Etiology: Precipitating factors:

GABHS ages 5-16

Malnutrition
History of rheumatic fever,URI, smoking
crowded living condition
suppressed immune system
Weather, climate (cool damp water)

Presence of streptococcus

Streptococcal infection invades upper respiratory tract

Invasion and multiplication of GABHS in pharynx

Penetrates vessels and enter circulation

Infects the heart

Results to URI and triggers inflammatory
Infects and damages the pericardial tissues response leading to fever, chills, malaise,
Cough
Inflammatory response

Friction of pericardial layers chest pain

Leakage of fluids and proteins

Extracellular heart edema

 Phagocytosis

Fibrosis and scaring

Restricts heart contraction

Survived pathogens further invades and

transverses endocardium and myocardium

Inflammation of the endocardium myocarditis

Infects the heart valves

(Bicuspid, tricuspid) ↑heart contraction deposition of
Granular fibrinoid
material
Altered valve functions myocardial hypertrophy
↑heart O2 demand Aschoff bodies

Regurgitation (valve leakage) cardiomegaly

↓cardiac output and ↓ ↓Contractility of the heart
Systematic BP valvular stenosis
Tissue perfusion
Activation of the SNS valvular regurgitation
Tissue hypoxia

Tachypnea DOB
↑cardiac workload
Systemic arteriolar vasoconstriction ↓myocardial workload

Right sided heart failure

↓renal perfusion constriction of peripheral blood

vessels ↓stroke volume
kidneys release renin ↓ejection fraction
↓O2 supply in peripheries ↓tissue perfusion
End diastolic preload
Rennin converts angiotensin1 to 11 Pale skin and cold to touch hypoperfussion to
↑RVED pressure peripheral blood vessels

Stimulates adrenal cortex

Vasoconstriction Blood goes backward to
Release of aldosterone pulmonary circulation pallor,cyanosis on nail
↑BP beds, palms, soles,
Enhance Na and water retention palpebral conjunctiva,
By renal tubules buccal mucosa

Cold extremities
 Fluids move from
↑heart rate pulmonary vasculature
oliguria to alveoli and interstitial irritation of alveolar and
↑afterload spaces bronchial mucosa

Stress on ventricular wall fluid reaches bronchioles mucosal production of

And pleural space the goblet cells
↑cardiac workload
Cough reflex to remove
Ventricular hypertrophy obstruction

Crackles with cough Air flows through productive cough

Narrowed airway

Anaerobic ↓oxygen saturation ↓gas exchange

Metabolic ↑CO2 saturation
pathway

↓ATP production ↑lactic acid

Muscle pain
Easy fatigueability,
Weakness, activity
Intolerance