart failure.

  • Shortness of breath (SOB)
  • Fatigue (Tiredness)
  • Swollen ankles and legs
  • Light headedness
  • Fainting

RHD – Patho physiology

CHF – Patho Physiology

Presenting Complaints and History

A 27 years old antenatal mother is Rheumatic heart disease on treatment.  Present with C/O breathing difficulty since today and (Orthopnea) 3.7.25.  B/L pedal edema sing 1 month, H/O excemine fluid intake since 3 days.

Diagnosis

He diagnosed as DCDA twin GA 34 weeks 2 days antenatal mother RHD/ CHF/ Mild TR / MILD MS/ Moderate and severe MR. Patient Plan – Medical management.

ECG

ECHO Report

Scan Report

Fetal Biometry Report

Course of Stay in Hospital

A 27 years old antennal mother having history of past illness on rheumatic heart disease for 9 months on treatment. She diagnosed as DCDA twin antenatal mother RHD/CHF/ Mild MS/Moderate Severe MR.  She was medical management and investigation for pre op works in LSCS and fitness.  Attained for surgery successful LSCS, X Twin baby 05.07.25.  She is operative and post-operative hospital stay was uneventful during the post-operative.  She was managed with necessary supportive measures. The patient and new born condition improved and is being discharged in a stable hemodynamic status with following advice.

Pre Op Nursing Management

  • Patient for continue cardiac and fetal heart rate monitor.
  • Nurses maintained every hourly vitals signs and intake output and assessed neurologically.
  • Blood sampling done for pre op investigation under aseptic technique to prevent thrombophlebitis. That is CBC, Blood grouping RFT, Electrolyte, Serology, USG abdomen, Doppler and abdomen screening.
  • Doctor advice and explained about risk of procedure to the attender and skin preparation was done and patient was given a provide one bath to minimize the risk of infection.
  • NPO instruction were explained to the patient and maintained to ensure an empty to stomach.
  • Nurese were provided psychological support.
  • Patient was shifted to OT for LSCS.

Post OP Nursing Management

  • The patient was transferred the OT to ICU for continue the monitoring.
  • Received for new born in NICU for continue monitoring and observation.
  • Nurses monitored and maintained vitals signs and reflexes for new born.
  • Vitals signs monitoring and surgical site any oozing and skin colour changes observation.
  • Using sterile technique to prevent thrombophlebitis.
  • The doctors explained the patient and new born condition to attenders.
  • Early amputation and mobilization done with helps of nurses.
  • All the bundles care followed properly to prevent from hospital acquired infection.
  • All suture removed and patient condition improved.
  • 3rd POD daily octenison solution bath was given.
  • Patient condition improved and she was discharge a stable hemodynamic status for mother and new born.

Conclusion

Lower segment cesarean section procedure aimed at reducing the risk of patient life threatening.  The focus should be on mother and baby.  Life savings the immediate surgical intervention but also on long-term health and rehabilitation.

Reference

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